LUPUS PATIENTS' GUIDE TO DENTAL CARE

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Lupus Patient's Guide to Dental Care

by Galusha-

In the haste of our busy everyday lives when we always seem to be on

yet another trip to a medical professional, it is far too easy to

let our daily dental care and periodic checkups slip through the

cracks. Approximately 95% of lupus patients suffer from some form of

oral involvement. Disregarding the importance of proper dental care

can be a painful and costly error that in some cases may actually be

dangerous.

The mouth is a virtual hotbed for various forms of bacteria so good

dental hygiene is crucial. Lupus patients should floss and brush

their teeth at least twice a day with a soft brush and fluoride

toothpaste. Mentadent, Arm and Hammer, and other baking soda based

toothpastes with fluoride are also highly recommended to help keep

the mouth clean and bacteria free. Dental checkups should be

scheduled every 3-4 months or at the very least every 6 months.

Lupus patients may also need more specialized care than the average

dental patient so it is important to find a dentist who has

experience with patients with special needs. The oral complications

that face lupus patients are either directly related to the disease

or come about as a side effect of medical treatment.

Special problems require individualized care from specialists in the

practice of dentistry. Dental specialists that you might want to

look at are those who practice Oral Medicine, Oral Pathology, Oral

Surgery, and Periodontics. Tips for picking a good dentist include

1) making sure that your dentist has experience with or knowledge of

lupus or autoimmune diseases. and 2) that your dentist not only

takes a full medical history but also has an updated list of all

your medications.

Lupus patients suffer from the following mouth symptoms: dry mouth,

cracked lips, bleeding gums, sore jaws, gingivitis (gum disease),

cracked tongue, oral lesions, lichen planus, ulcers (tongue, mouth,

gums and cheeks), and candidias thrush infections (yeast

infections). Those patients also suffering from TMJ or oral

scleroderma can have tightening of the mouth and jaw which can

result in more abscesses and cavities. Patients with Sjögren's

Syndrome usually have severe dry mouth which results in massive

decay, dental infections, thrush (yeast infections), and gum

disease. Patients with Mitrovalve Prolapse (MVP) and Antiphospolipid

Antibody Syndrome require antibiotics before dental procedures to

protect against life threatening infections.

Certain forms of SLE organ involvement also carry dental care

warnings and every procedure and medication must be carefully

evaluated. Some areas of note are:

* Kidney Involvement: Prescriptions for certain antibiotics (e.g.

Tetracycline) or analgesics (e.g. Aspirin, NSAIDS) by a dentist can

adversely affect kidney function.

* Liebman-Sacks Endocarditis (a form of heart involvement):

Approximately 50% of patients with SLE suffer from this condition,

yet many don't even know it. The majority of cases are not detected

until an autopsy is performed. Antibiotics need to be given before

any invasive dental procedures, not just surgery, are performed.

These antibiotics help prevent the bacteria from the mouth from

entering the bloodstream and infecting the vegetations from this

disease that are imbedded in and around the heart. Antibiotics will

help reduce the risks if not eliminate them completely. Infections,

from dental care, can cause life threatening complications that are

too often a reality not just a vague possibility.

* Lung Involvement: Laughing Gas (also known as Nitrous Oxide) may

be problematic in those suffering from Lupus related lung problems

because of it's tendency to depress breathing.

* Lupus Anticoagulant or ITP: Periodontal surgery or extraction of

teeth can be complicated in those patients suffering from these

conditions due to abnormal bleeding. Any invasive dental work or

surgery needs to be evaluated fully and then undergone with caution.

Medications taken for Systemic and Discoid Lupus can also affect our

mouths and require special dental care. Some oral related side

effects from these medications are:

* Anti-Convulsants: Many of these seizure and neuropathy medications

can cause gum atrophy and bleeding which can lead to infection and

decay.

* Anti-Malarials: Plaquenil can cause a rash in the mouth or an oral

lichen planus type reaction.

* Immunosuppressive agents: Cytoxan, Immuran, Methotrexate, etc. act

by suppressing the immune system and therefore may result in

bacterial, fungal and other infections that can effect dental

implants, teeth, gums, and the mouth.

* NSAIDS: Nonsteroidal Anti-Inflammatories (Advil, Motrin, Feldene,

Daypro, etc.) can cause oral ulcers and canker sores.

* Steroids: Prednisone and other corticosteroids increase the

likelihood of bacterial and oral fungal infections such as

thrush/candidias (yeast).

Here are some helpful hints at combating these often painful mouth

symptoms and the problems they cause:

* Dry Mouth: Salagen, Artificial Saliva Sprays, Sugar Free candies,

ice chips, non-alcohol dental rinse/mouthwash, and drinking plenty

of water and fluids throughout the day.

* Oral Sores: Orabase ointment (numbs the area and promotes healing)

or Oragel (if you just want an anesthetic), a paste made up of

Mylanta and baking soda, ice chips, baking soda rinse (1 tsp. baking

soda per 8 oz. water), nutritional drinks such as Ensure and Boost

to provide you with the nutrition you are missing from not eating

due to discomfort, cool drinks and plenty of fluids to rinse out

bacteria, and a hydrogen peroxide rinse (50 /50 mix) to prevent

infection.

* Canker Sores: Orabase Ointment (numbs the area and promotes

healing), over the counter canker sore remedies such as Zilactin HP,

keeping the area clean, applying protective ointment such as

Vaseline, and avoiding irritating foods/beverages/makeup.

*Frequent Decay and Infections: Baking soda rinses (1 tsp baking

soda per 8 oz. of water), various dental floss tools, electrical

toothbrushes, artificial saliva substitutes (sprays and

medications), non-alcohol rinse/mouthwash, night guards, hydrogen

peroxide rinse (50/50 mix) and WaterPik tools.

Foods and substances that you should avoid while experiencing oral

sores and other dental problems include citrus fruits, spicy foods,

alcohol, caffeine, carbonated beverages, and foods/drinks that are

acidic. These items will exacerbate your oral discomfort and can

irritate already inflamed areas of the mouth.

© 2001 Lupus Foundation Of Greater Washington (703) 644-0058 fax:

(703) 644-0038

6120 Avenue, Suite 315, Springfield, VA 22150

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