Scleroderma is a disease that causes the skin to
thicken and become less pliable and less resilient. The
same disease may affect internal organs causing
hardening of the arteries, lung disease, and kidney
disease. Although there is no cure for scleroderma, many
treatments are available. The treatments slow the
progression of the disease.
Many show outward signs of their affliction. Due to
scleroderma's effect on the lungs, one carries a small
oxygen tank. Several, who have severe arthritis, use
assistive devices such as canes , crutches or
wheelchairs . Scleroderma affects the circulatory system
causing high blood pressure and Raynaud's syndrome, a
painful loss of blood flow to the fingers and toes when
there is a chill in the air, so many wear gloves and
blankets to stave off the air conditioning. All have
dental problems due to scleroderma.
Four effects of scleroderma affect dental health. The
tightening skin of the face causes microstomia or small
mouth. Xerostomia, dry mouth, often accompanies
scleroderma. Many scleroderma sufferers have depression.
Finally, the medications that physicians prescribe to
treat scleroderma and depression effect oral health in a
variety of ways.
Microstomia is a classic symptom of scleroderma. Skin
on the face tightens and becomes smooth and shiny. The
tongue may loose mobility as well; without a free moving
tongue, bits of food accumulate around the mouth. Many
people find that they can no longer close their lips
together. Some find that they cannot speak the way they
always have. They cannot kiss normally. For some, the
emotional toll of not being able to show their affection
for their spouse or children is unbearable
The tightening skin and muscles make it difficult and
uncomfortable to open wide enough for routine dental
treatment. This is frustrating to patients and dentists.
The dentist may feel that the patient is not
cooperating. The disaffection between the patient and
the dentist is liable to prevent the patient from
returning to that office or even finding another dental
Talking with the dentist before or during the
appointment about any condition that affects treatment
is very important. A dentist who knows that a patient is
not able to open wide or hold their mouth open for long
periods will make shorter appointments. There are
instruments available for smaller mouths. Dentists and
dental hygienists know exercises that help maintain and
increase the size of the mouth. Surgical procedures can
improve mobility of the lips and tongue.
Saliva is very important to oral health. The lack of
saliva is called xerostomia*.
Saliva is a solution of electrolytes, proteins,
immunogloben, and water that cleans, protects, and
restores teeth. Bacteria create acid that robs the teeth
of calcium. Saliva contains calcium, which can
remineralize teeth. Without saliva, bacterial plaque
covers teeth and creates tooth decay.
Dry mouths are more prone to
candidiasis (yeast infection) which many notice as a
burning sensation or cracks in the corners of the mouth.
Antibodies and proteins in the saliva protect the lining
of the mouth from yeast infection. Saliva is important
to denture wearers. Saliva lubricates the lining of the
mouth and helps maintain suction for the upper denture.
Drinking more water and sucking on sugar free hard
candies increases the flow of saliva. Dentists can
prescribe antifungal medications to treat candidiasis,
artificial saliva to
lubricate the oral tissues, and fluoride to make teeth
more resistant to decay.
Many of the medications that physicians prescribe to
treat scleroderma have side effects that effect oral
health. Some cause very uncomfortable mouth ulcerations.
Dentists can help diagnose this effect and recommend
palliative (soothing) treatments. Many medications cause
xerostomia. Some cause delayed wound healing which
effects gingival health, and delay healing after surgery
such as tooth extraction. Keep a current list of
medications in your purse or wallet. Ask your dentist to
review the list with you with an eye toward how the
medications affect oral health.
Depression is a hallmark of scleroderma. Patients
become demoralized when facing the inexorable
progression of their disease. In the face of
scleroderma, people ignore their oral health until they
feel better or have dental emergency. Microstomia and
xerostomia make treatment difficult and uncomfortable.
It is important for scleroderma patients to maintain
their oral health throughout the course of their disease
to decrease the necessity for long, uncomfortable
treatments. Additionally, some antidepressant
medications cause xerostomia.
Scleroderma is a serious disease. Dentistry is
important to maintain sufferers' comfort and quality of
life. If you have scleroderma, discuss your condition,
your medications, and your feelings with your dentist
Leader is the Chairman of the Health
Advisory Committee of the Lynnfield Schools, a member of
the Professional Advisory Committee of Tri-CAP Head
Start, and is a member of the Mass Dental Society
Council on Dental Care and Benefits Programs.