Study design and ethical aspects
In this case controlled clinical trial, subjects were recruited from the outpatient clinic of the Oral Medicine and Periodontology Department, Faculty of Dentistry, October University for Modern Sciences and Arts (MSA) and Al-Azhar Universities and from Rheumatology Department, Al-Zahraa Hospital, Al-Azhar University, Cairo, Egypt, from October 2019 to December 2020. The study was conducted according to the Declaration of Helsinki (1964, revision 2008). All subjects participated voluntary and received detailed information about the study. A written consent was obtained from each participant before the start of the trial. This trial was registered on 