Tooth Decay, Dental Caries, and Lupus

Trips to the dentist aren’t really fun. But, they are crucial to oral health. Around 85% of Lupus Warriors experience tooth decay during the battle with lupus.

As if the pain and fatigue wasn’t enough! Many people with lupus experience dental caries, better known as cavities, in their life.

Lupus Warriors may find it valuable to go to the dentist more frequently, going up to 4 times a year (or every 3 months). Though the visits may be unpleasant, visiting the dentist has many benefits, especially if you have temporal-mandibular joint pain (jaw pain) or mouth sores. Read more about the mouth-related symptoms of lupus and the importance of oral health here.

But tooth decay has symptoms beyond just the tooth itself – read on to find out more!

What is Tooth Decay

Teeth are very interesting structures in the mouth. Each one is coated with enamel, a calcium-containing substance. Enamel is the hardest material that the human body can produce — It can stand up to the force of chewing, which is no small feat! However acids, either produced by bacteria or carried in food, can dissolve it. Once the enamel has been worn away, it reveals the softer layer known as dentine, which is more easily damaged.

Everyone has bacteria living naturally in their mouths. When their numbers are under control, they don’t cause health problems. However, these bacteria eat starch and sugar, grow in number, and produce acid as a waste product. This acid, plus acid from our food, are what causes tooth decay. This is also why sugar can speed up the process – the bacteria love it, though the fact that sugar often comes with acidic foods (soda, lemonade, coffee with milk or sugar, and most fruits) certainly doesn’t help. Cleaning your teeth frequently, especially after meals, is important since it removes sugars and acids in the mouth and disrupts and kills the bacteria that eat them.

When left alone, thriving bacteria form slimy layers called plaques. These plaques can harden and become difficult to remove. Not only does plaque protect the bacteria and allow them to produce more acid, but – especially when they are near the gumline – they can cause inflammation in the gums (also known as periodontal disease), gum disease (also known as gingivitis), and eventually lead to an infection in the sensitive root of the tooth. This causes pain as the nerve in the tooth comes under attack which can lead to the removal of the whole tooth.

Tooth Decay and Lupus Symptoms

Tooth decay is both more frequent for people with lupus, and more serious. Protecting against tooth decay also protects against its side effects, which can be even worse than toothaches and losing teeth.

Mouth Bacteria, Infection, and Lupus

Although it is healthy for people with lupus to have some bacteria in their mouths, they cause problems when they are too abundant. These bacteria may be fairly safe in the mouth, but if they get into the lungs or bloodstream, they can cause a lot of trouble. Several studies link tooth decay to higher levels of inflammation in generally healthy people. For Lupus Warriors or people with compromised immune systems, issues may compound.

People with lupus are at a higher risk of:

• blood infections (through injured or inflamed gums, through sores in the mouth, and through infections at the root of the tooth)
• pneumonia (through inhaling mouth bacteria into the lungs)
• increased bacteria

Tooth Decay, Inflammation, and Lupus

The immune system can also react to bacteria in the bloodstream with less severe symptoms. It can trigger an inflammation response, and cause lupus flares. Gums irritated due to plaque build up can also trigger inflammation. And, of course, the constant pain of a toothache is a source of stress, another trigger of flares.

Mouth Pain and Lupus

It is important, even with all of the other pain that lupus can bring, to not trivialize the pain of cavities and tooth decay.

Cavities can be very painful when they reach the nerve. If you have never had a cavity and a toothache before, consider yourself fortunate. The dental procedures used to remove infected and painful teeth, including tooth removal and root canals, are also painful and unpleasant, and frequently require recovery time. The pain from toothaches and the dental procedures required to fix them can be very stressful and trigger a flare on their own. However, they can interfere with health in other ways.

Tooth and mouth pain make eating and drinking more difficult, impacting hydration, nutrition, weight, and energy levels. It also interferes with concentration, making tasks and chores more difficult to handle, and it interferes with sleep, affecting cognitive functioning.

Why is Tooth Decay More Likely with Lupus?

