The following presentation comes from the Spring Patient Education Conference on May 3, 2025. This presentation was done by Martin Hogan, DDS and Margaret Miller, DDS from Loyola University. Dr. Hogan and Dr. Miller will review the most common findings associated with scleroderma and oral health. They will discuss some of the methods your dental team can utilize to help manage your condition, and also some ways that you can help yourself. They will discuss some unique methods for maintaining your oral health care.

1. Ask the Dentist:
A Conversation About Scleroderma from the Neck Up
Saturday May 3, 2025
Scleroderma Patient Education Conference

2. Martin J. Hogan DDS
Associate Professor, Department of Surgery
Division of Dental Medicine
Director, General Practice Residency Program
Margaret Miller, DDS
Assistant Professor, Department of Surgery
Division of Dental Medicine

3. • No Disclosures

4. Objectives
• Interactive Conversation!!
• Discuss common oral findings associated with scleroderma
• Discuss how these things might all be interconnected
• Discuss how patients and oral health care providers can
work together to manage oral conditions
• Q&A

5. Most Common Oral Findings
• Xerostomia
• Limited Opening
• Things we often hear
• Mobile teeth, periodontal/gum disease

6. Xerostomia
• “dry mouth”
• Caused by the destruction of salivary glands
• Causes trouble in the ability to eat, speak and chew
• Medications that reduce salivary flow
• Increased risk of periodontal disease and caries, fungal infections, denture retention
• 1) Salivary substitutes
• Sprays, gels, rinses, Biotene products, among many others
• 2) Water and/or sugar free drinks, gums, lozenges
• 3) Saliva stimulating medications
• Pilocarpine

8. OTC
ALCOHOL FREE!!!!!

9. Mouthrinse
• Prescribe appropriate combination based on clinical findings
• Bacterial
• Viral
• Fungal
• Palliative
• Other

10. Limited Mouth Opening
• Collagen deposition in connective tissue leads to fibrosis
and progressive limitation of mouth opening
• Microstomia
• Always measure at initial appointment
• Monitor and ways to help

11. Measure and document

13. Ways to Improve Maximum Opening
• Tongue depressors (popsicle sticks)
• Stacked
• Easy
• Cheap

14. Tongue Depressors (popsicle sticks)

16. Ways to Improve Maximum Opening
• TheraBite and Orastretch
• Requires a prescription, parts, insurance/letter
• Helps increase max opening
• Easy to use
• Great success

19. “My scleroderma makes my teeth loose.”
• First and foremost: ALL of these things are multifactorial-
ALL of them.
• Periodontal disease  loss of bone  mobility of teeth
• Widening of PDL  mobility of teeth
• Patients with scleroderma  widening of PDL
• Challenges with manual dexterity  challenges with oral
hygiene practices  periodontal disease  (see above)

20. “My scleroderma
makes my teeth
loose.”
• Limited opening + dexterity
challenges  challenges with
oral hygiene practices 
increased risk of periodontal
disease  (see previous chain
of events)

21. “My scleroderma makes my teeth more susceptible to cavities.”
“Scleroderma gives me really bad dry mouth. Is that bad for my teeth?”
• Saliva is KEY!!!
• Xerostomia (from Sjogren’s +/- meds)  higher risk of decay
due to inability to regulate pH in mouth and inability to help
‘clean’ teeth following meals
• Saliva is VERY valuable!!!!!
• Dexterity challenges  challenges with oral hygiene
practices

22. Recap
• Review of the most common oral findings
• Things we often hear
• Q&A