Lupus and Oral Health

Lupus is a complex autoimmune disease that impacts almost 2 million Americans. It can cause health problems in any part of the body including the skin, organs and joints. This condition also has a number of negative effects on oral health. Here are a few of the problems you and your dentist may need to discuss about lupas and oral health problems.

Dry Mouth (Xerostomia)

Dry mouth is often a chronic oral health problem for patients with lupus. It can crop up as a symptom of the disease, as a side effect of lupus medications or as part of a condition called Sjogren’s Syndrome that sometimes occurs along with lupus. Besides being uncomfortable, dry mouth limits your mouth’s self-cleaning abilities. Saliva is your body’s primary defense against oral bacteria that cause plaque. It washes your mouth and gums throughout the day, helps restore and strengthen enamel, helps inhibit bacterial overgrowth and neutralizes some of the acid produced by oral bacteria.

When saliva production is impaired, bacteria are free to multiply and cause tartar buildup above and below the gum line. The acids released by bacteria as they feed damage enamel and lead to cavities. The irritation caused by tartar below the gum line leads to periodontitis (gum disease). Gums and underlying bone can be damaged by periodontitis to the point that they no longer hold your teeth in place. You should consult with your dentist about prevention and treatment options if you experience dry mouth symptoms or have any of the following warning signs of gum disease:

• Patches of redness or irritation along your gum line
• Areas of your gums that bleed when you brush or floss your teeth
• Swollen, shiny, soft and dry gum tissue
• Receding gums
• Persistent bad breath
• Loose teeth

Your dentist may prescribe medications or oral rinses to help ease the symptoms of dry mouth. Diet changes and the use of at-home remedies (like sucking on sour, sugar-free candy) may also help.

Additional Lupus and Oral Health Issues

Since lupus is a chronic inflammatory condition that involves your immune system, it can lead to many abnormal changes in the tissues in your mouth. Patients with lupus may experience:

• Cracked lips and tongue
• An oral rash called lichen planus (some medications used to treat systemic lupus can lead to this rash – which may eventually increase your risk of oral cancer)
• Yeast infection (thrush) on the tongue and inside the mouth (steroids used to treat lupus increase the risk of oral yeast infection)
• Canker sores (ulcers) on the cheeks, gums, mouth and tongue (anti-inflammatory drugs used to minimize lupus symptoms may increase the risk of oral ulcers)

Your dentist should be able to recommend at-home treatments and/or medications to help heal these conditions and relieve discomfort. It’s important for you to disclose all the medications you are taking for lupus and other health conditions so your dentist can verify that your dental treatment plan will not conflict with these drugs.

Improperly fitted dentures and dental restorations can contribute to oral health problems like thrush and lichen planus. So, it’s important for you to talk to your dentist about any discomfort you are experiencing with your dental restorations.

Jaw and Facial Problems Linked to Oral Health Issues

When lupus attacks the jaw joint, this can lead to temporomandibular joint disorder (TMJ). A lupus-related condition called oral scleroderma can cause the skin around the mouth to tighten, harden and contract. Both of these diseases can make proper oral care very difficult by limiting how far the mouth opens. Oral scleroderma can also cause your gums to pull away from your teeth, leaving the roots exposed to decay and increasing your problems with gum disease.

You may need to use specially designed tooth brushing and flossing equipment to allow you to properly clean your teeth and gums. These may include electric toothbrushes, floss picks and water flossers. Your dentist can recommend at-home physical therapy exercises to help restore some jaw mobility and make access to your teeth and gums easier. Don’t get discouraged if you need to try several approaches to dealing with microstomia (small mouth) and jaw problems. It will be worth it to be able to keep your teeth clean and healthy.

Lupus and Dental Procedures

Patients with lupus may be at increased risk for many complications from common dental treatments (both surgical and non-surgical). Some risks include:

• Increased risk of infection even with fairly non-invasive dental procedures due to the use of immunosuppressive agents in treating lupus
• Compromised lung function with some forms of lupus (this may make it inadvisable to administer nitrous oxide during treatment)
• Excessive bleeding during oral surgery
• A heart problem called Liebman-Sacks Endocarditis (this hidden effect of lupus can cause death if oral bacteria enter the bloodstream as a result of a dental procedure)
• Kidney problems that increase the risk of organ damage from commonly prescribed dental antibiotics and anti-inflammatory medications

With these risks of serious complications from dental procedures, it is in the best interest of lupus patients to prevent gum and tooth problems whenever possible. You may need to see a dentist more often than every six months for preventive cleanings to ensure that gum disease is kept in check and cavities are detected early.