Prosthodontic Management Of An Edentulous Patient With Systemic Sclerosis

摘要

Systemic sclerosis is a chronic multisystem progressive disease affecting the connective tissues. The thickened skin distinguishes scleroderma from other connective tissue diseases. The oral aperture may be greatly reduced and the resultant microstomia with limited oral access presents a challenge to prosthodontic treatment. A brief review of the manifestations of scleroderma and the clinical procedure for dental rehabilitation in a patient with microstomia is presented. Introduction Systemic sclerosis is a chronic systemic disorder of unknown etiology. It is characterized by thickening of skin and distinctive involvement of multiple internal organs most notably the lungs, gastrointestinal tract, heart and kidneys. The thickened skin distinguishes scleroderma from other connective tissue diseases. Patients can be divided into diffuse cutaneous systemic sclerosis and limited cutaneous sclerosis. In diffuse cutaneous systemic sclerosis progressive skin induration is present. These patients are at risk of early pulmonary fibrosis and acute renal involvement. While in limited cutaneous sclerosis patients generally have long standing Raynaud’s phenomenon before manifestations of systemic sclerosis appear.1-3 Progressive systemic sclerosis occurs more commonly in women, with a female to male ratio of 4:1 and peak age of onset at 30-50 years of age.1,3 The symptoms of scleroderma that are of dental interest are the result of a slow collagenous fibrosis and loss of cellular definition. An abnormally small oral orifice, defined as microstomia, can be associated with scleroderma. Involvement of temporomandibular joint, which further reduces the oral opening, is frequently observed.3 The reduced mouth opening and rigidity of tongue presents difficulties to the dentist. The treatment in an edentulous patient poses problems using the conventional methods, sectional impressions that can be recorded in two or more parts and then reassembled outside the mouth is a useful procedure. Modified technique for denture fabrication in an edentulous patient of progressive systemic sclerosis with microstomia is being presented. Case Report A 58 years old female edentulous patient presented to the department of Prosthodontics for a set of dentures. She was a diagnosed case of systemic sclerosis and a known case of hypertension for more than four years on regular treatment. Her general physical examination revealed hardening of facial skin, vertical peri-oral furrows, thinning of lips with reduced mobility. (Fig 1)