Oral and dental involvement in scleroderma: What happens and how can it be managed?

Recently, our community made us aware of a poll that was run online to understand the impact that the oral and dental complications of scleroderma can have on someone living with the condition.

We want to ensure that everyone has the support that they need, as well as the information to help manage the conditions as best as they can. We've selected some questions from the poll to answer here. Further information can be found in our factsheet 'Oral and Dental Aspects of Scleroderma' which is available on our online shop. Alternatively, you can call us at our head office line to receive a hard copy of this factsheet, free of charge.

I'm experiencing issues with my mouth, it's narrowing to the extent that dental treatment and eating are becoming difficult.

Microstomia, or'reduced mouth opening', in SSc is caused by the tightening of the facial skin around the mouth. If the mouth opening becomes very small, it can have an impact on being able to eat, dental hygiene and speech. There is no evidence to show that it has ever progressed to a point where patients are ever unable to eat or speak.

Mouth stretching exercises are probably the best treatment for microstomia and have been shown to improve mouth opening and help with eating, dental hygiene and speaking. It's recommended that these exercises are performed once or twice a day, in front of a mirror. However, if you have sores around your mouth, you should avoid doing this as it may cause the sores to rupture.

I'm really worried about losing my teeth and about whether I'll experience tooth decay.

A lack of saliva increases susceptibility to dental decay (caries) and gum diseases (gingivitis), which can lead to tooth loss if left untreated. Recent work has suggested that the progression of SSc can in itself affect the health of the gums and roots in people living with the condition. In addition to keeping the mouth moist, we recommend avoiding things that can affect dental hygiene such as cigarette smoking or having a high intake of refined sugar.

I have telangiectasia on my lips and mouth.

Telangiectasia, caused by small dilated blood vessels, are sometimes evident around the mouth, lips or gums but do not cause any problems at this site. Concealers such as make up and lipstick can be helpful if you consider it to be unsightly.

My tolerance for regular toothpastes and mouthwash has decreased.

Toothpastes aid the removal of plaque and tartar, freshens the breath and can provide fluoride, which strengthen the outer surface of teeth. Fluoride mouthwashes(e.g. Fluorigard) are available and recommended for patients with a dry mouth (xerostomia) to reduce the risk of dental decay.

Some patients with dry mouth report local irritation with fluoride containing products and cannot tolerate them. Modern toothpastes also contain a foaming agent, Sodium Laurel or Laureth Sulphate(SLS), which can irritate mouth ulcers and may delay their healing.

There are a number of products that do not contain this ingredient(Corsodyl, greenpeople) and may be better for gum health and for people who experience frequent mouth ulcers. Difflam mouthwash may also be helpful in oral ulceration and is available over the counter.

I've noticed that my bottom lips feel sore and tight, and that there is some peeling on my lips.

Dryness of the mouth (xerostomia) is common in people living with SSc and is caused by the reduced formation of saliva, possibly due to inflammation or scar tissue formation within the salivary glands.

Lack of saliva can lead to soreness of the mouth and increase the likelihood of dental caries, gingivitis, fungal infections of the mouth and bacterial infections of the salivary glands. People living with the condition are also advised to avoid smoking and excessive alcohol which can also worsen oral dryness.

Chewing sugar-free gum or salivary stimulation tablets are a useful way of encouraging the salivary glands to produce more saliva. At least two chewing gums have been developed specifically for the management of dry mouth (Biotene dry mouth gum and BioXtra chewing gum).

I have recurring mouth ulcers, is there anything I can do?

Oral ulceration can be a feature of auto immune rheumatic diseases and can occur as a common side-effect of immunosuppressing drugs (such as MMF, cyclophosphamide, methotrexate) which are sometimes prescribed to people living with SSc. Recurrent oral ulceration may require a change of drug.

As with many oral complications, maintaining good oral hygiene can help prevent mouth ulceration. The best treatment for active mouth ulceration can be applying creams which contain a small amount of steroids such as hydrocortisone oromucosal tablets or Adcortyl in Orabase. Steroid inhalers can also be sprayed onto active ulcers to promote healing.

If you are interested in helping SRUK to fund more work like this, then please visit our donations page here. We rely on the generosity of our community to continue to support groundbreaking research in both scleroderma and Raynaud's.

If you would like information on managing scleroderma, please visit: Managing scleroderma.

Another article covering tips for self-management in scleroderma can be found here: 6 tips for self-management.