Upper extremity HAQ score and fingertip-to-palm distance were not related to periodontal disease in univariate analyses (= 0.208 and = 0.322, respectively) (Table 2) or in multivariate analyses (RR 1.13 [95% CI 0.87, 1.46], = 0.366 and RR 0.95 [95% CI 0.83, 1.08], = 0.392, respectively). Relationship between periodontal disease and global disease severity Disease severity was not related to periodontal disease in univariate analysis (Table 2) or in multivariate analysis (RR 0.99 [95% CI 0.91, 1.08], = 0.803). Sensitivity analyses All analyses that used the physician global assessment of disease severity were repeated using either the multiple Medsger disease severity scores or the sum of the individual Medsger scores. skin thickness score (= ?0.38; 95% CI ?0.53, ?0.23). The number of missing teeth was associated with decreased saliva production (relative risk [RR] 0.97; 95% CI 0.94, 0.99), worse hand function (RR 1.52; 95% CI 1.13, 2.02), and the presence of gastroesophageal reflux disease (GERD; RR 1.68 [95% CI 1.14, 2.46]). No clinical or serologic variables were correlated with periodontal disease. Conclusion In SSc, diminished interincisal distance is related to overall disease severity. Decreased saliva production is related to concomitant Sj?grens syndrome antibodies. Tooth loss is associated with poor upper extremity function, GERD, and decreased saliva. The etiology of excess periodontal disease is likely multifactorial and remains unclear. INTRODUCTION Oral abnormalities are common in systemic sclerosis (SSc; scleroderma) (1). Our first report from a study of 163 SSc patients and 231 controls demonstrated that SSc patients have less saliva production, smaller interincisal distances, more missing teeth, and more periodontal disease than controls (2). The aim of the present study was to determine which clinical and serologic aspects of SSc are associated with these Uramustine abnormalities. We hypothesized a priori that 1) because Sj?grens syndrome has been associated with SSc (3C9), saliva production would be associated with the presence of Sj?grens syndromeCrelated antibodies; 2) because limitation of mouth opening is probably related to fibrosis of periorbital soft tissue, interincisal distance would be associated with the extent of skin involvement and global disease severity; 3) because tooth loss previously has been associated with dry mouth (10) and periodontal disease, missing teeth in SSc would be associated with decreased saliva and periodontal disease; 4) because tooth loss due to decay might be related to poor brushing resulting from decreased interincisal distance and/or hand contractures, missing teeth would be associated with interincisal distance and measures of hand Uramustine function; 5) because there has been a suggestion that tooth loss may be related to gastroesophageal reflux disease (GERD), missing teeth in SSc would be Uramustine associated with GERD; 6) because it is possible that tooth loss in SSc is a direct effect of the disease process on the periodontal membrane, missing teeth would be associated with increased severity of SSc; and 7) periodontal disease may be associated with decreased saliva production, tooth decay due to poor oral hygiene (resulting from decreased interincisal distance and/or hand contractures), or increased severity of SSc. SUBJECTS AND METHODS Study design and subjects The study design and subjects have been previously Uramustine described in detail (2). In brief, this multisite, cross-sectional study was conducted between 2008 and 2011 at a subset of the Canadian Scleroderma Research Group (CSRG) sites. Control patients consulting for mechanical joint problems were of same sex and similar age and were recruited from the same sites (2). The research ethics board of each participating center approved the study and all study subjects provided informed consent in compliance with the Helsinki Declaration. Study measures GTBP Information regarding sex, age, ethnicity, education, and smoking status was obtained by patient self-report. Medication use was recorded by the study physicians, and medications known to be associated with dry mouth according to the manufacturers product monographs were identified. SSc disease duration was measured as the time since onset of the first nonCRaynauds phenomenon disease symptoms to study visit. Skin involvement was assessed using the modified Rodnan skin thickness score, ranging from 0C51 (11). Limited cutaneous SSc (lcSSc) was defined as skin involvement distal to the elbows and knees, with or without face involvement (12). Diffuse cutaneous SSc (dcSSc) was defined as skin involvement proximal to the elbows and knees, with or without truncal involvement (12). The presence of GERD was ascertained by patient self-report of a history of acid regurgitation (I have food or acid-tasting liquid that comes back up into my mouth or nose), nocturnal choking (I wake up at night choking), or heartburn (I have a burning.