{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:17:45Z","timestamp":1791811065343,"version":"4.3.4"},"reference-count":50,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2016,7,22]],"date-time":"2016-07-22T00:00:00Z","timestamp":1469145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Scleroderma is a disorder involving oral and facial tissues, with skin hardening, thin lips, deep wrinkles, xerostomia, tongue rigidity, and microstomia. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in Systemic Sclerosis (SSc) patients compared with healthy people. Eighty patients (6 men, 74 women) fulfilling ACR\/EULAR SSc Criteria were enrolled. A randomly selected group of 80 patients, matched by sex and age served as control group. The examination for TMD signs and symptoms was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC\/TMD) through a questionnaire and clinical examination. SSc patients complained more frequently (78.8%) of oral symptoms (Xerostomia, dysgeusia, dysphagia and stomatodynia) than controls (28.7%) (\u03c72 = 40.23 p = 0.001). TMD symptoms (muscle pain on chewing, difficulty in mouth opening, headaches) were complained by 92.5% of SSc patients and by 76.2% of controls (\u03c72 = 8.012 p = 0.005). At the clinical examination, 85% of SSc patients showed restricted opening versus 20.0% of controls (\u03c72 = 67.77 p = 0.001), 81.2% of SSc showed reduced right lateral excursion versus 50% of controls (\u03c72 = 17.316 p = 0.001); 73.8% of SSc showed limited left lateral excursion versus 53.8% of controls (\u03c72 = 6.924 p = 0.009); and 73.8% of SSc had narrow protrusion versus 56.2% of controls (\u03c72 = 5.385 p = 0.02).<\/jats:p>","DOI":"10.3390\/ijms17071189","type":"journal-article","created":{"date-parts":[[2016,7,22]],"date-time":"2016-07-22T09:54:45Z","timestamp":1469181285000},"page":"1189","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":84,"title":["Orofacial Manifestations and Temporomandibular Disorders of Systemic Scleroderma: An Observational Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0236-0205","authenticated-orcid":false,"given":"Vito","family":"Crincoli","sequence":"first","affiliation":[{"name":"Complex Operating Unit of Odontostomatology, Interdisciplinary Department of Medicine, \u201cAldo Moro\u201d University of Bari., Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Fatone","sequence":"additional","affiliation":[{"name":"Complex Operating Unit of Odontostomatology, Interdisciplinary Department of Medicine, \u201cAldo Moro\u201d University of Bari., Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0128-9745","authenticated-orcid":false,"given":"Margherita","family":"Fanelli","sequence":"additional","affiliation":[{"name":"Complex Operating Unit of Nuclear Medicine\u2014Medical Statistics, Interdisciplinary Department of Medicine, \u201cAldo Moro\u201d University of Bari., Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossana","family":"Rotolo","sequence":"additional","affiliation":[{"name":"Complex Operating Unit of Odontostomatology, Interdisciplinary Department of Medicine, \u201cAldo Moro\u201d University of Bari., Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Chial\u00e0","sequence":"additional","affiliation":[{"name":"Complex Operating Unit of Rheumatology, Interdisciplinary Department of Medicine, \u201cAldo Moro\u201d University of Bari., Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranco","family":"Favia","sequence":"additional","affiliation":[{"name":"Complex Operating Unit of Odontostomatology, Interdisciplinary Department of Medicine, \u201cAldo Moro\u201d University of Bari., Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8427-6092","authenticated-orcid":false,"given":"Giovanni","family":"Lapadula","sequence":"additional","affiliation":[{"name":"Complex Operating Unit of Rheumatology, Interdisciplinary Department of Medicine, \u201cAldo Moro\u201d University of Bari., Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2016,7,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2246","DOI":"10.1002\/art.11073","article-title":"Prevalence, incidence, survival, and disease characteristics of systemic sclerosis in a large US population","volume":"48","author":"Mayes","year":"2003","journal-title":"Arthritis Rheum."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1002\/art.1780390811","article-title":"Heterogeneity of collagen synthesis in normal and systemic sclerosis skin fibroblasts. Increased proportion of high collagen-producing cells in systemic sclerosis fibroblasts","volume":"39","author":"Jelaska","year":"1996","journal-title":"Arthritis Rheum."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1172\/JCI31139","article-title":"Systemic sclerosis: A prototypic multisystem fibrotic disorder","volume":"117","author":"Varga","year":"2007","journal-title":"J. Clin. Investig."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/j.1346-8138.2009.00738.x","article-title":"Mechanisms of skin fibrosis in systemic sclerosis","volume":"37","author":"Jinnin","year":"2010","journal-title":"J. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.clindermatol.2006.07.004","article-title":"Systemic and localized scleroderma","volume":"24","author":"Chung","year":"2006","journal-title":"Clin. