Lupus: pathophysiology, clinical manifestations, and treatment approaches

¶ … Oral Hygiene Needs of the Lupus Patient

Researching the condition of Lupus, it quickly becomes apparent how elusive the diagnosis is. The myriad of Lupus symptoms that mirror other diseases and conditions can cause it to be misdiagnosed as other closely related conditions, or remain undiagnosed, a mystery condition that afflicts the patient causing pain, swelling, inflammation, painful joints, and, in the worst case, involves a slow and painful shutdown of vital organs leading to death. One of the manifestations of the disease is on the patient's oral health. An appearance of poor dental hygiene and dryness of the mouth are oral symptoms associated with lupus. The need for people diagnosed with Lupus to comply with a strict routine for dental hygiene is often overlooked when discussing Lupus. If we consider the mouth the gateway to the body's health, it would perhaps be less overlooked. Much of what we experience in the way of disease and maladies is related to how well, or how poorly, we take care of our mouth and teeth. People diagnosed with lupus need to pay extra attention to following and maintaining good oral hygiene (Wallace, Daniel J., 2005, 124). This essay examines those conditions and the care of lupus symptoms as it relates to dental hygiene.

Drs. Scott and Michael Glick DDS say:

Dental care providers need to identify these patients, understand the complications associated with these conditions and their implications for dental therapy, and establish appropriate modifications of outpatient dental care. This article provides an overview of the pathogenesis and medical management of LE, as well as dental considerations for patients with this condition (De rossi and Glick, 1998, 330-339)."

To receive dental care without properly advising the practitioner of the condition of lupus or rheumatoid arthritis - a lupus like condition - is taking an unnecessary risk. De Rossi and Glick discuss at length the many conditions and reasons that preventative action is required when treating patients who have lupus.

Oral Conditions Associated with Lupus

Twenty percent of patients diagnosed with systemic lupus erythematosus (SLE) manifest periodontal and orthodontic conditions related to SLE (Wallace, 124). Periodontitis is a "disease of the supporting structures of the teeth (Blau, Sheldon Paul, and Schultz, Dodi, 1993, 109)." Lupus patients experience a lack of regeneration of the bone, a natural process that occurs throughout our lives as bone is being constantly broken down, resorbed, and replaced through our natural calcium building bodily processes, which also involve our teeth (Blau and Schultz, 109).

Bone consists of a protein framework, called the osteoid matrix, in which calcium -- the chief constituent of bone (as well as teeth) -- is deposited. Certain cells, called osteoclasts, do the breaking down of old bone, while other cells, called osteoblasts, are responsible for building new bone. Various other substances, including calcitriol (the active form of vitamin D, also known as 1,25-dihydroxycholecalciferol), the thyroid hormone calcitonin (sometimes called thyrocalcitonin), and parathyroid hormone, play important roles at various points in this cycle (Blau and Schultz, 109)."

Drs. De Rossi and Glick point out that oral manifestations also include lesions found on the buccal mucosa, gingival and vermillion. The lesions are described in dental terms as appearing "plaque-like" or "corrosive" and fall into the form medical classification of "discoid lesions (331). The oral hygiene in managing the condition is a focus on the cutaneous and mucosal manifestation of the disease (331).

The dry mouth condition that lupus patients experience is called Sjogren's Syndrome (Blau and Schultz, 15). The mouth is becomes dry, unable to produce the saliva that deals with bacteria and keeping the mouth wet (Blau and Schultz, 15). People suffering from lupus are prone to ulcerations, and sores, and there is a tendency to develop cavities because of the inability to restore the calcium needed to build stronger teeth.

Another caution that exists for people suffering from lupus is to exercise caution before and after receiving dental treatment. Lupus patients could develop serious heart infections from the streptococci that might be released into their bloodstream during routine dental procedures, even bi-annual teeth cleanings (Blau and Schultz, 174). The infection can travel to the heart when the patient has certain other manifestations of lupus, and, if the patient has developed a condition called verrucous endocarditis, then it can be deadly if the streptococci infect the heart (Blau and Schultz, 174). Therefore it is strongly recommended that prior to and following dental procedures and cleanings that lupus patients receive antiobiotics that can help them to be prepared to defend their body against the streptococci (Blau and Schultz, 174-175).

The antibiotic -- usually amoxicillin, or another member of the penicillin family, or erythromycin in cases of penicillin allergy -- is taken an hour or two before, and again a few hours after, the dental treatment, the exact times depending on the drug. Preferably, put your dentist and your rheumatologist in touch with each other, so they can discuss the best preventive strategy for you (Blau and Schultz, 175)."

Another condition arising out of the deterioration and inability to replace the calcium needed in the body to regenerate bone growth is temporomandibular joint syndrome (TMJ). TMJ is a painful condition, and it often is found in people with lupus because the deterioration of the jawbone causes the alignment of the jaws to become misaligned, and leads to TMJ (Wallace, Daniel and Wallace, Janice Brock, 2003, 46).