CHICAGO—People with scleroderma face many dental challenges related to oral fibrosis that can greatly disrupt their lives; the situation is made worse because dentists and rheumatologists aren’t talking to each other to share information, said Andrew Leask, BSc, PhD, a distinguished professor at the University of Saskatchewan College of Dentistry in Canada, who spoke on the topic Overview of Periodontal and Gingival Disease in Scleroderma and Sjögren’s Disease at ACR Convergence 2025.
Oral Manifestations
Scleroderma is an autoimmune disease that attacks healthy tissue and triggers fibrotic action in the body including the oral cavity. This can lead to dry mouth, tooth loss and decay, poor or difficult oral hygiene, tongue rigidity and other symptoms that could be overlooked as being associated with the autoimmune disease.
The symptoms are often stressful, causing physical pain and emotional discomfort, Dr. Leask said. They can also contribute to psychological difficulties because patients feel self-conscious about their appearance, affecting how they interact with people daily.
When a patient has fibrosis in the oral cavity, it can be difficult for them to open their mouth, speak and swallow, which combined with pain and loss of teeth can lead to malnutrition. Although the condition and issues surrounding it are not immediately life-threatening, they take a toll on patients overall and have a negative impact on quality of life. “I cannot emphasize it enough, despite the fact that it’s not directly causing mortality, it is affecting severely the well-being of the patients on a daily basis,” Dr. Leask said.
The situation is made worse because “dentists have no idea what they’re looking at” and because of the disconnect between the dentistry and rheumatology communities, Dr. Leask said. “They haven’t communicated with each other adequately.”
Good Communication Critical
Good communication could be clinically critical to patients, especially those who have not yet been diagnosed, Dr. Leask said. The oral cavity and fluids inside it, which are easy to access, could be used to help diagnose scleroderma. For example, tooth loss and gingival retraction without bleeding could indicate scleroderma. Those same symptoms and dry mouth may also be associated with salivary fibrosis, he said.
When dentists are more informed about patients who have scleroderma, they can take steps to address concerns. Some examples include using a moisturizer or a balm around the patient’s mouth to make it easier to manipulate and giving water as often as possible to alleviate dry mouth and ease discomfort, Dr. Leask said.
Dentists can also assist with issues outside of the dental office to help improve oral hygiene. For example, they can suggest an electric toothbrush for patients who have difficulty with the movement required for a manual brush, he advised. “Generally, if a dentist is educated as to the clinical parameters of scleroderma, they may be able to give advice to improve the quality of life,” Dr. Leask said, noting the depth of impact symptoms have on patients. “They are a major cause of anxiety and stress on a daily basis, and I think the dentist should be more aware of what scleroderma is and how to treat potential patients in the clinic.”
Treatment Options for Oral Disease
Natalia Trehan, DMD, assistant professor at the Medical University of South Carolina in Charleston, addressed the session topic from an oral medicine perspective during her talk on Treatment Options for Oral Disease in Scleroderma and Sjögren’s Disease.
She discussed recognizing oral manifestations of both diseases, the collaboration of medical specialties with disease management, and emerging and complementary therapies. She began by highlighting a small survey she and colleagues conducted among 36 healthcare professionals and 51 patients to explore the connection between oral health and rheumatic diseases.
Asked what oral health means to them, the respondents offered a variety of answers; those that stood out in the survey included equitable access to care, healthy teeth and gums, and taking care of related rheumatic diseases, such as Sjögren’s. The main answer dealt with trust and confidence, which relates to another response that said dentistry is scary but important, Dr. Trehan noted.
On the topic of oral health and rheumatic disease, 41% of patients said they didn’t know about the connection between the two medical fields, 21% of respondents self-learned about it through Google and other internet interactions and 27% of responses were listed as other. Notably, only 10% of patients had discussed it with their dentist and 1% with their rheumatologist.
Among the responding rheumatologists, 61% said they communicate with dental providers but 39% said they didn’t. Although the higher percentage reflects well on the push for collaboration between the specialties, room for improvement clearly exists, noted Dr. Trehan.
Common Oral Health Issues
Dry mouth, gum inflammation, temporomandibular joint pain and mouth sores are common oral health issues that rheumatologists see in their practice, including patients with scleroderma and Sjögren’s disease. Patients who take biologics as treatment for their rheumatic disease also have the potential to have oral lesions.
“The primary pathology in a dental context for Sjögren’s disease is that lymphocytic destruction of the salivary glands,” explained Dr. Trehan. “Whereas for scleroderma, it’s more that fibrosis of the skin and connective tissue.”
Although oral moisture is reduced in both conditions, for patients with Sjögren’s it’s “very markedly” reduced in the form of dry eyes and dry mouth, she said. For scleroderma, the reduction is because of fibrosis of the glands.
Dr. Trehan discussed how she topically manages dry mouth for her patients, suggesting over-the-counter sprays, drops, mouthwashes and sugar-free lozenges. Self-massaging of saliva glands, drinking green tea and swishing a teaspoon of coconut oil in the mouth are other ways to manage dryness. “It’s soothing; it promotes saliva,” she noted. “It’s just coconut oil.” However, the oil can clog the sink, so she advised the audience to tell patients to spit it out into a trash bag instead.
To encourage good oral hygiene, healthcare professionals can recommend tools that are designed for people who struggle with restricted movement. To help control disease pain, patients may benefit from physical therapy, massage and muscle relaxants, Dr. Trehan said.
“Oral health is rheumatologic health,” concluded Dr. Trehan, echoing Dr. Leask’s message. “Collaboration does improve outcomes for our patients and our patient voice really guides our best practices.”
Catherine Kolonko is a medical writer based in Oregon.
