Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada.
College of Dentistry, University of Saskatchewan, Saskatoon, SK, Canada.
J Dent Res. 2024 Jul;103(7):689-696. doi: 10.1177/00220345241249408. Epub 2024 May 23.
Scleroderma (systemic sclerosis, SSc) is an autoimmune fibrosing connective tissue disease of unknown etiology. SSc patients show increased levels of autoantibodies, profibrotic cytokines, and extracellular matrix remodeling enzymes that collectively cause activated (myo)fibroblasts, the effector cell type of fibrosis. Despite these impacts, no disease-modifying therapy exists; individual symptoms are treated on a patient-to-patient basis. SSc research has been principally focused on symptoms observed in the lung and skin. However, SSc patients display significant oral complications that arise due to fibrosis of the not only skin, causing microstomia, but also the gastrointestinal tract, causing acid reflux, and the oral cavity itself, causing xerostomia and gingival recession. Due to these complications, SSc patients have impaired quality of life, including periodontitis, tooth loss, reduced tongue mobility, and malnutrition. Indeed, due to their characteristic oral presentation, SSc patients are often initially diagnosed by dentists. Despite their clinical importance, the oral complications of SSc are severely understudied; high-quality publications on this topic are scant. However, SSc patients with periodontal complications possess increased levels of matrix metalloproteinase-9 and chemokines, such as interleukin-6 and chemokine (C-X-C motif) ligand-4. Although many unsuccessful clinical trials, mainly exploring the antifibrotic effects of anti-inflammatory agents, have been conducted in SSc, none have used oral symptoms, which may be more amenable to anti-inflammatory drugs, as clinical end points. This review summarizes the current state of knowledge regarding oral complications in SSc with the goal of inspiring future research in this extremely important and underinvestigated area.
硬皮病（系统性硬化症，SSc）是一种病因不明的自身免疫性纤维性结缔组织疾病。SSc 患者表现出自身抗体、促纤维化细胞因子和细胞外基质重塑酶水平升高，这些共同导致激活的（肌）成纤维细胞，即纤维化的效应细胞类型。尽管存在这些影响，但目前尚无疾病修正治疗方法；根据患者个体症状进行治疗。SSc 研究主要集中在肺部和皮肤观察到的症状上。然而，SSc 患者还会出现明显的口腔并发症，这些并发症不仅源于皮肤纤维化导致的小口畸形，还源于胃肠道的胃酸反流，以及口腔本身的口干和牙龈退缩。由于这些并发症，SSc 患者的生活质量受损，包括牙周炎、牙齿缺失、舌头活动度降低和营养不良。事实上，由于其特征性的口腔表现，SSc 患者通常首先由牙医诊断。尽管这些口腔并发症具有临床重要性，但它们的研究严重不足；关于该主题的高质量出版物很少。然而，患有牙周并发症的 SSc 患者具有更高水平的基质金属蛋白酶-9 和趋化因子，如白细胞介素-6 和趋化因子（C-X-C 基序）配体-4。尽管针对 SSc 进行了许多不成功的临床试验，主要探索了抗炎药物的抗纤维化作用，但没有一个试验将口腔症状作为临床终点，而口腔症状可能更适合抗炎药物治疗。本综述总结了 SSc 口腔并发症的当前知识状态，旨在激发该极其重要但研究不足的领域的未来研究。
