I have a phobia of going to the dentist. Even before my Lupus diagnosis it caused me a great deal of anxiety. Now even more so since I am on coumadin for
antiphospholipid syndrome. Now a trip to the dentist involves an appointment with a hematologist in order to wean me off coumadin prior to the appointment.
Several visits for lab work, I need to have my PT/INR checked to make sure my blood wont be to "thin" so I can get my dental work done. Needless to say I rarely ever
go to the dentist. It's time consuming and I'll be honest I think it's a pain to have to do all that.
However in the last 3 years I've noticed that my teeth are changing. I've been on prednisone for around 17 years and it is damaging to my bones, joints and my teeth.
There have been times when my teeth chip while I'm chewing gum! I brush my teeth and try to practice good oral hygiene, unfortunately it isn't enough anymore.
I decided to research a little and find out how prednisone effects our teeth and mouth. I was surprised to learn that it isn't just predisone that has a negative effect on teeth.
Many of the medicines that I've either been on in the past or am still on now like plaquenil and Cytoxan can also cause damage as well.
The list below contains warnings for those of us with organ involvement. These are things we need to bring to the attention of our dental provider before we get work done.
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 preformed. Antibiotics need to be given
before any invasive dental procedures, not just surgery, are preformed. 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, Imuran, Methotrexate, etc. act by suppressing the
immune system and therefore may result in bacterial, fungal and other infections that can
affect 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 *
The Lupus Foundation of America, Inc. would like to thank the LFA Greater Washington chapter for the use of the above lupus information.*
www.lupus.org *
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