A rare case of hidebound disease with dental implications
A 30-year-old female patient reported to the Department of Dentistry in our hospital with a complaint of difficulty in chewing due to decreased mouth opening since past few months. Extraoral examination of the patient revealed multiple ill defined white patches on the forehead and cheeks []. Facial skin was smooth, taut, and mask like. It was firm and could not be picked up. Temporomandibular joint was stiff on palpation. Paraoral examination revealed circumoral fibrosis resulting in microstomia with characteristic furrows radiating from the mouth giving rise to ‘purse string appearance’. The lips had become thin and nasal alae were atrophied giving a pinched appearance to the nose, classically known as “mouse facies” [].\nIntraoral examination was difficult due to microstomia and limited mouth opening (28 mm). On palpation, tongue was rigid with decreased mobility. Periodontal examination revealed generalized mild chronic periodontal disease, with an average probing depth of 3-5 mm. Periapical intraoral radiographs showed normal lamina dura with widening of periodontal space, which was most prominent on the posterior teeth [].\nStiffening of phalangeal joints in both fingers and toes was observed. Flexure contractures producing shortened ‘claw like’ fingers were also present []. Roentgenographic examination of hands showed resorption of terminal phalanges (acro-osteolysis) [].\nThe patient was treated symptomatically, with scaling and root planning and was advised oral hygiene instructions. The periodontal pockets responded well to scaling and root planning. Other recommended aids were to eat a balanced diet and using electrical tooth brush and anti-bacterial mouth washes.