Periodontal manifestations of collagen vascular disorders

Chronic degeneration of connective tissue components can be produced by a variety of autoimmune mechanisms. The designations connective tissue disease and collagen-vascular disease are commonly used to describe such conditions when a patient exhibits chronic, immune-mediated deterioration of connective tissue structures in a systemic distribution. Recognized conditions that fit this definition include rheumatoid arthritis, lupus erythematosus, progressive systemic sclerosis, CREST syndrome, and mixed connective tissue disease. Several characteristic oral manifestations of these conditions are recognized. Xerostomia associated with any of these conditions in addition to dryness of the eyes is the definition of secondary Sjögren's syndrome. Fibrosis of facial skin and the resulting limited jaw opening are diagnostic features of progressive systemic sclerosis. Several periodontal manifestations are associated with these connective tissue disorders. Dramatic periodontal ligament space widening that is associated with some cases of progressive systemic sclerosis has been appreciated for more than five decades. However, it has been more recently reported that the majority of progressive systemic sclerosis patients exhibit at least subtle generalized periodontal ligament widening when intraoral radiographs are carefully evaluated. This finding is, however, of limited periodontal significance because the teeth are typically not mobile. Comparisons of periodontitis indices such as pocket depth between healthy subjects and patients with progressive systemic sclerosis do not reveal significant differences (21). In addition, recent evidence suggests a tendency for more severe or progressive manifestations of periodontitis as a consequence of xerostomia that may result from these diseases.