AB1401-HPR An exploratory study evaluating feasibility and effectiveness of two different exercise programs in systemic sclerosis associated microstomia
Authors: E Sydow, S. Arat, S. Severi, R. Westhovens, J. Lenaerts, E. De Langhe
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Systemic sclerosis (SSc) is a severe chronic connective tissue disease with a high disease burden. Oral involvement with impaired oral aperture (microstomia) is frequent and associated with impaired food intake, oral hygiene and secondary dental problems. Preventive measures through mouth-stretching and oral augmentation exercises have been shown to reverse the progression of microstomia. <h3>Objectives</h3> This exploratory study assesses the effectiveness and feasibility of two different exercise approaches designed to increase oral aperture. <h3>Methods</h3> Two groups had to exercise for 10 min, 3 times/day for 3 months. Group A exercised with a passive jaw motion device (Therabite), and Group B did mouth-stretching exercises. Patients were contacted 4 times by telephone to address encountered problems. The subjects used an exercise diary to document compliance. Patients were evaluated at baseline, 3 months (period without intervention), 6 months (at the end of the treatment after 3 months of intervention) and 9 months (follow-up). <h3>Results</h3> At present, 9 patients (Therabite n=4, mouth-stretching exercises n=5) were included and recruitment is ongoing. Seven patients completed the study and increase of oral aperture was observed in all patients in both groups. In the Therabite group, after 3 months of exercise, increase of oral aperture was 9, 2, 9 and 10 mm. In the mouth-stretching exercise group the increase of oral aperture was 11, 10 and 4 mm after 3 months. The compliance, measured as the ratio of executed exercises relative to the planned number of exercises was 95,2%, 85,7%, 98,9% and 63,7% in the Therabite group and 97,4%, 48,6% and 68,3% in the mouth-stretching exercise group. <h3>Conclusions</h3> An increase of oral aperture is observed in all patients after 3 months of exercising with the Therabite device as well as after mouth-stretching exercises. No clear differences are observed between both groups, but the study was not designed nor powered for this. Remarkably, a high compliance for the treatment regime was observed in most patients. <h3>References</h3> [1] Agarwal SK. The genetics of systemic sclerosis. Discov Med. 2010Aug;10(51):134–43. [2] Alantar A, Cabane J, Hachulla E, Princ G, Glinist D, Hassin M, Sorel M, Maman L, Pilat A, Mouthon L. Recommendations for the Care of Oral Involvement in Patients With Systemic Sclerosis. Arthritis Care and Research. VOL. 63. No8, august 2011, pp 1126–1133. [3] Albilia JB, Lam DK, Blanas N, Clokie CML, Sandor GKB. Small Mouths…Big Problems? A review of Scleroderma and its Oral Health Implications. www.cda-adc.ca/jcda. November 2007, vol 73,no 9. [4] Maddali-Bongi S, Landi G, Galluccio F, Del Rosso A, Miniati I, Conforti M.L, Casale R, Matucci-Cerinic M. The rehabilitation of facial involvement in systemic sclerosis: efficacy of the combination of connective tissue massage, Kabat’s technique and kinesitherapy: a randomized controlled trial. Rheumatol Int (201131:895–901. [5] Pizzo G, Scardina GA, Mesina P. Effects of nonsurgical exercise program on the decreased mouth opening in patient with systemic sclerosis. Clin Oral Invest2003; 7:175–178. <h3>Disclosure of Interest</h3> None declared