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/j.berh.2007.09.003","article-title":"Localized scleroderma and systemic sclerosis: Is there a connection?","volume":"21","author":"Gupta","year":"2007","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1590\/S1806-83242009000100014","article-title":"Clinical and radiographic study of orofacial alterations in patients with systemic sclerosis","volume":"23","author":"Marcucci","year":"2009","journal-title":"Braz. Oral Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s00281-015-0551-z","article-title":"Systemic sclerosis and localized scleroderma\u2014Current concepts and novel targets for therapy","volume":"38","author":"Distler","year":"2016","journal-title":"Semin. Immunopathol."},{"key":"ref_9","first-page":"114","article-title":"Oral manifestations of systemic sclerosis","volume":"16","author":"Salem","year":"2013","journal-title":"Pan. Afr. Med. J."},{"key":"ref_10","first-page":"89","article-title":"Oral manifestations in progressive systemic sclerosis: Case report","volume":"3","author":"Singh","year":"2011","journal-title":"J. Dent. Oral Hyg."},{"key":"ref_11","first-page":"171","article-title":"Topical review-connective tissue diseases: Orofacial manifestations including pain","volume":"21","author":"Klasser","year":"2007","journal-title":"J. Orofac. Pain"},{"key":"ref_12","first-page":"1","article-title":"Increased Periodontal Attachment Loss in Systemic Sclerosis Patients","volume":"28","author":"Pischon","year":"2016","journal-title":"J. Periodontol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/0030-4220(88)90161-2","article-title":"Analysis of the oral manifestations of systemic sclerosis (scleroderma)","volume":"65","author":"Wood","year":"1988","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1007\/s00784-010-0472-0","article-title":"Oral health of Chinese people with systemic sclerosis","volume":"15","author":"Chu","year":"2011","journal-title":"Clin. Oral Investig."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/j.1754-4505.2000.tb01157.x","article-title":"Scleroderma: Oral manifestations and treatment challenges","volume":"20","author":"Fischer","year":"2000","journal-title":"Spec. Care Dent."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"271","DOI":"10.4103\/0972-124X.99275","article-title":"Oral and periodontal manifestations associated with systemic sclerosis: A case series and review","volume":"16","author":"Jagadish","year":"2012","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"340","DOI":"10.17126\/joralres.2015.065","article-title":"Dental management of patients with microstomia. A review of the literature and update on the treatment","volume":"4","author":"Silvestre","year":"2015","journal-title":"J. Oral Res."},{"key":"ref_18","first-page":"197","article-title":"Mandibular function is severely impaired in systemic sclerosis patients","volume":"24","author":"Ferreira","year":"2010","journal-title":"J. Orofac. Pain"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S0901-5027(95)80025-5","article-title":"Mandibular resorption due to systemic sclerosis. Case report of surgical correction of a secondary open bite deformity","volume":"24","author":"Haers","year":"1995","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1002\/acr.20480","article-title":"Recommendations for the care of oral involvement in patients with systemic sclerosis","volume":"63","author":"Alantar","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_21","unstructured":"Schwartz, L. (1959). Disorders of the Temporomandibular Joint, W.B. Saunders."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/j.ijom.2011.02.026","article-title":"Temporomandibular joint involvement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis","volume":"40","author":"Aliko","year":"2011","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/0030-4220(94)90276-3","article-title":"Analysis of the oral manifestations of systemic sclerosis","volume":"77","author":"Nagy","year":"1994","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/0030-4220(81)90169-9","article-title":"Scleroderma: Oral manifestations","volume":"52","author":"Marmary","year":"1981","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jbspin.2015.04.014","article-title":"Occlusal and MRI characterizations in systemic sclerosis patients: A prospective study from Southern Italian cohort","volume":"83","author":"Matarese","year":"2016","journal-title":"Jt. Bone Spine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"153","DOI":"10.5455\/medarh.2015.69.153-156","article-title":"Oral manifestations of Systemic Sclerosis and Correlation with anti-Topoisomerase I Antibodies (SCL-70)","volume":"69","author":"Bajraktari","year":"2015","journal-title":"Med. Arch."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1177\/000348947808700307","article-title":"Head and neck manifestations of scleroderma","volume":"87","author":"Weisman","year":"1978","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1002\/art.21922","article-title":"Systemic sclerosis-associated Sj\u00f6gren\u2019s syndrome and relationship to the limited cutaneous subtype: Results of a prospective study of sicca syndrome in 133 consecutive patients","volume":"54","author":"Avouac","year":"2006","journal-title":"Arthritis Rheum."