The primary reason that people with lupus experience higher rates of tooth decay appears to be a drier mouth. For various reasons, the salivary glands of people with lupus are less active, potentially cuased by:

• low levels of hydration
• high levels of stress

• immune system suppression
• chemotherapy
• breathing through the mouth
• smoking
• injuries such as burns, serious wounds, and fevers.

Certain medications can also lead to dry mouth including prednisone, sedatives, painkillers, chemotherapy drugs, seizure medications, hypertension medicines, muscle relaxants, and bronchodilators.

Saliva is an important part of how the mouth works and in the digestion of food, but it also protects the teeth. Saliva has antibacterial substances in it that keep bacteria levels down, and minerals in it that help patch up acid damage on teeth. It also physically washes away sugars, keeping them from sitting in the mouth and becoming food for bacteria.

Dry mouth is associated with mouth infections of both the bacterial and fungal variety, so it is very important to take care of.

In addition to being more likely to have dry mouth, people with lupus may also have additional health conditions (or medication side effects) that lead to nausea and vomiting. Acid reflux, where stomach acid flows up the esophagus at night and during sleep, can also be present. Even if there is no vomiting, rising stomach acid can leak into the mouth in a dilute form and damage the teeth, making tooth decay more likely.

Sjogren’s Syndrome and Tooth Decay

Sjogren’s syndrome is an autoimmune disease that many Lupus Warriors experience in addition to lupus. It attacks tear glands, salivary glands, and the glands that produce mucus, causing dryness throughout the body. Affected areas include the nose, mouth, and stomach, regions that are important to oral health and tooth decay. Not only can Sjogren’s syndrome cause dry mouth, it can also irritate the stomach and lead to acid reflux, making it a major cause of tooth decay.

You can read more about how Sjogren’s syndrome and lupus interact here.

How can I Prevent Tooth Decay?

Special dietary restrictions, frequent brushing and washing, and regular trips to the dentist can keep tooth decay at bay.

Tooth Decay Diet

One way to avoid tooth decay is to be careful what you put in your mouth – in other words, watch the foods you eat.

It’s best to avoid sugary or starchy foods. You should also make sure to get plenty of calcium, magnesium, and vitamin D in your diet. Supplements are a good way to get these nutrients, and so is milk. However, milk contains sugars as well.

Fruits have many benefits for people with lupus, but should be eaten sparingly (and teeth should be brushed afterwards) due to their high sugar and acid content. This is (unfairly enough) especially true for healthy, antioxidant-rich fruits such as blueberries, strawberries, lemons, and oranges. Dried fruits have a lot of fiber, but often are cured with sugar, making them a poor alternative. Better alternatives include low-sugar, high-antioxidant fruits such as gac fruit, eggplant (yes, it’s a fruit!) and papaya. Tomato is also a low-sugar choice, but note that it is acidic.

Sugary drinks such as sodas and lemonade should be avoided, along with sugared gums and acidic drinks like coffee and tea. Sugarless gums are actually good, however, since they nudge the salivary glands to produce more saliva and can help prevent dry mouth.

Taking Care of Your Teeth

Sometimes, it can be hard to find the “spoons” to brush and floss twice a day. But people with lupus may want to consider brushing and flossing after every meal. Keeping teeth clean prevents tooth decay and reduces all of the risks of infection and inflammation that tooth decay can bring. Many dentists recommend frequent rinses with a non-drying fluoride mouthwash, also about three times a day.

They also recommend an alternative to flossing called a “Waterpik” which uses jets of water to dislodge food particles and plaque from teeth. This helps keep the moisture level up and washes out the mouth in addition to the benefits of flossing.

Visiting the Dentist

Keeping the mouth and its teeth clean can make emergency visits to the dentist less necessary, but even people with lupus who can keep up this intensive ritual should visit the dentist 4 times a year.

Dentists can check on the status of teeth and gums and can clean deeper and more thoroughly. They can also offer sealants, which protect vulnerable teeth, and fluoride, which strengthens the teeth.

Dentists can also help keep track of and treat other oral symptoms of lupus, such as mouth sores, and can check for head and neck cancers. People with lupus are more likely to get all forms of cancer, which  you can read about on the Health and Human Services website.