Oral health issues with lupus

When Laurah Rodgers went to her dentist for her regular six-month cleaning, she thought she would leave with a brighter smile and perhaps a boost to her self-confidence. She never imagined she would find a champion who would help her receive the diagnosis she had spent years looking for.

“My lupus story actually begins with the dentist!” says Rodgers of Texas. “I had health problems my entire life and was always in and out of hospitals. But I always left the doctors scratching their heads in wonder.”

But on the day of her dental appointment, Rodgers was experiencing an outbreak of oral ulcers. “My mouth was badly broken out, but I knew I needed to go because I suspected I had a cavity. I warned the hygienist about my ulcers and asked her to be gentle.”

After spotting 50 to 100 ulcers, the hygienist called for the dentist, who referred Rodgers to an oral pathologist to rule out oral cancer. When the test came back negative, the dentist referred Rodgers to a rheumatologist. Blood work confirmed that, as the dentist suspected, Rodgers had an autoimmune disease—lupus.

Most lupus diagnoses occur without the intervention of a dentist. But Rodgers’ story illustrates two important points: Systemic diseases such as lupus may include some sort of oral involvement. And, good regular dental care with a trusted dentist can help discover and alleviate any problems that might arise.

The oral care connection

The mouth is a hotbed of activity for bacteria, many of which can cause problems to a person’s overall health. “In our mouths we have 500 different types of bacteria, at least 11 of which can cause periodontal disease,” says Daniel Klein, D.D.S., a dentist in Arizona. “Lupus is tied to a variety of oral health concerns. But lupus only starts the problem. It can be elevated highly because of poor oral hygiene.”

Periodontal disease—more commonly known as gum disease—is of particular concern because of the link between inflammation of the gum area and the overall health of the rest of the body. “Recent scientific literature suggests a strong relationship between oral disease and other systemic diseases and medical conditions,” Klein says. “It is imperative that patients understand periodontal disease and how it is treated or prevented.”

There is strong evidence for a link between lupus and poor oral and dental health. Recently, a 2019 study highlighted the need for lupus patients to have increased dental management due to the high risk of periodontal disease and temporomandibular (jaw) joint disorders.

Michael Richards of Alabama was diagnosed with lupus in 1987, but had problems with her mouth and gums before that. “In the late ’80s, I had TMJ (temporomandibular joint disorder) surgery, first on the left side, then on the right,” she says. The oral surgeon explained that the chronic inflammation of Richards’ temporomandibular joint, which connects the jaw to the skull, was directly related to the way lupus was affecting her joints.

At the same time, she developed many problems with her teeth. She developed rapid decay, which led to numerous cavities and the need for root canals. “Trying to prevent more dental problems, I started going to the dentist every three months instead of six,” Richards says. This helped, but many of her teeth broke despite the care. Her dentist attributed this to lupus and the prednisone she has been taking since 1989.

Dry mouth

Termed “xerostomia,” the dry mouth often associated with lupus can be caused by medications, but also by an autoimmune condition called secondary Sjogren’s syndrome. (It receives the designation of primary Sjogren’s when it occurs by itself; secondary, when it occurs with another disease such as lupus.)

Among many other harmful health effects, Sjogren’s affects the moisture-secreting glands in the eyes and mouth. “Those who have dry mouth develop high levels of acid in the mouth, because of the lack of saliva,” Klein says. Under attack from the acid, the teeth decay rapidly. Products are available that encourage saliva production and add moisture to the mouth.

To counteract dry mouth, Klein tells his patients with lupus to use fluoride rinses at least three times a day and to drink a lot of water. In fact, he recommends brushing, flossing, and fluoride rinsing after breakfast and before bedtime for all his patients with lupus. Brushing and rinsing should also be done after lunch. Before bedtime, Klein recommends Waterpik®, an alternative to flossing that allows a person to remove plaque from the gum line with a flow of water, to be followed by an antimicrobial rinse mixed with water.

Most important, he says, “You should also keep up with your dentist.” Those with lupus who have periodontal disease need to visit their dentist more often, approximately every three months, he says. “If periodontal disease isn’t present, make sure you make and keep appointments every six months.”

Finding the right dentist—one who will partner with you in your oral health care—is essential. “Finding a dentist who will work with you is so important. A lot of dentists won’t touch someone with lupus,” says Ellen Illsley of Phoenix.

Following a regular routine of dental care, including using a soft toothbrush and keeping regular check-ups, has paid off for Illsley. Though she has had problems with dry mouth from Sjogren’s syndrome and oral ulcers, she reports having had better exams recently. “Once I made my teeth and gums a priority, my problems decreased. You just have to put your mind to it.”

Finding affordable dental care

Although dental care can be expensive, there are some options to cut costs:

• Dental schools: Dental students gain hands-on experience by working on patients at a reduced fee. Students are supervised by experienced dentists. Check the Yellow Pages and online for dental schools, dental hygiene schools, and postgraduate dental clinics near you.
• Clinical trials: Dental schools and organizations often seek volunteers for clinical trials and research studies. Some free or reduced-cost dental treatment may be available for those who have specific conditions that are being studied. To find studies led by the National Institute of Dental and Craniofacial Research at the National Institutes of Health, visit www.nidcr.nih.gov. For information on other federally funded research, go to ClinicalTrials.gov. Contact the nearest dental school for information on studies conducted locally.
• Dental insurance: Some states provide dental insurance to those in need, but programs vary from state to state. Contact your local department of health for information.
• The U.S. Health Resources and Services Administration can connect you with federally funded community health care centers that may provide low-cost dental care. Visit https://findahealthcenter.hrsa.gov/ or call 888-Ask-HRSA.
• Dry mouth products: Prescription products treat dry mouth by stimulating more saliva. Two of the most commonly used are Evoxac® (cevimeline HCl) and Salagen® tablets (pilocarpine). Over-the-counter products include a variety of mouth moisturizers, gels, sprays, and specialized mouthwashes. Talk to your dentist, pharmacist, or rheumatologist about the different brands. The Sjogren’s Syndrome Foundation also offers tips for living with dry mouth.