Scleroderma and dentistry: Two case reports

Clinical Characteristics and Management of Oral Candidiasis Associated with Calcinosis, Raynaud's Phenomenon, Esophageal Dysmotility, Sclerodactyly, and Telangiectasia Syndrome

Calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome, a systemic sclerosis subtype, features skin thickening, vascular issues, and organ involvement, causing complications in the gastrointestinal and musculoskeletal systems. Herein, we present a rare case of oral candidiasis, with CREST syndrome. The patient presented with xerostomia, tongue erythema, and burning pain. The patient reported finger stiffness, facial sclerosis, cold-induced pain, and a 10-year history of palmar-plantar pustulosis. Laboratory tests confirmed antinuclear antibodies (ANA) and anticentromere antibodies (1:1280), leading to a diagnosis of CREST syndrome. A fungal culture identified Candida albicans, and treatment with miconazole gel successfully resolved the infection. This case emphasizes the importance of recognizing oral manifestations in systemic autoimmune diseases, as conditions like xerostomia increase susceptibility to infections.

Clinician and patient experiences of managing and living with oral and dental manifestations of scleroderma: A scoping review

Oral and dental manifestations of scleroderma are extremely common, yet they are often overlooked within rheumatology and poorly understood within dentistry. Previous research has indicated the need to understand the oral and dental experiences of people living with scleroderma and those involved in their care. This scoping review aims, for the first time, to comprehensively map what is known regarding the identification and management of oral and dental manifestations of scleroderma, how these are experienced by people living with scleroderma, and to explore key characteristics of barriers and enablers to good oral and dental care in scleroderma. A scoping review was conducted using six databases (Embase, PubMed, PsychINFO, ASSIA, Scopus and SSCI), according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses - extension for Scoping Review. Grey literature was also included. Studies were eligible for inclusion if the full text and abstract were available in English, published between 2002 and 2022, and focused on the concept of oral and dental care in adults with scleroderma, either relating to identification and management, enablers and barriers to best practice, or patient experiences and well-being. Qualitative research which seeks to understand patients' lived experiences was a notable gap in the literature. Similarly, there was a significant lack of focus on the oral and dental manifestations of scleroderma in rheumatology. Three key features were identified which would facilitate best practice in research and clinical contexts: the necessity of multidisciplinary care; the necessity of centralising patient experience; and the necessity of mitigating barriers to dental care. We conclude that increased awareness of scleroderma within dentistry and streamlining referral procedures between the disciplines of dentistry and rheumatology, to enable the early identification and management of scleroderma, are crucial.

HIV-Associated Systemic Sclerosis: Literature Review and a Rare Case Report

Highly antiretroviral therapy (HAART) used in Human Immunodeficiency Virus (HIV) treatment may prolong the life span of people living with HIV/Acquired Immune Deficiency Syndrome (AIDS) but may also induce the onset of autoimmune disorders. However, HIV-associated systemic sclerosis (SSc) is an extremely rare occurrence, and only four case reports and two studies documenting this association have been reported to date. We report a rare case of HIV-associated SSc who was referred to us for pain management in her mandibular teeth. A 44-year-old female patient diagnosed with HIV-associated SSc reported a complaint of pain in the lower posterior teeth region. Physical examination revealed typical features of SSc. The pain in her mandibular teeth was due to food lodgement, and she was advised to use toothpaste with a powered toothbrush and mouth stretching exercises, followed by oral prophylaxis. The patient responded well to therapy. HIV-associated SSc is an extremely rare occurrence, with an obscure pathogenic mechanism of HIV-associated autoimmunity. Oral physicians play a crucial role in disease management and should be incorporated into the multidisciplinary team.

Oral manifestations of morphea en plaque: Case report

Introduction

Morphea, or localized scleroderma, is an inflammatory disease that leads to sclerosis of the skin and underlying tissues due to excessive collagen deposition. Its etiology remains elusive. Morphea also affects oral and perioral tissues, the most common clinical manifestations being facial skin and tongue rigidity. Below, we present a case of morphea with oral manifestations.

Case presentation

A 17-year-old patient was referred to our department of oral surgery by her dermatologist for possible oral morphea involvement. She presented pigmented skin lesions involving the right labial-chin region. On palpation, the skin of her perioral was sclerotic. the panoramic radiograph showed a shortening of the roots of the 46/47 with a developmental delay of the 48 compared to the 38. A bone biopsy was performed between 46/47 and distal to 48. histological examination showed bone tissue with fibrous and collagenous reorganization in favor of scleroderma.

