目的:系统性红斑狼疮(SLE)是一种结缔组织疾病,其特征是广泛的多形性图片,包括皮肤粘膜,肾,肌肉骨骼和神经症状。它涉及口腔组织,由于唾液分泌不足,蛀牙,牙龈炎,角状唇炎,溃疡和舌炎。颞下颌关节紊乱病代表了一组异质性的口腔系统的炎症或退行性疾病,具有疼痛和/或功能障碍的临床特征,涉及颞下颌关节(TMJ)和相关的咀嚼肌。这项研究的目的是调查与对照组相比,SLE患者(Lp)的口腔表现和颞下颌关节紊乱病(TMD)的患病率。方法:纳入55例诊断为狼疮的患者(9例男性和46例女性)。随机选择55名患者,性别和年龄相匹配,作为对照组。TMD症状和体征的检查基于颞下颌关节紊乱病的标准化研究诊断标准(RDC/TMD),通过问卷调查和临床检查。结果:狼疮患者更频繁地抱怨(95.8%)口腔和TMJ症状(味觉障碍,口痛,功能性咀嚼性肌肉疼痛,颈部和肩部肌肉疼痛和耳鸣的存在),但只有口干症(χ2=4,1548p=0,0415),太阳穴头痛(χ2=4,4542p=0,035)和下颌卡住感(中p检验p=0,043)显着。关于标志,唇炎(p=0,0284)口腔溃疡(χ2=4,0104p=0,045)和舌裂在研究组中明显更常见。与对照组相比,研究组的唾液流量显着降低(p<0.0001)。关于口腔运动学,研究组和对照组的前突和左侧运动受限运动(RM)差异显著.特别是,85,2%的Lp显示有限的突出,而对照组为56,4%(χ2=10,91p<0,001);59,3%的Lp在左侧运动期间也有限制,而对照组为47,3%(T=2,225p=0,0282)。关于磨牙症,Lp组(72,7%)仅发现舌头侧边缘的凹陷,与对照组有显著差异(χ2=7,37p=0,007)。结论:虽然咀嚼肌在两组中都有重叠的行为,收集的结果表明,Lp的TMJ运动学损害比对照组更严重,突起和左侧横向运动明显不同。此外,与对照组相比,Lp的唾液流量显著减少.总之,这种自身免疫性疾病似乎在口腔表现和TMJ疾病中起作用,导致口面部疼痛增加和咀嚼功能改变。
Aims: Systemic Lupus Erythematosus (SLE) is a connective tissue disease characterized by a wide range of pleomorphic pictures, including mucocutaneous, renal, musculoskeletal and neurological symptoms. It involves oral tissues, with hyposalivation, tooth decay, gingivitis, angular cheilitis, ulcers and glossitis. Temporomandibular disorders represent a heterogeneous group of inflammatory or degenerative diseases of the stomatognatic system, with algic and/or dysfunctional clinical features involving temporomandibular joint (TMJ) and related masticatory muscles. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in SLE patients (Lp) compared with a control group. Methods: Fifty-five patients (9 men and 46 women) with diagnosed Lupus were recruited in the study group. A randomly selected group of 55 patients, matched by sex and age, served as control group. The examination for TMD symptoms and signs was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a questionnaire and clinical examination. Results: Lupus patients complained more frequently (95.8%) of oral and TMJ symptoms (dysgeusia, stomatodynia, masticatory muscle pain during function, neck and shoulder muscles pain and presence of tinnitus) but only xerostomia (χ2=4,1548 p=0,0415), temple headache (χ2=4,4542 p=0,035) and the sensation of a stuck jaw (Mid-p-test p=0,043) were significant. About signs, cheilitis (p=0,0284) oral ulcers (χ2=4,0104 p=0,045) and fissured tongue are significantly more frequent in study group. The salivary flow was significantly decreased in the study group respect to the control one (p<0.0001). As regard to the oral kinematics, restricted movements (RM) in protrusion and left lateral movement were significantly different between study group and controls. In particular, 85,2% of Lp showed limited protrusion versus 56,4% of controls (χ2= 10,91 p<0,001); 59,3% of Lp had also a limitation during left lateral movement versus 47,3% of controls (T=2,225 p=0,0282). About bruxism, only the indentations on the lateral edges of the tongue were found in Lp group (72,7%), with a significant difference respect to controls (χ2=7,37 p=0,007). Conclusions: While masticatory muscles have an overlapping behavior in both groups, the findings collected show a more severe TMJ kinematic impairment in Lp than in controls, with protrusion and left lateral movements significantly different. In addition, a remarkable reduction of salivary flow has been detected in Lp compared to controls. In conclusion, this autoimmune disease seems to play a role in oral manifestations and TMJ disorders, causing an increase in orofacial pain and an altered chewing function.