Autoimmune & Connective Tissue
Dental Management of Patients with Scleroderma / systemic sclerosis
Scleroderma — limited mouth opening & reflux
Perioral fibrosis causes microstomia (restricted access) and patients often have GORD and Raynaud's phenomenon; a widened periodontal ligament may be seen radiographically.
Emergency vs routine management
If EMERGENCY — what to do
- • Limited mouth opening: small instruments, short sessions; check for associated renal/pulmonary disease.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
If ROUTINE — what to do
- • Mouth-stretching exercises, adapted oral-hygiene aids, frequent recall.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
Clinical precautions
- • Microstomia: plan for restricted access, smaller instruments and shorter appointments; encourage mouth-opening exercises
- • GORD: dental-erosion risk — reinforce erosion prevention
- • Raynaud's: keep the patient and room warm
- • A widened PDL space on radiographs is usually non-pathological in scleroderma
- • Review current corticosteroid / methotrexate / biologic therapy
- • Consider stress-dose steroids for major surgery (see the steroid-cover note)
- • Meticulous infection control
Information & tests to request
- • Daily prednisolone-equivalent dose (mg) — This patient's condition/therapy is commonly associated with long-term corticosteroids, which can suppress the adrenal response to surgical stress. Enter the daily dose (0 if none) to determine whether supplementary stress-dose cover is needed.
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION Scleroderma — limited mouth opening & reflux |
| Supragingival scaling / polish | MODIFY / CAUTION Scleroderma — limited mouth opening & reflux |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Scleroderma — limited mouth opening & reflux |
| Root canal treatment | MODIFY / CAUTION Scleroderma — limited mouth opening & reflux |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Scleroderma — limited mouth opening & reflux |
| Surgical / bony extraction | MODIFY / CAUTION Scleroderma — limited mouth opening & reflux |
| Implant placement | MODIFY / CAUTION Scleroderma — limited mouth opening & reflux |
References
- Autoimmune / connective tissue disease — dental management
- Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.