Conclusion

The management of plaque morphea is multidisciplinary. The role of the dentist is very important to avoid any oral complications.

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“Morphea en plaque”is a rare condition involving in oro-facial area.

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Its etiology remains elusiveand its diagnosis requires a careful clinical, radiographic and histological examination.

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Themanagement of plaque morphea is multidisciplinary. The role of the dentist is very important to avoid any oral complications.

Photobiomodulation in the treatment of xerostomia associated with hyposalivation in a pediatric patient with systemic scleroderma

Scleroderma is a rare autoimmune disease characterized by excessive collagen production. The oral manifestations of the patient with scleroderma can include microstomia, xerostomia, and changes in the resorption teeth. We report the case of a 7-year-old female patient diagnosed with systemic scleroderma where photobiomodulation therapy was used to treat xerostomia associated with hyposalivation. She attended a pediatric clinic and presented with dry and rigid facial skin, trismus, xerostomia, malocclusion, and difficulty swallowing. Stimulated salivary flow was assessed before, during, and after treatment. Photobiomodulation therapy was conducted at four points at the sublingual glands with 660 nm, 100 mW, and 0.8 J/cm² to each point; eight points at the parotid glands; and six points at the submandibular glands with 808 nm, 100 mW, and 0.8 J/cm² for 8 seconds at each point. After this therapy, an increase in salivary flow, remission of the xerostomia, and an improvement in mastication and swallowing were observed. Photobiomodulation therapy was effective in controlling xerostomia in this pediatric patient, resulting in increased salivary flow and an improvement in her quality of life.

Characterization of dental phenotypes and treatment modalities in Korean patients with Parry-Romberg syndrome

Objective

To investigate the dental phenotypes and treatment modalities (Tx-Mod) in Korean patients with Parry–Romberg syndrome (PRS) using longitudinal data.

Methods

The samples consisted of 10 PRS patients, who were treated and/or followed-up at Seoul National University Dental Hospital between 1998 and 2019. Using a novel PRS severity index based on the numbers of the atrophy-involved area and asymmetry-involved item, we classified them into mild (n = 3), moderate (n = 2), and severe (n = 5). Dental phenotypes, including congenitally missing tooth (Con-Missing-Tooth), microdontia, tooth with short root (Short-Root), tooth with dilacerated root, and delayed eruption/impacted tooth, were investigated along with Tx-Mod.

Results

The side of occurrence of all dental phenotypes showed 100% concordance with the side of PRS involvement. The most two common dental phenotypes were Con-Missing-Tooth and Short-Root (n = 29 and n = 17 in six patients). The sums of the average number of Con-Missing-Tooth and Short-Root increased from mild PRS to moderate PRS and severe PRS cases (1.0, 6.0, and 6.2). In terms of Tx-Mod, growth observation due to mild atrophy, fixed orthodontic treatment, and grafting were used for mild PRS cases. Tx-Mod for moderate PRS cases involved growth observation for surgery due to an early age at the initial visit. For severe PRS cases, diverse Tx-Mod combinations including unilateral functional appliance, fixed orthodontic treatment, growth observation, grafting, and orthognathic surgery were used.

Conclusions

The novel PRS severity index may be useful to provide primary data for individualized diagnosis and treatment planning for PRS patients.

Morphea with Oral Mucosa Involvement and Unilateral Nevoid Telangiectasia as an Early Presentation of Morphea: A Case Report and Review of the Literature

Oral mucosal involvement in patients with morphea is quite rare. Unilateral nevoid telangiectasia is a rare vascular dermatosis characterized by unilateral telangiectasia distributed in a dermatomal pattern, especially on the upper trunk and extremities. We describe a case of a 10-year-old female patient that presents with morphea on her left chin and upper lip extending to the inner oral mucosa as well as a unilateral nevoid telangiectasia on her left cheek as an early presentation of localized scleroderma. This case is significant as it demonstrates a striking clinical presentation of morphea and an interesting early presentation of morphea as a unilateral nevoid telangiectasia that improved after treatment with oral methotrexate and prednisone.

Progressive Hemifacial Atrophy and Linear Scleroderma En Coup de Sabre: A Spectrum of the Same Disease?

Similar clinical and histhopathological features in progressive hemifacial atrophy and linear scleroderma en coup de sabre are well known. Trauma may predispose to the development of both diseases. The lack of association with anti-Borrelia antibodies was shown in both cases as well. The otolaryngological and endocrine disorders may be associated findings in both diseases. However, there are certain differences in neurological and ophthalmological changes in the diseases.