Adaptive devices and orofacial exercise improve gingival health in adults with systemic sclerosis

shutterstock_2345735-powered toothbrush

Medical treatment of systemic sclerosis (SSc), and its complications involves the use of immunosuppressants and calcium channel blockers which are known to increase the risk of developing gingival hyperplasia . In addition defective vascularity and alterations of the  microcirculation of the gingival tissues may lead to gingival inflammation. Sicca symptoms (including dry mouth) are also are common in SSc.

The aim of this study was to evaluate the effect of a multi-faceted oral health intervention for improving gingival health among adults with SSc.

Participants were randomised to  the multi-faceted oral health intervention group (Test) or control. The test group  received a rechargeable, Oral-B® powered toothbrush and a Reach® Access™ Flosser. For those with an oral aperture of less than 40 mm, manual mouth-stretching and oral augmentation exercises were taught.  The control group were each given an Oral-B®  manual and dental floss. Both groups received instructions and demonstrations and requested to perform these intervention twice a day.

The main outcome was gingival index (GI), which was evaluated at baseline and at 3-, and 6- months.

The researchers found that:-

  • Both groups showed significant reduction in GI scores at 6 months (ps<0.005)
  • Reduction in GI scores of the test group at 6 months was 20.8%
  • Reduction inGI in the test group was 8% larger than the control group (p=0.0007).

They concluded that:-

Results support the use of adaptive devices and orofacial exercise to improve gingival health in adults with SSc when compared to use of manual toothbrushing and finger-held flossing. Recommending and educating patients with SSc to use adaptive devices to clean the tooth surfaces looks promising for long-term oral healthimprovement.

Yuen HK, Weng Y, Bandyopadhyay D, Reed SG, Leite RS, Silver RM. Effect of a multi-faceted intervention on gingival health among adults with systemic sclerosis. Clin Exp Rheumatol. 2011 Mar-Apr;29(2 Suppl 65):S26-32. Epub 2011 May  12. PubMed PMID: 21586215.

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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