From the Archives: Spring 2005 Issue of Lupus Now Magazine
Good oral health is crucial for those with lupus
By Jaclyn Law
Patricia Morton was diagnosed with lupus 17 years ago. Three years later, she learned she had Sjögren’s syndrome, a condition in which the immune system attacks moisture-producing glands. Since then, she has coped with an oral health problem common to people with lupus: dry mouth.
“Dry mouth is very uncomfortable,” Morton, 52, says from her home in Kansas City, MO. “At times, the dryness makes it hard for me to speak.” Among other things, it can also make chewing and swallowing difficult.
Dry mouth is just one of three serious oral health conditions for the estimated 10 to 20 percent of adults with lupus who have Sjögren’s syndrome. Because the saliva in our mouths helps neutralize acid made by certain bacteria, when saliva is reduced, the risk of tooth decay dramatically increases. Also, decay-causing bacteria grow at a much higher rate in a dry mouth. For Morton, the combination of lupus and Sjögren’s syndrome has resulted in serious dental problems, including losing 10 teeth.
With proper oral care, your doctor and dentist can help ease symptoms of dry mouth by prescribing medications that stimulate saliva, such as Evoxac (cevimeline) and Salagen (pilocarpine). Your dentist or doctor may also suggest using an oral rinse, such as chlorhexidine, saltwater mouthwashes, or gums and candies containing xylitol. (Sugary candies, which can cause tooth decay, should be avoided.)
The second primary oral health concern for those with lupus is mouth ulcers, which may be painful. “There seems to be a greater incidence in the young and in patients with active disease,” says Ernie B. Luce, D.D.S., a clinical assistant professor in the Department of General Dentistry at the University of Texas Health Science Center at San Antonio. “Forty-six percent of children with lupus have mouth ulcers, while 18 percent of adults and children with lupus have ulcers at any given time.”
While ulcers can heal on their own, several drugs are used to treat them, including hydroxychloroquine, azathioprine, dapsone, and thalidomide. Using antiseptic mouthwashes and drinking plenty of fluids may also help. Experts suggest avoiding spicy, acidic, or hot foods that can aggravate ulcers.
To prevent a third common oral problem—gum disease—people with lupus must practice good oral hygiene and seek dental care. Luce acknowledges that this can be tricky when one’s health is already challenged. “For many of our lupus patients, dental care is often not at the top of the priority list.”
The consequence is that small dental problems can quickly become big ones. Luce recommends choosing a dentist who will provide early and aggressive preventive care. “Maintaining healthy teeth in the presence of lupus is far easier, and almost certainly less expensive, than restoring teeth to health in the presence of lupus.”
Morton, who wears partial dentures and sees her dentist every three months for a checkup and cleaning, couldn’t agree more. “Immediately start an aggressive dental plan,” she says. “Be very insistent in educating yourself and asking your dentist and doctor questions. The health of my remaining teeth is always foremost on my mind.”
A reader wrote concerning the Summer 2004 issue of Lupus Now. Here is her comment and Dr. Luce’s reply.
Dear Dr. Luce,
I disagree with your answer to the question [of whether a] dental situation and lupus has a connection. Before I was diagnosed with lupus in 1996, when I was 36 years old, my dental health was A+. I used to go to the dentist twice a year for a checkup and once a year for a cleaning. I never had any dental decay, cavities, or gum problems. Five years later, after having been on many therapies for lupus, including chemotherapy with Cytoxan for nine months, my dental problems started. One day I was having a croissant and a piece of tooth fell off. Then a surgeon had to remove three teeth because I had deep cavities and the doctors did not approve a root canal. In my own experience, lupus affects the dental health of the patients. —Gloria E. Gardner, South Windsor, CT
Dr. Luce replies:
Dear Ms. Gardner,
I think you pointed out a significant error in my choice of words. A better way to phrase my answer to the question, “Could my dental situation and my lupus be connected?” would be, yes, they can be related. I believe there is no direct alteration of the teeth because of the lupus (the teeth are not directly changed chemically or structurally as a result of the disease, as are other parts of the body). However, the oral environment in which the teeth live is changed when the patient has lupus. For instance, medications used to treat lupus may cause dry mouth or oral ulcerations, either of which may be associated with an increased risk of tooth decay. Sjögren’s syndrome, which is also commonly present [in lupus], represents a fibrosis of the salivary glands resulting in a dramatic reduction in saliva production, and the dry mouth of Sjögren’s syndrome is also associated with a dramatic rise in the risk of tooth decay. Thank you for pointing out what I believe was a misleading statement.
A Mouthful of Advice
Everyone should pay attention to their teeth and gums, but people with lupus have special concerns that require extra vigilance. Good oral care is critical and should be part of your wellness strategy. Here is some advice to chew on:
•See your dentist to determine if you have any existing dental problems and discuss how often you should have checkups.
•Practice good oral hygiene. Ask your dentist or hygienist to review your brushing and flossing techniques.
•Watch for signs of periodontal disease: gums that are swollen, bleeding, red and/or sensitive; painful, sensitive teeth.
•If you have dry mouth, talk to your doctor about treatment.
•Before you have major dental work, talk to your doctor. He or she may advise you to postpone the procedure if your lupus is active, because steroids and immunosuppressives you may be taking can delay healing and make it harder to fight infection.
•Tell your dentist all the medications you are taking, whether your lupus is active, and whether you have concerns about blood clotting. Your dentist may ask you to adjust your medication dosage (for example, extra prednisone) for a few days before and after the procedure to help your body cope with the stress.
•If you think you have an infection, seek treatment immediately. Infections can be especially dangerous for people with lupus whose immune systems are compromised.