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Jung S, Gavriiloglou M, Séverac F, Haumesser L, Sayeh A, Chatelus E, Martin T, Huck O. Influence of systemic sclerosis on periodontal health: A case-control study. J Clin Periodontol 2023; 50:1348-1359. [PMID: 37431838 DOI: 10.1111/jcpe.13846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/12/2023]
Abstract
AIM Patients with systemic sclerosis (SSc) present various clinical and radiological oral manifestations. However, precise evaluation of the oral features associated with diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc) is limited. The objective of this study was to evaluate the periodontal ligament (PDL) surface in SSc patients in comparison with controls. Assessment of oral-health-related quality of life (OHRQoL) and the levels of different biomarkers in the gingival crevicular fluid (GCF) was performed. MATERIALS AND METHODS SSc patients and matched controls underwent standardized oral examination and cone-beam computed tomography (CBCT). Levels of interleukin-6 (IL-6), chemokine (C-X-C motif) ligand 4 (CXCL-4) and matrix metalloproteinase-9 (MMP-9) in the GCF were determined by enzyme-linked immunosorbent assay. PDL surface was measured on CBCT axial views. OHRQoL was quantified using the Mouth Handicap in SSc Scale (MHISS). RESULTS Thirty-nine SSc patients and 39 controls were included. SSc patients exhibited increased PDL surface, higher number of missing teeth as well as elevated IL-6, MMP-9 and CXCL-4 levels. Reduced mouth opening was observed in dcSSc but not in lcSSc patients. MHISS score was higher in dcSSc than in lcSSc patients. Although worse periodontal parameters were found in both subgroups compared with controls, dcSSc patients presented lower gingival inflammation. CONCLUSIONS SSc is associated with PDL space widening, impaired oral health and OHRQoL.
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Affiliation(s)
- Sophie Jung
- Faculté de Chirurgie Dentaire Robert Frank, Université de Strasbourg, Strasbourg, France
- Pôle de Médecine et de Chirurgie bucco-dentaires, Centre de Référence des maladies rares orales et dentaires (O-Rares), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- INSERM UMR_S 1109 "Molecular ImmunoRheumatology", Fédération de Médecine Translationnelle de Strasbourg (FMTS), LabEx TRANSPLANTEX, Strasbourg, France
| | - Marianna Gavriiloglou
- Faculté de Chirurgie Dentaire Robert Frank, Université de Strasbourg, Strasbourg, France
- Unité Fonctionnelle de Parodontologie, Pôle de Médecine et de Chirurgie bucco-dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - François Séverac
- Groupe Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Lucille Haumesser
- Groupe Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Amira Sayeh
- Unité Fonctionnelle de Radiologie, Pôle de Médecine et de Chirurgie bucco-dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Emmanuel Chatelus
- Service de Rhumatologie, Centre de Référence des maladies autoimmunes systémiques rares (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thierry Martin
- INSERM UMR_S 1109 "Molecular ImmunoRheumatology", Fédération de Médecine Translationnelle de Strasbourg (FMTS), LabEx TRANSPLANTEX, Strasbourg, France
- Faculté de Médecine, Université de Strasbourg, Strasbourg, France
- Service d'Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Huck
- Faculté de Chirurgie Dentaire Robert Frank, Université de Strasbourg, Strasbourg, France
- Unité Fonctionnelle de Parodontologie, Pôle de Médecine et de Chirurgie bucco-dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), INSERM UMR 1260 "Regenerative Nanomedicine", Strasbourg, France
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Alhendi FJ, Werth VP, Sollecito TP, Stoopler ET. Systemic sclerosis: Update for oral health care providers. SPECIAL CARE IN DENTISTRY 2021; 40:418-430. [PMID: 33448431 DOI: 10.1111/scd.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
Systemic sclerosis (SSc), also known as scleroderma, is an autoimmune disease of unknown origin characterized by an uncontrolled inflammatory process resulting in fibrosis of the skin, internal organs and vasculopathy. Manifestations of SSc are heterogenous and can include pulmonary, cardiac, neural, renal, muscular, cutaneous and orofacial complications. Recent scientific advances have led to a better understanding of disease etiopathogenesis and the development of a new classification system. Therapeutic management is often multidisciplinary and targeted toward the affected organs. Oral health care providers (OHCPs) should be familiar with SSc, particularly as it relates to its impact on the orofacial region and modifications to delivery of oral health care for patients with this condition.
