Scleroderma and Dental Health
By Philip Nauert, D.D.S. (originally published in Scleroderma Foundation Newsline, Summer/Fall 1999)
The ability to effectively chew nutritious and appealing food is vital to a healthy body. Any process that compromises this simple function can result in poor nutrition and a reduced ability to resist opportunistic diseases.
Scleroderma can compromise oral and dental health in a number of ways. In this article, we will look at some of the more common dental problems complicated by scleroderma and I will suggest some ways you can prevent or manage them.
Dental diseases are of only a few categories. This column will address dental decay (cavities), periodontal (gum) disease, and special problems related to scleroderma.
Dental Decay (Cavities)
Tooth decay is the result of acid which is produced by one strain of bacteria (Streptococcus mutans). When we eat, we provide the bacteria on our teeth with a food source that is rapidly converted into acid, which dissolves the hard outer coating of the tooth, creating a cavity in the inside or dentin of the tooth.
Once the dentin layer is invaded by bacteria, the decay process is much more rapid.
The key to reducing the dental decay is to eliminate decay-producing bacteria from every surface of the teeth. Then, it is important to apply fluoride to the teeth to make the enamel less easily dissolved by acid.
Toothbrush selection is important. Some of the new toothbrushes have handles with a thumb stop and soft rubber inserts which allow for a better grip and more control. Good examples are the Crest Complete and the Butler Gum Supra. Make sure the brush has a small (child) head and be sure to select soft bristles.
Commonly in patients with tightening of the lips and cheeks (microstomia) the areas most difficult to clean are the cheek sides of the upper and lower teeth. You can take another soft-bristle child's toothbrush and with tweezers, pull all but the end two rows of bristles out. This will allow cleaning the cheek side and back surface of these teeth.
For those with limited use of the hands and fingers, a dentist can mold a custom grip around your toothbrush handle with dental acrylic. This can be made of hard acrylic or of a soft, rubbery acrylic and the cost should be nominal.
If using a modified toothbrush handle is not possible, there are several rechargeable electric toothbrushes that are very helpful. The RotaDent by Professional Dental Technologies is a rotary brush-type device which has very fine soft brush filaments. This product is distributed through dental offices only, and your dentist can supply ordering information.
Another excellent electric brush is the Sonicare. This brush vibrates its bristles with ultrasonic energy but is very gentle to fragile tissue. This is available at most drug stores.
The job of plaque removal is completed by the use of dental floss. Not all floss is alike, however. Glide Floss by W.L. Gore Co., is very slippery and is great for hard-to-floss contacts. Unfortunately, patients with compromised dexterity will have a hard time holding on to this very slippery floss.
Super Floss from Oral B has a floss threader built in, which is attached to a portion of floss that is puffed out like thick yarn. Extending from the fuzzy area is a length of conventional floss.
My favorite floss is Johnson and Johnson Dental Tape. This product is easy to hold on to and has a large diameter to easily clean the areas between teeth.
Gum Disease
In addition to tooth decay, periodontal (gum) disease is another area for concern to the scleroderma patient.
One form of periodontal problem involves active infection of the tissue by harmful bacteria.
Skin tightening due to scleroderma
Another area of periodontal problem stems from the gradual tightening of the lips, cheeks, and gum tissues as a result of the progress of scleroderma. As the elasticity of the lips and cheeks is lost, the result can be a tough band of fibrous tissue connecting the inside of the lip to the gum tissue near the necks of the teeth. When this happens, every movement of the lip pulls healthy tissue away from the tooth and results in gum recession. This can lead to more serious dental decay and periodontal disease. It may become necessary to have a gum specialist (periodontist) surgically correct this condition.
Regular dental examination, necessary diagnostic x-rays, and dental cleanings should be a part of every person's routine. However, for the scleroderma patient, the challenge of the process is a special concern.
A simple exercise you can do at home
A great, yet simple, physical therapy exercise can help ease the visit to the dentist. Gradual and incremental stretching exercises can make opening the mouth easier. Take several common tongueblades (available from your pharmacist) and stack them one onto the other. Then slip the stack between the upper and lower teeth. Count the number of blades which can be comfortably fit between the teeth. Now with this stack between the teeth, slip one more tongueblade in the middle of the stack and let it gently stretch the mouth a little. By increasing the number of blades more opening can be obtained. Be very cautious, do not add more to the stack than is comfortable. Done regularly, this can be a helpful addition to your overall stretching regimen.
For all patients, dental problems are much better prevented than treated. The key is to be an informed patient and to have an understanding dentist. Working together, dental health is a very attainable goal.
Below I have included a list of products that persons with scleroderma
may find beneficial in treating their particular dental problems. 