Oral Health, Smiles, & Lupus Symptoms

Good oral health can be the difference between smiling & screaming. But, it’s not as easy as proper brushing when you have lupus.

The mouth is the beginning of the digestive system. When considering oral health, all aspects of the mouth including the tongue, teeth, mucous membrane, and salivary glands are involved.

Oral ulcers and oral lesions are often found in people with lupus. Anywhere from 9% – 45% of people with lupus experience these symptoms. Despite this, according to the Colgate Oral Care Center, lupus does not contribute to tooth decay or periodontal disease.

A recent study published in January 2017 in Lupus looked more closely into the effects of lupus on oral health. Participants were matched for gender and age, and the researchers conducted interviews and oral health examinations.

People with lupus had a greater number of missing teeth than those people without lupus. This was the case even though people with lupus reported a higher frequency of brushing their teeth.

Corroborating the finding above, there were no differences found between the rate of periodontitis or decayed teeth. Additionally, there were no significant differences between the two groups on any of the following habits or clinical parameters:

• smoking
• flossing
• salivary flux

Participants with lupus reported that their oral health negatively impacted quality of life. A significant decrease in quality of life was tied to the wearing of prosthesis (p < 0.05).

Oral health: lesions & lupus

Dr. Paul Friedman, an expert on diseases that impact the mouth, presented on oral lesions and lupus at the Hospital for Special Surgery. He noted that 40% of oral lesions in people with active lupus are caused by other factors such as medications. But, the only way to truly identify the cause of a lesion is to perform a biopsy.

However, some oral lesions associated with lupus do have a distinctive look. Lupus oral lesions are, “usually red ulcers surrounded by a white halo [with] white, radiating lines.” The lesions can be painful and typically occur in three locations:

• Inside the cheeks
• On the roof of your mouth (the hard palate)
• On the lower lip

NOTE: Inform your doctor as soon as you notice a lesion that fits the description above

Dr. Friedman says it is essential that a dentist provides an oral soft tissue exam regularly. This type of exam takes only a couple of minutes and can be conducted during a routine cleaning.

The Lupus Foundation of America shared the story of Laurah Rodgers’ path to a lupus diagnosis. Laurah had a history of undiagnosed health problems when she arrived at the dentist for a possible cavity. Laurah had upwards of 100 oral ulcers. The dentists began the diagnostic process, referring Laurah to an oral pathologist (to rule out cancer) then to a rheumatologist who confirmed that Laurah had lupus.

Oral health & lupus medications 

Oral lesions will be impacted by the medications you take to combat lupus. Still, in some instances, antimalarial drugs may be used to treat lesions. These medications may cause a change in the pigment of the lining of the mouth and palate.

The most common drugs known to cause oral reactions are:

• NSAIDS
• COX-2 inhibitors
• Antimalarial drugs
• Calcium channel blockers
• ACE inhibitors
• Cholesterol lowering drugs
• Rituximab
• cyclosporin

As with any medication, there are always risks of serious and non-serious side effects. Be sure to discuss potential side effects with your doctor before starting any new medications.

Erythema multiforme (commonly known as Stevens-Johnson Syndrome) is a serious drug reaction that can develop overnight. A full-blown version of the reaction can be life-threatening. If you experience the following symptoms, contact your doctor immediately or go to the emergency room:

• crusting of the lips (typically symmetrical)
• painful ulcerations on the gums, lips, cheeks, tongue, and/or cheeks
• swollen glands
• fever
• genital lesions may occur

Sjogren’s Syndrome (SS) and oral health

Sjogren’s Syndrome (SS) is a different autoimmune disease that occurs in about 20-30% of people with lupus. Like lupus, it is a difficult-to-diagnose disease that may often go undiagnosed for years.

Sjogren’s Syndrome targets the salivary glands in the mouth and the lacrimal glands in the eyes causing sicca complex (dry mouth and dry eyes). While the destruction of the salivary glands is painless in up to 50% of people with SS, the decreased saliva is a detriment to oral health. People with SS are more likely to develop oral fungal infections and cavities.

Additional information on Sjogren’s Syndrome is available here.

Oral health recap

Lupus, and associated diseases like Sjogren’s Syndrome, negatively impact oral health which can have negative impacts on quality of life. It is important to consider your dentist as a part of your lupus treatment team so that they can be aware of potential irregularities.

Not all insurance plans cover dental. But, here are some strategies from Health & Human Services for finding affordable dental care.