Background Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease associated with significant morbidity and mortality (1). Sicca symptoms are frequent in SLE which may be related to concomitant occurrence of Sjögren’s syndrome (SS) (2).
Objectives To detemine prevalence of oral manifestations, oral health status, and salivary changes in Iraqi SLE patients.
Methods One hundred and two individuals were enrolled in this study; 52 of them were SLE patients; and 50 were healthy control individuals matched in age and sex. The assessment of teeth decay was made according to the decay missing filling teeth (DMFT) index; the gingival inflammation was assessed using the criteria of gingival index; Clinical pocket depth was measured with periodontal probe type William, and whole unstimulated saliva samples have been collected from each subject for biochemical analysis. Also, salivary flow rate and pH were measured. After centrifugation, the supernatant of saliva was aspirated for biochemical analysis.
Results Oral ulceration(72%) was the most prominent orofacial manifestations of SLE patients followed by Temporomandibular joint (TMJ)disorders(54%) and facial skin rash (54%) then oral vesicles& bullae (10%), oral lichen planus (8%)and finally oral petechiae & purpura (4%).
Salivary flow rate and salivary pH were significantly lower in SLE patients than in the control subjects (0.36±0.21 versus 0.85±0.29 ml/min, p<0.001; 6.34±0.60 versus 6.74±0.51, p=0.001 respectively).
Oral hygiene index (DMFT index, gingival index, Clinical pocket depth) were significantly higher in SLE patients than in the control subjects (p<0.001).
Salivary calcium, sodium, chloride, and total protein were significantly higher among SLE patients than in the control subjects (P<0.001).While salivary potassium and inorganic phosphorus were significantly lower among SLE patients than in the control subjects (P<0.001).
In addition, We found a highly significant positive linear correlation between age of SLE patients and DMFT (r=0.434, p=0.002), and between age and clinical pocket depth (r=0.355, p=0.012); and a highly significant negative linear correlation between salivary flow rate and salivary calcium in SLE patients (r= -0.396, p=0.004).
Also there was highly significant positive linear correlation between DMFT and salivary calcium(r=0.323, p=0.022), and between DMFT and salivary chloride (r=0.325, p=0.021).
Conclusions Oral manifestations are common in Iraqi SLE patients. Changes in salivary flow rate, pH,salivary composition, and increased dental caries may serve as potential markers of the extent of autoimmune mediated salivary gland dysfunction which is similar to Sjogren’s syndrome.
Louis PJ, Fernandes R. Review of systemic lupus erythematosus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 91: 512–6.
I-M Gilboe, T K Kvien, T Uhlig, G Husby. Sicca symptoms and secondary Sjögren’s syndrome in systemic lupus erythematosus:comparison with rheumatoid arthritis and correlation with disease variables. Ann Rheum Dis 2001;60:1103–1109
Disclosure of Interest None Declared
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