Ask the Experts -- Summer 2004
Q: I just returned from a dental exam. I had six cavities, which is unusual for me. Could my dental situation and my lupus be connected?
A: Dental decay can have a number of causes, such as frequent intake of sweets or carbohydrates, poor cleaning techniques, dry mouth, and/or the bad luck to be one of those individuals who seem to grow lots of bacteria that cause decay. I am not aware of a direct connection between tooth decay and lupus. However, dry mouth -- perhaps caused by the medications you may be taking for lupus or by the condition called Sjögren’s syndrome -- can create a terrible problem with decay. However, with a compliant patient, decay can almost always be conquered. It may take daily fluoride applications, dietary changes, prescription mouthwash and use of gums or mints containing significant amounts of xylitol, and of course meticulous daily use of a toothbrush and dental floss. -- Ernest B. Luce, D.D.S.
Editor’s Note: Xylitol, which occurs naturally in many fruits and vegetables, is gaining increasing acceptance as an alternative sweetener because of its role in reducing the development of dental caries (cavities).
Q: Can I die from discoid lupus?
A: I personally have never seen anyone die directly from discoid lupus erythematosus (discoid LE) skin lesions during my 25 years of subspecialty practice in this area. Nor am I aware of any medical publications that document deaths directly from discoid LE.
However, a relatively rare complication that can develop within discoid LE lesions can be life-threatening: a form of skin cancer called squamous cell carcinoma. If it is not treated appropriately, it can cause death by directly invading a large blood vessel, resulting in massive bleeding, or it could spread (metastasize) to internal organs and cause death in this way.
There also is a form of lupus skin disease called lupus profundus, or lupus panniculitis. Some patients with this deeper, more aggressive form of lupus skin disease have died from severe bacterial infections that can complicate skin ulcers and an associated condition called skin calcification (calcium stone formation in the skin).
An indirect risk to one’s life, however, can be the severe depression that can develop as a result of disfiguring, difficult-to-treat lupus skin disease. I have seen patients become extremely depressed as a result of having to deal with the chronic scarring skin problems that can be produced by severe discoid LE or lupus profundus. Such patients have suffered to the point of considering suicide.
If you are trying to cope with severe lupus skin lesions, please talk to your doctors about additional help they may be able to offer. If you are a family member, friend or health care provider of a person with severe discoid LE and you think you are seeing behavioral changes that might indicate depressive symptoms, you are urged to seek help for that person immediately. -- Richard D. Sontheimer, M.D.
Q: Can the antiphospholipid syndrome (APS) seen in SLE go into remission?
A:It appears that APS, a blood-clotting disorder that affects one-third of those with SLE, can go into remission, but, unfortunately, there is no specific test to determine that it has actually truly remitted at any given time. Antiphospholipid antibodies and lupus anticoagulants are accepted blood tests in the diagnosis of APS, but other antibodies are known to be associated with the syndrome. For some of these other antibodies, testing is not yet available. Also, these antibodies can go away and then come back again in some people.
Once a person is clearly diagnosed with APS, the current recommendation is to assume that preventive treatment is required indefinitely. This poses a serious problem for patients and their doctors, since long-term blood thinners have significant side effects, and there is no way to know, in individual cases, if this ongoing treatment is really necessary. Still, as it stands today, the risks of not using anticoagulation therapy outweigh the risks of using it.
Numerous laboratories around the world are working on this problem, and we hope that tests to assess a person’s actual ongoing risk for blood clotting will be improved in the near future. We can also be cautiously optimistic that in time safer therapies will be developed, possibly immune therapies, so that APS patients will no longer require long-term blood thinners. -- Joan T. Merrill, M.D.
Ernest B. Luce, D.D.S. is an associate professor in the Department of General Dentistry, University of Texas Health Science Center, in San Antonio, Texas.
Richard D. Sontheimer, M.D. is a professor and head of the Department of Dermatology, University of Iowa Hospitals and Clinics in Iowa City, Iowa. He is a member of the LFA Medical/Scientific Advisory Council.
Joan T. Merrill, M.D. is head of the Clinical Pharmacology Department, Oklahoma Medical Research Foundation, in Oklahoma City, Okla. She is also the consulting medical director for the LFA.