Dental Question and Answer

Q: What kind of dental problems does a person with lupus have to deal with?
 
A person with lupus, depending on the type of disease, generalized or the localized form, and the type of medication they are taking, may face a variety of different dental problems.  Because lupus is an autoimmune disease that affects the collagen tissue in the entire body, the collagen component of the mucosa of the mouth, including the gingival tissue and salivary glands also present the symptoms seen elsewhere in the body. A person with lupus demonstrates increased levels of xerosthemia or dry mouth leading to increased levels of caries, periodontitis and candidiasis. The gingival tissue may become red and appear to be desquamating.  What are called leukoplakic lesions (white scaly tissue detaching from the underlying tissue) can appear on the skin or mucosa of the cheek, palate, o r vermillion border of the lips.  These lesions need to be diagnosed and treated as necessary.
 
Q: Can a person with lupus go under anesthesia when undergoing dental treatments?</b><br>
 
A person with lupus who is undergoing dental treatment usually will be administered local anesthetics such as lidocaine, xylociane, or marcaine. Depending on the type of medication the person is on, such as steroids, cyclosporin, methotrexate, their side effects may have an influence in the healing capability of the individual from a mostly periodontal standpoint.  For example, cyclosporin causes gingival hyperplasia, and periodontal treatment is necessary for individuals who are placed on cyclosporin.  Steroids affect the immune system, and a patient with Lupus who is being administered steroids will not demonstrate the same healing capacity as an average person.  The person with lupus may need to be administered antibiotics following a dental treatment to prevent possibility of an infection, should the person have a compromised immune system.  The more serious concerns are the cases with systemic lupus whose circulating blood has been affected, hence their coagulation system.  Serious bleeding problems may occur.  Consultation with the physician in controlling any bleeding problems before a dental treatment is to be considered.  Also the person with systemic lupus may have their heart and its lining involved, and for this reason they are more prone to endocarditis, which is a serious infection of the lining of the heart that can be induced with dental treatment.  Therefore, the person with lupus needs to be prophylactically pre-medicated with antibiotics.<p>
 
Q: Is there a benefit for a patient with lupus choosing a dentist who has knowledge of Lupus and or other autoimmune diseases? <br></b>
 
A dentist or any clinician treating a patient with lupus has to be aware of the intraoral symptoms of this disease, as at times this disease first manifests itself in the mucosal lining of the mouth.  These lesions can at times be treated with topical ointments that contain steroids.  Also, the clinician needs to be aware of pre-medicating the patient with antibiotics before commencing treatment, should the heart be involved.  He also needs to be aware of any possible systemic conditions such as compromised healing or bleeding problems that may occur during or after treating the patient. The drymouth syndrome in lupus that can rise to dental caries (decay) and periodontitis can be helped with avariety of adjunctive treatments such s fluoride trays, regular debridement of the periodontal tissues, and dental visits to detect decay. Clinician needs to be aware of informing and educating the person affected by lupus on how to take care of their oral health. 
 
Q: What can I do About Dry Mouth?</b><br>
 
If your salivary glands still produce some saliva, you can stimulate them to make more by chewing gum or sucking on hard candy.  However, gum and candy must be sugar free because dry mouth makes you extremely prone to cavities.  Take sips of water or another sugar free drink often throughout the day to wet your mouth, especially when you are eating or talking.  Note that you should take sips of water—drinking large amounts of liquid throughout the day will not make your mouth any less dry.  It will only make you urinate more often and may strip your mouth of mucus, causing even more dryness.  You can soothe dry, cracked lips by using oil- or petroleum-based lip balm or lipstick.  If your mouth hurts, the doctor may give you medicine in a mouth rinse, ointment, or gel to apply to the sore areas to control pain and inflammation.
 
If you produce very little saliva or none at all, your doctor might recommend a saliva substitute.  These products mimic some of the properties of saliva, which means they make the mouth feel wet, and if they contain fluoride, they can help prevent cavities.  Gel-based saliva substitutes tend to give the longest relief, but all saliva products are limited since you eventually swallow them.
 
At lease two drugs that stimulate the salivary glands to produce saliva are available.  These are pilocarpine and cevimeline.  The effects last for a few hours, and you can take them three or four times a day.  However, they are not suitable for everyone, so talk to your doctor about whether they might help you.
 
People with dry mouth can easily get mouth infections.  Candidiasis, a fungal mouth infection, is one of the most commonly seen in people with Sjogren’s.  It most often shows up as white patches inside the mouth that you can scrape off, or as red, burning areas in the mouth.  Candidiasis is treated with antifungal drugs.  Various viruses and bacteria can also cause infections; they’re treated with the appropriate antiviral or antibiotic medicines.