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Affiliation(s)
- Fatmah J Alhendi
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Department of Dermatology, Philadelphia V.A. Hospital, Hospital of the University of Pennsylvania and the Veteran's Administration Medical Center, Philadelphia, Pennsylvania
| | - Thomas P Sollecito
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
| | - Eric T Stoopler
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
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3
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Selifanova EI, Makeeva MK, Turkina AY, Esayan MS. [Oral health in patients with systemic sclerosis]. STOMATOLOGII︠A︡ 2019; 98:104-108. [PMID: 31322605 DOI: 10.17116/stomat201998031104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to conduct literature review about oral manifestations of scleroderma. Systemic sclerosis is a multisystem autoimmune disorder characterized by widespread fibrosis, vascular alterations and inflammation. Systemic sclerosis mainly affects people in age from 30 to 50 years, but the onset of disease can occur in any age. The disturbance of microcirculation with the activation and proliferation of endothelium and smooth muscle cells plays an important role in pathogenesis of sclerodrma. These changes lead to sclerosis and fibrosis of various part in human body. Orofacial manifestations of scleroderma include: reduced mouth opening, widening of periodontal ligament, teleangiectasia, bone lesions. Systemic scleroderma is often accompanied by Sjogren's syndrome. Oral manifestations of Sjogren's syndrome are recurrent parotitis, angular cheilitis, xerostomia and multiple caries. Sjogren's syndrome leads to negative impact on patients health and mental status. Orofacial manifestations of systemic sclerosis are still poorly known, that is why more researches should be made to improve dental treatment of patients with systemic sclerosis.
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Affiliation(s)
| | - M K Makeeva
- Peoples friendship university of Russia, Moscow, Russia
| | - A Yu Turkina
- First Moscow State Medical University, Moscow, Russia
| | - M S Esayan
- First Moscow State Medical University, Moscow, Russia
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Yalcin ED, Avcu N, Uysal S, Arslan U. Evaluation of radiomorphometric indices and bone findings on panoramic images in patients with scleroderma. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:e23-e30. [DOI: 10.1016/j.oooo.2018.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 06/08/2018] [Accepted: 08/14/2018] [Indexed: 11/26/2022]
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Abstract
Systemic sclerosis (SSc) is a multisystem disease of unknown aetiology characterised by microangiopathy, dysregulated immune function and tissue remodelling, which commonly involves the oral cavity. Orofacial manifestations of SSc contribute greatly to overall disease burden and yet are regularly overlooked and under-treated. This may reflect a pre-occupation amongst rheumatology clinicians on potentially life-threatening internal organ involvement, but is also a consequence of insufficient engagement between rheumatologists and dental professionals. A high proportion of SSc patients report difficulty accessing a dentist with knowledge of the disease and there is recognition amongst dentists that this could impact negatively on patient care. This review shall describe the clinical features and burden of orofacial manifestations of SSc and the management of such problems. The case is made for greater collaborative working between rheumatologists and dental professionals with an interest in SSc in both the research and clinical setting.
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Mortazavi H, Baharvand M. Review of common conditions associated with periodontal ligament widening. Imaging Sci Dent 2016; 46:229-237. [PMID: 28035300 PMCID: PMC5192020 DOI: 10.5624/isd.2016.46.4.229] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/28/2016] [Accepted: 10/05/2016] [Indexed: 01/07/2023] Open
Abstract
Purpose The aim of this article is to review a group of lesions associated with periodontal ligament (PDL) widening. Materials and Methods An electronic search was performed using specialized databases such as Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus to find relevant studies by using keywords such as “periodontium”, “periodontal ligament”, “periodontal ligament space”, “widened periodontal ligament”, and “periodontal ligament widening”. Results Out of nearly 200 articles, about 60 were broadly relevant to the topic. Ultimately, 47 articles closely related to the topic of interest were reviewed. When the relevant data were compiled, the following 10 entities were identified: occlusal/orthodontic trauma, periodontal disease/periodontitis, pulpo-periapical lesions, osteosarcoma, chondrosarcoma, non-Hodgkin lymphoma, progressive systemic sclerosis, radiation-induced bone defect, bisphosphonate-related osteonecrosis, and osteomyelitis. Conclusion Although PDL widening may be encountered by many dentists during their routine daily procedures, the clinician should consider some serious related conditions as well.