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.revmed.2008.06.012","article-title":"Orofacial manifestations of systemic sclerosis: A study of 30 consecutive patients","volume":"30","author":"Vincent","year":"2009","journal-title":"Rev. Med. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/S0003-9993(97)90087-3","article-title":"Systemic sclerosis (scleroderma): An integrated challenge in rehabilitation","volume":"78","author":"Casale","year":"1997","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1179\/crn.2011.010","article-title":"Signs and symptoms of temporomandibular joint disorders in Caucasian children and adolescents","volume":"29","author":"Tecco","year":"2011","journal-title":"Cranio"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.bjoms.2012.04.271","article-title":"Management of the temporomandibular joint in rheumatoid disorders","volume":"51","author":"Sidebottom","year":"2013","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_33","first-page":"232","article-title":"The arthropathy of systemic sclerosis","volume":"57","author":"Malesci","year":"2005","journal-title":"Reumatismo"},{"key":"ref_34","first-page":"S44","article-title":"Efficacy of a tailored rehabilitation program for systemic sclerosis","volume":"27","author":"Galluccio","year":"2009","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"84","DOI":"10.3109\/09638288.2011.587589","article-title":"Effect of orofacial exercises on oral aperture in adults with systemic sclerosis","volume":"34","author":"Yuen","year":"2012","journal-title":"Disabil. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2737","DOI":"10.1002\/art.38098","article-title":"2013 classification criteria for systemic sclerosis: An American College of Rheumatology\/European League against Rheumatism collaborative initiative","volume":"65","author":"Khanna","year":"2013","journal-title":"Arthritis Rheum."},{"key":"ref_37","first-page":"301","article-title":"Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique","volume":"6","author":"Dworkin","year":"1992","journal-title":"J. Craniomandib. Disord."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"341","DOI":"10.7150\/ijms.11288","article-title":"Temporomandibular Disorders in Psoriasis Patients with and without Psoriatic Arthritis: An Observational Study","volume":"12","author":"Crincoli","year":"2015","journal-title":"Int. J. Med. Sci."},{"key":"ref_39","first-page":"7","article-title":"Xerostomia: Diagnosis and management","volume":"10","author":"Greenspan","year":"1996","journal-title":"Oncology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0011-8532(22)00289-0","article-title":"Diagnosis and management of taste disorders and burning mouth syndrome","volume":"37","author":"Mott","year":"1993","journal-title":"Dent. Clin. N. Am."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.gerinurse.2007.12.001","article-title":"Assessment and early diagnosis of dysphagia","volume":"29","author":"Wieseke","year":"2008","journal-title":"Geriatr. Nurs."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1093\/qjmed\/hcm049","article-title":"Burning mouth syndrome (stomatodynia)","volume":"100","author":"Fedele","year":"2007","journal-title":"QJM"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.prosdent.2013.10.001","article-title":"Is there a link between tinnitus and temporomandibular disorders?","volume":"111","author":"Buergers","year":"2014","journal-title":"J. Prosthet. Dent."},{"key":"ref_44","unstructured":"DuBrul, E.L. (1982). Anatomia Orale di Sicher, Edi.Ermes. [2nd ed.]."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"169","DOI":"10.12968\/denu.1999.26.4.169","article-title":"Orofacial disease: Update for the dental clinical team: 4. Red, brown, black and bluish lesions","volume":"26","author":"Scully","year":"1999","journal-title":"Dent. Update"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1111\/j.1365-2842.2008.01881.x","article-title":"Bruxism physiology and pathology: An overview for clinicians","volume":"35","author":"Lavigne","year":"2008","journal-title":"J. Oral Rehabil."},{"key":"ref_47","unstructured":"Bell, W.E. (1979). Orofacial Pains: Differential Diagnosis, Year Book Medical Publishers Inc.. [2nd ed.]."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1055\/s-0039-1698905","article-title":"Correlation between the Condyle Position and Intra-Extraarticular Clinical Findings of Temporomandibular Dysfunction","volume":"5","author":"Sener","year":"2011","journal-title":"Eur. J. Dent."},{"key":"ref_49","first-page":"81","article-title":"Maximal mandibular movements in young men and women","volume":"67","author":"Agerberg","year":"1974","journal-title":"Sven. Tandlak. Tidskr."},{"key":"ref_50","unstructured":"Solberg, W. (1976). Clinical Dentistry, Harper & Row Publishers."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/17\/7\/1189\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T19:26:52Z","timestamp":1760210812000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/17\/7\/1189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7,22]]},"references-count":50,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2016,7]]}},"alternative-id":["ijms17071189"],"URL":"https:\/\/doi.org\/10.3390\/ijms17071189","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,22]]}}}