Background Systemic sclerosis (SSc) is associated with decreased saliva production and interincisal distance, more missing teeth, and periodontal disease. Orofacial manifestations of SSc contribute greatly to overall disease burden and still are regularly overlooked and under-treated. Previous studies did not confirm correlation between disease severity and oral health-related quality of life in SSc patients.
Objectives The aim of this study was to determine possible correlation of the SSc clinical parameters with oral health-related quality of life measured with the Oral Health Impact Profile 49 (OHIP 49).
Methods Subjects were recruited from the Center of excellency for systemic sclerosis in Croatia cohort. Detailed dental by the same dentist and clinical examinations were performed according to standardized protocols. Associations between oral health-related quality of life and disease charachteristics were examined. We evaluated the disease severity using clinical and laboratory parameters according to the Medsger Severity Scale. The level of SSc activity was evaluated according to Valentini activity score. Oral quality of life was measured using the OHIP 49, which consists of 49 questions on the frequency of adverse oral conditions such as toothache, mouth pain, difficulty chewing or pronouncing words and discomfort related to appearance (higher scores indicating worse oral health-related quality of life). The study was approved by the University Hospital Split Ethics Committee.
Results Thirty-one SSc patients (29 women and 2 men, mean age 56.45±13.60 years, median disease duration 7 years with minimum–maximum range 1–28 years) were consecutively enrolled for this study between January 2014 and December 2015. All patients fulfilled the ACR criteria for the diagnosis of SSc. The distinction between limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc) was made according to the Leroy et al. criteria (28 dcSSc, 3 lcSSc). OHIP 49 scores highly positively correlated with disease activity (p=0.005, r=0.4872, Spearman's rank coefficient) and severity (p=0.016, r=0.4303, Spearman's rank coefficient). Furthermore, oral health-related quality of life positively correlated with the skin involvement evaluated by modified Rodnan skin score (p=0.003, r=0. 5207, Spearman's rank coefficient). Impaired quality of oral health positively correlated with the severity of general involvement, skin, gastrointestinal and joint/tendon involvement (p=0.003, r=0.506 for general involvement, p=0.003, r=0.511; p<0.001, r=0.591 and p=0.02, r=0.391 for skin, gastrointestinal and joint/tendon involvement, respectively, Spearman's rank coefficient). OHIP 49 score was highly variable between anti-topoisomerase I antibodies positive or negative SSc patients (p<0.001, Fisher's exact test).
Conclusions Contrary to previous studies in our study disease severity and activity were related to OHIP 49 scores. Our data suggest that OHIP scores correlate with severity of general involvement, skin, gastrointestinal, and joint/tendon involvement in SSc patients. Disease subset and autoantibodies profil could play a role in the oral manifestation of SSc. Better collaboration between rheumatologists and the dental team is required to improve access to dental care and oral health outcomes for SSc patients.
Disclosure of Interest None declared