Lupus Guide to Dental Care

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Lupus Guide to Dental Care
by Heather Galusha-Phillips

In the haste of our busy everyday lives when we always seem to be on yet another trip to a
medical professional, it is far too easy to let our daily dental care and periodic checkups slip
through the cracks. Approximately 95% of lupus patients suffer from some form of oral
involvement. Disregarding the importance of proper dental care can be a painful and costly error
that in some cases may actually be dangerous.
The mouth is a virtual hotbed for various forms of bacteria so good dental hygiene is crucial.
Lupus patients should floss and brush their teeth at least twice a day with a soft brush and
fluoride toothpaste. Mentadent, Arm and Hammer, and other baking soda based toothpastes with
fluoride are also highly recommended to help keep the mouth clean and bacteria free. Dental
checkups should be scheduled every 3-4 months or at the very least every 6 months. Lupus
patients may also need more specialized care than the average dental patient so it is important to
find a dentist who has experience with patients with special needs. The oral complications that
face lupus patients are either directly related to the disease or come about as a side effect of
medical treatment.
Special problems require individualized care from specialists in the practice of dentistry. Dental
specialists that you might want to look at are those who practice Oral Medicine, Oral Pathology,
Oral Surgery, and Periodontics. Tips for picking a good dentist include 1) making sure that your
dentist has experience with or knowledge of lupus or autoimmune diseases. and 2) that your
dentist not only takes a full medical history but also has an updated list of all your medications.
Lupus patients suffer from the following mouth symptoms: dry mouth, cracked lips, bleeding
gums, sore jaws, gingivitis (gum disease), cracked tongue, oral lesions, lichen planus, ulcers
(tongue, mouth, gums and cheeks), and candidias thrush infections (yeast infections). Those
patients also suffering from TMJ or oral scleroderma can have tightening of the mouth and jaw
which can result in more abscesses and cavities. Patients with Sjogren's Syndrome usually have
severe dry mouth which results in massive decay, dental infections, thrush (yeast infections), and
gum disease. Patients with Mitrovalve Prolapse (MVP) and Antiphospolipid Antibody Syndrome
require antibiotics before dental procedures to protect against life threatening infections.
Certain forms of SLE organ involvement also carry dental care warnings and every procedure
and medication must be carefully evaluated. Some areas of note are:
Kidney Involvement: Prescriptions for certain antibiotics (e.g. Tetracycline) or analgesics
(e.g. Aspirin, NSAIDS) by a dentist can adversely affect kidney function.

Liebman-Sacks Endocarditis (a form of heart involvement): Approximately 50% of
patients with SLE suffer from this condition, yet many don't even know it. The majority
of cases are not detected until an autopsy is preformed. Antibiotics need to be given
before any invasive dental procedures, not just surgery, are preformed. These antibiotics
help prevent the bacteria from the mouth from entering the bloodstream and infecting the
vegetations from this disease that are imbedded in and around the heart. Antibiotics will
help reduce the risks if not eliminate them completely. Infections, from dental care, can
cause life threatening complications that are too often a reality not just a vague
Lung Involvement: Laughing Gas (also known as Nitrous Oxide) may be problematic in
those suffering from Lupus related lung problems because of it's tendency to depress
Lupus Anticoagulant or ITP: Periodontal surgery or extraction of teeth can be
complicated in those patients suffering from these conditions due to abnormal bleeding.
Any invasive dental work or surgery needs to be evaluated fully and then undergone with
Medications taken for Systemic and Discoid Lupus can also affect our mouths and
require special dental care. Some oral related side effects from these medications are:
Anti-Convulsants: Many of these seizure and neuropathy medications can cause gum
atrophy and bleeding which can lead to infection and decay.
Anti-Malarials: Plaquenil can cause a rash in the mouth or an oral lichen planus type
Immunosuppressive agents: Cytoxan, Imuran, Methotrexate, etc. act by suppressing the
immune system and therefore may result in bacterial, fungal and other infections that can
affect dental implants, teeth, gums, and the mouth.
NSAIDS: Nonsteroidal Anti-Inflammatories (Advil, Motrin, Feldene, Daypro, etc.) can
cause oral ulcers and canker sores.
Steroids: Prednisone and other corticosteroids increase the likelihood of bacterial and oral
fungal infections such as thrush/candidias (yeast).
Here are some helpful hints at combating these often painful mouth symptoms and the
problems they cause:
Dry Mouth: Salagen, Artificial Saliva Sprays, Sugar Free candies, ice chips, non-alcohol
dental rinse/mouthwash, and drinking plenty of water and fluids throughout the day.
Oral Sores: Orabase ointment (numbs the area and promotes healing) or Oragel (if you
just want an anesthetic), a paste made up of Mylanta and baking soda, ice chips, baking
soda rinse (1 tsp. baking soda per 8 oz. water), nutritional drinks such as Ensure and
Boost to provide you with the nutrition you are missing from not eating due to
discomfort, cool drinks and plenty of fluids to rinse out bacteria, and a hydrogen peroxide
rinse (50 /50 mix) to prevent infection.
Canker Sores: Orabase Ointment (numbs the area and promotes healing), over the
counter canker sore remedies such as Zilactin HP, keeping the area clean, applying
protective ointment such as Vaseline, and avoiding irritating foods/beverages/makeup.
Frequent Decay and Infections: Baking soda rinses (1 tsp baking soda per 8 oz. of water),
various dental floss tools, electrical toothbrushes, artificial saliva substitutes (sprays and
medications), non-alcohol rinse/mouthwash, night guards, hydrogen peroxide rinse
(50/50 mix) and WaterPik tools.

Foods and substances that you should avoid while experiencing oral sores and other dental
problems include citrus fruits, spicy foods, alcohol, caffeine, carbonated beverages, and
foods/drinks that are acidic. These items will exacerbate your oral discomfort and can irritate
already inflamed areas of the mouth

The Lupus Foundation of America, Inc. would like to thank the LFA Greater Washington chapter for the use of the above lupus information.