Oral manifestations, oral health status and saliva composition changes in a sample of Iraqi systemic lupus erythematosus patients


Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease associated with significantmorbidity and mortality. Sicca symptoms are frequent in SLE which may be related to concomitant occurrence ofSjögren's syndrome (SS). The aims of study were to determine prevalence of oral manifestations andtempromandibular joint disorders, and to find a correlation between the changes in saliva flow rate, pH andcomposition with the incidence of dental caries in SLE patients.Subjects, materials and methods: One hundred and two individuals were enrolled in this study; 52 of them were SLEpatients; and 50 were healthy control individuals matched in age and gender. The assessment of dental status wasmade according to the decay missing filling teeth (DMFT) index; the gingival inflammation was assessed using thecriteria of gingival index; Clinical pocket depth was measured with periodontal probe type William, and wholeunstimulated saliva samples have been collected from each subject for biochemical analysis. Also, salivary flow rateand pH were measured. After centrifugation, the supernatant of saliva was aspirated for biochemical analysis.Results: Oral ulceration was the most prominent orofacial manifestations of SLE patients followed byTempromandibular joint (TMJ) disorders and facial skin rash then oral vesicles& bullae, oral lichen planus and finallyoral petechiae & purpura. Salivary flow rate and salivary pH were significantly lower in SLE patients than in the controlsubjects. Oral hygiene index (DMFT index, gingival index, Clinical pocket depth) were significantly higher in SLEpatients than in the control subjects .Salivary calcium, sodium, chloride, and total protein were significantly higheramong SLE patients than in the control subjects. While salivary potassium and inorganic phosphorus were significantlylower among SLE patients than in the control subjects. In addition, there was a highly significant positive linearcorrelation between age of SLE patients and DMFT, and between age and clinical pocket depth; and a highlysignificant negative linear correlation between salivary flow rate and salivary calcium in SLE patients. Also there washighly significant positive linear correlation between DMFT and salivary calcium, and between DMFT and salivarychloride.Conclusions: Oral manifestations are common in Iraqi SLE patients. Changes in salivary flow rate, pH, salivarycomposition, and increased dental caries may serve as potential markers of the extent of autoimmune mediatedsalivary gland dysfunction which is similar to Sjogren’s syndrome