Scleroderma:
When Brushing Your Teeth
Becomes a Challenge

For the schleroderma patient with severe scarring and tightness of the skin and mouth, taking care of their oral health and hygiene is a true challenge.

“In the patients that I see with scleroderma, the physical changes that occur in the face and mouth, together with dexterity problems, can significantly compromise their oral health,” says Dr. Catherine M. Flaitz, professor and Interim Dean of the University of Texas Dental Branch at Houston.

For several reasons, the risks of cavities and gum disease are increased with this group of patients, who find oral hygiene difficult. “Due to widespread scarring and deformity of the hands, manual dexterity is difficult, making it a challenge to brush and floss and avoid these common problems,” says Flaitz.

Dental Nightmare for Patients

Another very real problem for the scleroderma patient is scarring on the face and around the mouth which can restrict how far the individual can open their mouth or move their tongue. This presents a problem for the patient and for the dentist.

“Up to 70 percent of patients I see have restrictive opening of the mouth because of the tightness and shrinkage of the skin on the face and around the lips. Not only does the mouth scar but the gums pull away from the teeth in some individuals,” Flaitz observes.  “This scarring pulls the gums down and exposes part of the root of the teeth.

As the gums recede from the teeth, the patients may complain about sensitivity to hot and cold and even to tooth brushing. As a result of this problem, the teeth are more prone to cavities at the gum line.”

Hard to Swallow

Because these patients have difficulty swallowing, they tend to eat a softer high- carbohydrate diet including breads and cereals. This diet combined with the inability to brush and floss properly increases the risk for cavities. If the tongue is scarred, not only does the patient have difficulty speaking, they lose that self-cleansing action of the tongue.

Pressure on the Jaw

“When severely affected, the widespread scarring on the face puts a constant pressure on the lower jaw and deforms it. This tightness against the jaw can resorb [reabsorb] or melt away part of the bone on the chin as well as the back part of the jaw and the joint.  In addition, there is an increased risk for the roots of teeth to resorb or melt as well,” she explains.

Dry Mouth

Another real problem for the scleroderma patient is dry mouth. Scarring has an effect on the salivary or spit glands so they do not produce an efficient amount of saliva.

“Besides telling the patients to constantly sip fluids or suck on finely crushed ice, I recommend chewing sugarless gum and sucking on sugarless candy to stimulate the glands. Also, drinking low-fat milk with meals will make the mouth more comfortable because it lubricates the inside.” There are medications that can be prescribed to stimulate these glands.

Parted Lips

When the area around the mouth and lips becomes scarred, the lips do not come together and the front teeth are exposed. The result is that those teeth become dry and stained without that natural barrier, the lips. This adds to the problem with gum disease and oral dryness.

Help on Its Way

These are Flaitz’ recommendations to help the scleroderma patient manage their oral hygiene program:

• a prescription high-fluoride toothpaste to control the cavities at the gum line
• a visit to the dentist every three months for a professional cleaning to better control and prevent the progression of gum disease  
• a fluoride varnish that can be applied on the sensitive roots of the teeth every three months
• an electric toothbrush which cleans the teeth effectively and requires less physical coordination
• over-the counter dry mouth products that can help with oral comfort. Biotene makes a toothpaste, non-alcoholic mouth rinse and a chewing gum for these particular oral problems
• Also available is artificial saliva, but all of these products have only a temporary effect.

“There is no reason why a scleroderma patient should lose their teeth to gum disease,” says Flaitz. “Developing an oral hygiene program that is tailor-made for the patient will significantly improve oral comfort and prevent the gum disease from progressing to the bone. We can prevent the infection of the bone.”

 Flaitz also believes that people do not realize how important flossing is and that it breaks up and gets rid of the biofilm, microscopic plaque on the tooth surface that cannot be removed with brushing alone. It contains a lot of bacteria that infects the gums and destroys the bone around the teeth. “When patients have hand deformities and find flossing difficult, we recommend flossing aids,” she says.

 

 

Last Updated: 2-12-2009

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