An Oral Health Checklist for Scleroderma Patients

Scleroderma is an auto-immune disease that affects about 300,000 Americans. The hallmark of scleroderma is thickening and tightening of the skin. This is an unusual disease. Patients may suffer for years before there is a diagnosis. Some people with scleroderma report difficulty finding a dentist to care for them. This may be due to practitioner's unfamiliarity with the disease. Therefore, some scleroderma patients find it necessary to be more knowledgeable and proactive when caring for their oral health.

Patients with Scleroderma have oral health issues particular to the illness. Scleroderma is a chronic disease. The oral health issues will be life long. Long standing oral health conditions may become worse over time. Treatments may not be curative, and only improve the patient's condition.

Xerostomia (dry mouth) is very common in scleroderma. This may be due to the disease itself or a side effect of medication. Microstomia (small mouth) is a common feature of scleroderma. Home care (brushing and flossing) may be complicated by microstomia and sclerodactyly (tightening of the skin of the hands and fingers). Gastro-esophageal reflux disease (GERD) is common in scleroderma. Acidic stomach contents will cause tooth decay and erosion.

People who have scleroderma or any chronic illness should choose a dentist who is patient. The dentist must either be familiar with scleroderma, or willing to learn about the condition.

Prevention is important for scleroderma patients. Return to the dentist or dental hygienist for checkups every 3 months. Annual x-ray exams are recommended. (Dress warmly for dental appointments to prevent Raynauds Syndrome flair ups during dental appointments.) The use of professionally applied fluoride and prescription fluoride products is essential to prevent tooth decay. The dentist should test the patient for xerostomia (dry mouth) regularly and record the results. Treat if necessary. Patients with sclerodactyly and microstomia should speak with the dentist or dental hygienist about strategies and tools for improved brushing and flossing.

Ask the dentist for suggestions for exercises to maintain and increase maximum jaw and mouth opening. See the accompanying photos for demonstrations of two exercises. Patients who are not able to use their hands to perform the exercises may use appliances such as the TheraBite (www.craniorehab.com)

More information on scleroderma and oral health is available on the website of the Scleroderma Foundation at www.scleroderma.org. Local and regional chapters of the foundation are a wonderful resource for dentists and physicians who have experience treating scleroderma patients. The Scleroderma Foundation is a clearing house for the latest information on this disease, and funds research that advances the body knowledge of the disease and support for patients.