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.


Objectives: To evaluate the effect of adaptive oral hygiene devices and orofacial exercise to improve gingival health among adults with systemic sclerosis (SSc).

Methods: Forty-eight patients with SSc were assigned randomly to the multifaceted oral health intervention or usual dental care control group. Participants in the intervention group received a rechargeable, powered Oral-B® oscillating-rotating-pulsating toothbrush and a Reach® Access™ Flosser that has a toothbrush-like handle. For those with an oral aperture of less than 40 mm, orofacial exercises were taught. Participants in the control group were each given a manual toothbrush and dental floss. Participants in both groups received instructions and demonstration on the use of the devices, and were requested to perform the respective intervention twice a day for 6 months. Evaluations were at baseline, 3-, and 6-months. The main outcome was gingival index (GI), an indicator of gingival inflammation.

Results: Both groups showed significant reduction in GI scores at 6 months (ps<0.005). Reduction in GI scores of the intervention group at 6 months was 20.8% which is considered to be clinically significant. Compared to the control group, the intervention group showed a significant and larger reduction in GI score by 8% at 6 months (p=0.0007).

Conclusions: 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 health improvement.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Dental Devices, Home Care / standards*
  • Dental Plaque Index
  • Equipment Design
  • Exercise Therapy / methods
  • Exercise Therapy / standards
  • Female
  • Gingiva / pathology
  • Gingivitis* / etiology
  • Gingivitis* / pathology
  • Gingivitis* / physiopathology
  • Gingivitis* / therapy
  • Humans
  • Male
  • Middle Aged
  • Mouth Rehabilitation / instrumentation
  • Mouth Rehabilitation / methods
  • Myofunctional Therapy*
  • Oral Health / standards
  • Patient Education as Topic
  • Scleroderma, Systemic / complications*
  • Scleroderma, Systemic / physiopathology
  • Tooth / pathology
  • Toothbrushing / instrumentation*
  • Toothbrushing / methods
  • Treatment Outcome