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Affiliation(s)
- Hamed Mortazavi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Baharvand
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jung S, Martin T, Schmittbuhl M, Huck O. The spectrum of orofacial manifestations in systemic sclerosis: a challenging management. Oral Dis 2016; 23:424-439. [PMID: 27196369 DOI: 10.1111/odi.12507] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 05/10/2016] [Accepted: 05/16/2016] [Indexed: 12/22/2022]
Abstract
Systemic sclerosis (SSc) is a rare multisystem connective tissue disorder characterized by the triad fibrosis, vasculopathy and immune dysregulation. This chronic disease has a significant impact on the orofacial region that is involved in more than two-thirds of the cases. SSc patients can show a wide array of oral manifestations, which are usually associated with a severe impairment of the quality of life. They often present a decreased the salivary flow and a reduced mouth opening that contribute substantially to the worsening of the oral health status. Therefore, SSc patients require specific and multidisciplinary interventions that should be initiated as early as possible. The identification of specific radiological and clinical signs at the early stage will improve the management of such patients. This study reviews the wide spectrum of orofacial manifestations associated with SSc and suggests clues for the oral management that remains challenging.
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Affiliation(s)
- S Jung
- Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, France.,Center of Chronic Immunodeficiency (CCI), Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - T Martin
- Service d'Immunologie Clinique, Hôpitaux Universitaires de Strasbourg, France.,Faculté de Médecine, Université de Strasbourg, France.,CNRS UPR 3572 'Immunopathologie et Chimie Thérapeutique', Institut de Biologie Moléculaire et Cellulaire (IBMC), Strasbourg, France
| | - M Schmittbuhl
- Faculté de Médecine Dentaire, Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - O Huck
- Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, France.,INSERM, UMR 1109 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), France
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Previously undescribed pulpal and periodontal ligament calcifications in systemic sclerosis: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e47-51. [DOI: 10.1016/j.oooo.2012.09.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/28/2012] [Accepted: 09/19/2012] [Indexed: 12/18/2022]
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9
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Prasad R S, Pai A. Localized periodontal ligament space widening as the only presentation of scleroderma--reliability recheck. Dentomaxillofac Radiol 2012; 41:440; author reply 441-2. [PMID: 22707333 DOI: 10.1259/dmfr/26475287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Anbiaee N, Tafakhori Z. Localized periodontal ligament space widening as the only presentation of scleroderma—reliability recheck: Author response. Dentomaxillofac Radiol 2012. [DOI: 10.1259/dmfr/14983572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Leung WK, Chu CH, Mok MY, Yeung KWS, Ng SKS. Periodontal status of adults with systemic sclerosis: case-control study. J Periodontol 2011; 82:1140-5. [PMID: 21815717 DOI: 10.1902/jop.2010.100593] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a systemic autoimmune disease that affects connective tissue in the skin, blood vessels, and major organs of the body. This project aims to compare the periodontal status of dentate Hong Kong Chinese with and without SSc. METHODS Thirty-six non-smoking adults with SSc (one male and 35 females: aged 50.6 ± 11.7 years; free from Sjögren syndrome) attending a teaching hospital were age- and sex-matched to systemically healthy controls attending a dental hospital. Both groups had similar demographic characteristics but a lower proportion of patients with SSc were working or studying (P <0.05). Twenty-three (32%) of all participants were regular dental attendees. Orthopantomogram radiographs were taken. Participants were surveyed and periodontally examined. RESULTS Both groups had a similar number of erupted teeth, proportion of sites with detectable plaque, and mean full-mouth clinical attachment level, whereas controls had less bleeding on probing (49.3% ± 22.6% versus 78.4% ± 19.6%; P <0.001) and a shallower mean full-mouth probing depth (1.92 ± 0.44 mm versus 2.52 ± 0.58 mm; P <0.001). Radiographically, patients with SSc had wider periodontal ligament spaces (0.36 ± 0.06 mm versus 0.33 ± 0.03 mm; P <0.01). CONCLUSIONS Hong Kong Chinese adults with SSc seem to exhibit higher levels of periodontal inflammation and wider radiographic periodontal ligament spaces than age- and sex-matched controls. Future studies are warranted to further investigate any associations between these periodontal features and SSc.
