Scleroderma is a rare and chronic autoimmune disease characterized by patches of scar-like thick skin caused by excessive collagen production, which normally gives tissues and organs their flexibility and firmness. This collagen buildup typically results in the tightening and hardening of the skin, but can also affect the heart, kidneys, lungs, blood vessels, muscles, and joints.
What is microstomia?
Microstomia, one of the symptoms of scleroderma, is the name given to the tightening and hardening of the skin around the mouth. This tightening can ultimately cause difficulties in speaking, eating, and brushing and flossing the teeth, and with dental procedures.
Microstomia occurs in 70 percent of scleroderma patients, and can affect quality of life. It is not possible to prevent its development, but there are ways to delay or manage the difficulties associated with this condition.
Avoiding cold and windy weather by covering the face with a scarf may slow the condition’s progression. A microstomia prevention apparatus can also be used to keep the mouth stretched, delaying skin tightening and shinkage.
An effective and straightforward method to increase the mouth opening is regularly stretching the jaw passively or actively. Passive jaw exercises entail placing stacks of tongue blades between the upper and lower molars at the back of the mouth. This method has been shown to increase the mouth opening by 10 mm after six weeks of exercise, six times a day. Active facial exercises include movements such as smiling, grimacing, and placing the thumbs at opposite corners of the mouth and then pulling them outward. A study showed that the combination of active and passive exercises resulted in a greater than 10 mm increase in the mouth opening.
Physical therapy techniques such as connective tissue massage and proprioceptive neuromuscular facilitation known as the Kabat method can help relax the tissue and widen the mouth opening. A combination of these techniques, along with jaw stretching exercises, was shown to be beneficial in a group of scleroderma patients with microstomia.
A child-size toothbrush can also help patients maintain good dental hygiene.
Treatments available for microstomia
Surgery may also be used to enlarge the mouth, but this is usually reserved for severe cases or patients unresponsive to other treatments, as people with scleroderma may have difficulties in wound healing and be vulnerable to infections.
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