Straight from the Mouth

INTRODUCTION

My lupus story actually began at the dentist.  Well, my childhood orthodontist – to be exact.  It all started with a normal “check-up” for a normal pre-teen, getting fitted for a normal retainer… or so we thought. 382936 After my appointment, my doctor pulled my mother aside and expressed concern about the way the inside of my mouth looked and the amount that I would bleed during the exams. “Something is not right with your daughter” were the words she uttered.  Confused and gobsmacked, my mother didn’t know exactly what to say.  I mean, I was in dance class several nights a week, I was what most would say was a functional pre-pubescent eleven-year-old.  However, my mouth told a different story, without me having to utter a single word.

Lo and behold, a few months later, I was hit hard with Epstein-Barr virus (EBV), which allowed my chrysalis to develop into a  mature butterfly – the butterfly known as systemic lupus erythematosus.  

And who called it? … Not the M.D. but, the D.D.S.

Lupus is an autoimmune disease that can affect one’s connective tissue in virtually any part of the body.  This includes the mouth and almost every part of it – the collagen and gingival tissue as well as the salivary glandular tissue.  Additionally, since the mouth is a literal hot tub full of over 500 kinds of bacteria, it is important to be proactive with oral health.   This blog will hopefully provide you with clarity on how to identify issues with lupus and the mouth, as well as treatments for those issues.  

DISORDERS OF THE MOUTH ASSOCIATED WITH LUPUS

Oral Lesions:

Mouth sores (also referred to as oral lesions or ulcers) occur in approximately 40-50% of lupus patients and are one of the most common symptoms of lupus. While not life threatening, mouth sores and other oral problems may cause issues such as physical discomfort, problems with overall health and reduced self-esteem. Mouth sores related to lupus most often present on the roof of the mouth but can also occur on the gums, inside of the cheeks, and the lips. These sores are usually painless (although some may experience pain), which makes them different from other types of

Dentist very carefully check up and repair tooth of his young female patient in the clinic

mouth sores or ulcers like canker sores. Mouth sores that are associated with lupus are typically red ulcers surrounded by a white ‘halo’ with white lines that radiate from the center. These types of lesions are called discoid lupus lesions.

Although lupus can cause mouth sores, they can be also brought on by:

  • Stress or anxiety
  • Trauma to the mouth
  • Hormonal changes
  • Certain foods
  • Stopping smoking
  • Immunodeficiency
  • Reactive arthritis (also known as Reiter’s Syndrome)
  • Crohn’s disease
  • Coeliac disease (gluten intolerance)
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Iron deficiency
  • Vitamin B12 deficiency

Treatment for mouth sores may include steroids (such as Prednisone) that are topical or intralesional (injected directly into the lesion or sore), but antimalarial drugs such as Plaquenil may be necessary to treat more resistant lesions. Controlling active SLE will often help with the reduction of lupus related mouth sores.

Sjogren’s Syndrome:  

This is a chronic disease that targets the lacrimal glands in the eyes and the salivary glands in the mouth.  The most common oral symptom is xerostomia, or dryness of the mouth, one may also experience:

  • Burning and/or cracking of the tongue
  • Intensified dental decay (cavities or root decay)
  • Need for lubrication while speaking
  • Painful swelling of salivary glands
  • Cracked or peeling lips
  • Gingivitis

About half of the time Sjögren’s occurs alone, and the other half it occurs in the presence of another autoimmune connective tissue disease such as Rheumatoid arthritis, lupus, or scleroderma which are commonly linked with Sjögren’s.  While nine out of ten patients are women, Sjögren’s syndrome impacts all racial and ethnic groups and it can be developed at any age, although it more commonly develops after age 40.  As with lupus, there is no single test to determine whether you have this condition.  A doctor may use a combination of different tests to confirm a Sjogren’s diagnosis:

These may include:

  • Schirmer’s Test: A piece of filter paper placed at the corner of the eye determines the degree of wetting over a five minute period of time.
  • Rose-Bengal Staining Test: This test will determine whether or not the cornea is inflamed.
  • Salivary Gland Flow Rates Test: This determines whether there is a decrease in the production of saliva.
  • Biopsy: The lip or the parotid gland (the gland that produces saliva) may be biopsied to determine the diagnosis.

There is no cure for Sjögren’s, so treatment revolves around controlling symptoms. Your treatment will depend on the severity of your individual symptoms and may require a combination of different methods.  Maintaining a diet rich in nutrients can improve your overall health.  For dry mouth: Dry mouth causes oral and dental problems, so proper oral hygiene is very important. Limit your sugar intake and get regular dental checkups. Choose dental products made specifically for dry mouth and be sure to floss every day. Hard candy and chewing gum can help you produce saliva, but make sure they are sugar-free. For dry lips, use lip balm or lipstick that has an oil or petroleum base. Your doctor can recommend mouth rinses or ointments to ease pain and inflammation. In severe cases, your doctor can prescribe a gel-based saliva substitute or other stronger prescription medications.  

MEDICATIONS: HOW THEY AFFECT THE MOUTH

The most common drug categories used to treat lupus are:

  • Antimalarial drugs (hydroxychloroquine or plaquenil)
  • NSAIDS and COX2 inhibitors (ibuprofen, naproxen, celebrex)
  • Corticosteroids (prednisone)
  • Rituximab (rituxan)
  • Immunosuppressive drugs (Imuran, methotrexate, cytoxan, cellcept)

Sadly, these medications, although needed at times, may have oral complications. Some of these complications include:

  • Infection in the mouth due to compromised immune system (remember the 500 different types of bacteria I spoke of?)
  • Drug reactions in the mouth which caused tongue or lip swelling
  • Changes in the pigment lining of the mouth
  • Bone loss in teeth
  • Candidiasis
  • Herpes virus

KEEP SMILING: HOW TO BE PROACTIVE WITH YOUR DENTAL HEALTH

Good oral health is important for your overall wellbeing, particularly if you have lupus.  Maintaining good oral hygiene not only enables you to feel confident when you talk and smile, it also makes it possible to speak and eat properly.

Preventive care must be done daily.  Besides regular visits to the dentist, take these steps to decrease your risk of developing dental problems:

Closeup of a tooth brush, with floss and rinse
  • Brushing and flossing twice a daily
  • limiting snacking between meals and eat well balanced meals
  • Using fluoride toothpaste and mouthwash

If you feel your mouth is telling you something, speak up.  See your orthodontist or dentist right away!

Sources:

https://www.hss.edu/conditions_oral-concerns-lupus.asp

http://www.lupusinternational.com/Related-Conditions/Dental-Concerns–1.aspx

http://www.lupus.org/magazine/entry/mouth-maintenance

http://www.mollysfund.org/2015/04/mouth-sores-lupus/

*All images unless otherwise noted are property of and were created by Molly’s Fund Fighting Lupus. To use one of these images, please contact us at [email protected] for written permission; image credit and link-back must be given to Molly’s Fund Fighting Lupus. **All resources provided by Molly’s Fund are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your medical provider with any specific questions or concerns.

Article by : Kelli Roseta

Kelli Roseta is the Client Services Coordinator for Molly’s Fund Fighting Lupus and facilitates the patient and caregiver support groups. She is also a 25-year lupus survivor. Connect with Kelli at [email protected].