Much of the information about systemic lupus erythematosus (SLE) focuses on how the disease affects the major organs, including the kidneys, lungs, and heart. While these are all important, in some patients, lupus also affects the health of the digestive system, including the mouth. 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 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. Many lupus patients may also have soreness or burning of the mouth and experience dry mouth or a lack of saliva. This is often caused by a common overlap disease with lupus called Sjogren’s syndrome which affects the salivary glands along with other moisture producing glands. Back to top
How is it diagnosed?
There are two types of oral sores or lesions:
- Those that do not correlate with active disease such as lupus (more common)
- Those associated with active disease (less common)
If mouth sores are visible, it may indicate active lupus disease but the only way to reliably diagnose whether or not an oral lesion is associated with an active disease is through a biopsy. This is a procedure where the doctor takes a small sample of the tissue for diagnosis. The dentist or doctor will rotate a small stiff-bristled brush over the area, causing abrasion or pinpoint bleeding. The cells from the area are collected and examined under a microscope by a pathologist. In up to 40% of people with lupus, these mouth sores are not associated with disease activity but rather a reaction or side effect of medication being used to treat lupus or another condition altogether. Back to top
What may be causing my mouth sores if it is not lupus?
Lupus can be one cause of mouth sores. Some other causes may include:
- Stress or anxiety
- Some form of trauma to the mouth: This can be caused by excessive brushing, chewing sharp or hard food, accidentally biting your cheek, etc.
- Hormonal changes: Some women can develop these ulcers during their period as hormone levels change during the menstrual cycle.
- Certain foods: Chocolate, coffee, peanuts, strawberries, cheese, tomatoes, wheat flour, and almonds may be culprits of mouth sores.
- Toothpaste additives: Some people may be sensitive to the sodium lauryl sulphate additive that is found in some toothpastes.
- Stopping smoking: When you stop smoking, your body is dealing with a change in chemicals and this change may cause mouth ulcers. It is usually temporary.
Certain conditions and/or medications can also be the cause of oral lesions:
- Immunodeficiency: Mouth sores may appear due to lupus medications that suppress the immune system.
- Reactive arthritis (also known as Reiter’s Syndrome): This is a form of arthritis that affects the joints, eyes, urethra (the tube that carries urine from the bladder to the outside of the body), and skin.
- Crohn’s disease: Complications of Crohn’s can include gum inflammation and cavities, but the most common are mouth sores or canker sores.
- Coeliac disease (gluten intolerance)
- Non-steroidal anti-inflammatory drugs (NSAIDs): This may include such medications as ibuprofen, aspirin, Celebrex, ketoprofen, naproxen, and diclofenac.
- Iron deficiency: A lack of iron in the blood leads to a reduced amount of oxygen reaching organs and tissues. This may result in mouth ulcers.
- Vitamin B12 deficiency
It is important to note that any of the medicines taken for lupus, such as corticosteroids (steroids), can cause problems such as dryness of the mouth, swelling, cold sores, yeast infections, and damage to bones that help the mouth function correctly (such as the jaw bone). For this reason, regularly scheduled check-ups with a dentist are strongly recommended for all lupus patients. *Do not begin taking any supplements before first speaking with your physician or another medical professional. Back to top
How are mouth sores treated?
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. Back to top
What can be done to help alleviate or prevent them?
Some things you can do to decrease the likelihood of getting mouth sores and to help existing ones heal more quickly are:
- Lower your stress levels: Try doing relaxing activities like yoga, meditation, breathing exercises, reading or listening to calming music and participating in gentle exercise such as walking or swimming. Learning about the mind/body connection can help with this.
- Avoid foods that may have caused or aggravated ulcers in the past.
- Eat a balanced diet
- Avoid sharp or hard foods that can further injure the mouth or cause other sores.
- Use a soft toothbrush and brush gently.
- Have good oral hygiene and see a dentist regularly.
- Follow doctor’s orders regarding the prescribed medications used to manage lupus disease
How can my dentist help?
If you have lupus, it is very important to let your dentist know as soon as possible. Connect your rheumatologist and dentist by making sure each doctor has the other’s phone number and encourage them to consult with each other on your care. It may be wise to connect your dentist with any other types of doctors that you see regularly as well. Your dentist should have a complete history of your condition and understand how lupus has uniquely affected you. Make sure to tell your dentist if you have had oral sores in the past, and you should also provide a complete list of the medicines, dietary supplements, and vitamins that you are currently taking. Having a complete understanding of your medical history will help ensure that dental work, cleanings, and any other procedures are done in a way that is safe and effective for your specific needs. Be sure to see your dentist and have an oral soft tissue exam regularly. For those who suffer with lupus and more specifically oral issues, it may be necessary to see a dentist every three months as opposed to the regular six recommendation. A soft tissue exam can be done in approximately three minutes. Ask for it specifically if your dentist does not automatically do so to check for any lesions you may not even be aware you have (especially since some lesions or sores can be painless). If your dentist sees any abnormalities, sores, or lesions he or she may then choose to proceed with a biopsy of the tissue to determine its cause and make a diagnosis. Your dentist will most likely recommend the same things as your other physicians such as keeping your mouth healthy, avoiding direct sunlight for those with photosensitivity (those with discoid lupus are often photosensitive), lowering your stress levels, getting the right amount of rest, eating a balanced diet, taking your prescribed medications, etc. Back to top
- Mouth sores, while not life threatening, may be very disruptive to daily life.
- If you notice a mouth sore or have persistent oral lesions, please seek the advice of a medical professional to determine the cause.
- Most mouth sores can be treated, managed, and prevented with medications, supplements and/or lifestyle changes, but only a doctor or dentist can determine the best course of action for your specific needs.
- Do not start or stop any medications or supplements without the supervision of your primary care physician.
- Practice good oral hygiene and see your dentist regularly for cleanings and soft tissue examinations to ensure your best optimal oral health possible.
- Keep smiling!
Sources: lupusny.org/about-lupus/coping-with-lupus-corner/lupus-and-oral-care, healthline.com/health/lupus/effects-on-body#Digestive_System, health.com/health/gallery, simplestepsdental.com, hss.edu/conditions_oral-concerns-lupus, webmd.com/osteoarthritis/arthritis-reactive-arthritis, healthunlocked.com/lupusuk/posts/148688/topic-of-the-month-february-coping-with-mouth-ulcers, everydayhealth.com/crohns-disease/how-crohns-affects-your-mouth
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