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Affiliation(s)
- W Keung Leung
- Prince Philip Dental Hospital, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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Anbiaee N, Tafakhori Z. Early diagnosis of progressive systemic sclerosis (scleroderma) from a panoramic view: report of three cases. Dentomaxillofac Radiol 2011; 40:457-62. [PMID: 21960405 DOI: 10.1259/dmfr/64340754] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Systemic sclerosis (scleroderma) is a multisystem disease involving the skin, lungs, heart, kidneys and gastrointestinal tract. It is probably owing to a disorder of the immune system. It may also have some oral manifestations, including limited ability to open the mouth, widening of the periodontal ligament (PDL) space and mandibular bone resorption. We report here on three asymptomatic cases that were referred to our oral and maxillofacial radiology centre for another reason, and in which we suspected scleroderma based on the widening of the PDL in the panoramic view. The early diagnosis was finally confirmed by pathological findings.
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Affiliation(s)
- N Anbiaee
- Department of Oral and Maxillofacial Radiology, Mashhad University of Medical Sciences, Mashhad, Iran
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Chu CH, Yeung CMK, Lai IA, Leung WK, Mok MY. Oral health of Chinese people with systemic sclerosis. Clin Oral Investig 2011; 15:931-9. [PMID: 20938795 PMCID: PMC3212684 DOI: 10.1007/s00784-010-0472-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 09/28/2010] [Indexed: 11/21/2022]
Abstract
The aim was to study oral health status, salivary function, and oral features of Chinese people with Systemic Sclerosis (SSc). Chinese people with SSc attending a university specialist clinic were invited for a questionnaire survey and a clinical examination. Ethics approval was sought (UW 08-305). Gender- and age-matched individuals without SSc who attended a university dental hospital were recruited for comparison. Forty-two SSc patients with a mean age of 54.0 ± 12.2 were examined. This study found no Chinese people with systemic sclerosis were periodontally healthy and many (76%) had periodontal pockets despite most of them (93%) practiced daily tooth-brushing. They all had caries experience (DMFT = 10.5) and many (65%) had untreated decay. Mucosal telangiectasia was a common oral feature (80%). They had lower resting salivary flow rates (0.18 ± 0.17 ml/min vs. 0.31 ± 0.21 ml/min; p = 0.003) and pH values (6.90 ± 0.40 vs. 7.28 ± 0.31; p < 0.001) and reduced maximal mouth opening (40.1 ± 6.5 mm vs. 43.6 ± 7.0 mm) than people without SSc.
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Affiliation(s)
- C H Chu
- Faculty of Dentistry, The University of Hong Kong, 3B61, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong SAR, China.
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Leung WK, Chu CH, Mok MY, Yeung KWS, Ng SKS. Periodontal Status of Adults With Systemic Sclerosis: Case-Control Study. J Periodontol 2011:1-9. [PMID: 21284551 DOI: 10.1902/jop.2011.100593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Systemic sclerosis (SSc) is a systemic autoimmune disease that affects connective tissue in the skin, blood vessels and major organs of the body. This project aimed to compare the periodontal status of dentate Hong Kong Chinese with and without SSc. Methods: Thirty-six non-smoking adults with SSc (35 women; 50.6 ? 11.7 years, free from Sjogren's syndrome) attending a teaching hospital were age- and sex-matched to systemically healthy controls attending a dental hospital. Both groups had similar demographic characteristics but a lower proportion of SSc patients were working or studying (p < 0.05). Twenty-three (32.0%) of all participants were regular dental attendees. Orthopantomogram rediograph were taken. Participants were surveyed and periodontally examined. Results: Both groups had a similar number of erupted teeth, proportion of sites with detectable plaque, and mean full-mouth probing attachment level, whereas controls had less bleeding on probing (BOP(%), 49.3 ? 22.6 vs. 78.4 ? 19.6; p < 0.001) and a shallower mean full-mouth probing pocket depth (PPD(mm), 1.92 ? 0.44 vs. 2.52 ? 0.58; p < 0.001). Radiographically, SSc patients had wider periodontal ligament spaces. (PDL (mm), 0.36 ? 0.06 vs. 0.33 ? 0.03, p < 0.01) Conclusion: Hong Kong Chinese SSc adults seem to exhibit higher levels of periodontal inflammation and wider radiographic PDL spaces than age- and sex- matched controls. Future studies are warranted to further investigate any associations between these periodontal features and SSc.
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Affiliation(s)
- W Keung Leung
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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