Lupus and gum disease: is there a connection?
As Lupus Awareness Month comes to a close, a general dentist encourages those people diagnosed with lupus to visit an oral health care provider every three to six months for best management of their lupus oral-related conditions to better manage their lupus activity.
Dr. Shamika Strachan says mouth sores are most commonly thought of when considering the oral effects of lupus. The sores she said are characteristically red, ulcerated lesions with a white “halo” and white lines that spread from the center. The ulcerations usually appear on the gums, cheeks, inner lip and roof of the mouth. Apart from the sores, she said conditions such as opportunistic oral fungal infections and dry mouth (xerostomia) as a result of medications and the disease’s attack on salivary glands (Sjogren’s Syndrome) can develop. In turn, she said that may lead to tooth decay and burning mouth, which are not uncommon and have been documented in many research studies.
“There is however few and inconclusive studies on the connection between lupus and gum [periodontal] disease. Nonetheless there is sufficient evidence to rationalize that the two are associated,” said the dentist who stressed that she is not an oral pathologist, medical physician, or a rheumatologist. “The conditions overlap in the area of inflammation as a result of the body’s immunologic response in both diseases. Research suggests that they demonstrate, although not directly, an inverse relationship — either one can exacerbate the other — similar to the relationship between diabetes and periodontal disease,” said the dentist.
Lupus is a chronic, inflammatory, autoimmune disease, sometimes associated with mucocutaneous (affecting mucous membranes and skin) lesions, with or without systemic involvement. Its origin is unknown, but factors such as smoking, hormonal changes, ultraviolet (UV) radiation and infections are possible etiologies. The condition most often affects women, first appearing anywhere from between 30-40 years (most commonly), however males and females may be affected at any age.
According to the dentist, periodontal disease is an irreversible, inflammatory disease of the gingiva (gums) and tooth supporting structures (alveolar bone and periodontal ligaments), eventually leading to tooth loss. Much like lupus she said periodontal disease affects individuals who are genetically predisposed, however the presence of bacteria in the gingival (gum) pockets are required for the disease process to ensue. And that it is important to note that tissue destruction doesn’t occur directly as a result of the presence of pathogens alone, but because of inflammatory mediators that infiltrate the areas around the tooth in response to these foreign bacteria.
“There is potential subsequent association between the two conditions because of similarities in their destructive mechanisms.”
Strachan said in lupus there are two main complications that may contribute to the development or exacerbation of periodontal disease.
“The first is defective genetic control of immune responses. During these immune responses, inflammation occurs when inflammatory mediators are activated, the same ones that cause periodontal disease. The second potential contributory factor is that there’s poor host response to infectious microorganisms. Therefore, it’s more challenging for individuals with lupus to defend themselves against bacterial load in the oral cavity that could potentially result in
periodontal disease, more so than individuals without the disorder. In a study by Rhodus and Johnson, 93.8 percent of study patients had periodontitis. In studies where it was concluded there was no greater risk of periodontal disease in lupus patients it was said to possibly be related to the use of anti-inflammatory medications.”
The dentist said inversely, periodontal disease may attribute to uncontrolled lupus (systemic form) activity.
“In a study by Fabbri et al. [and others], a reduction in SLE (systemic lupus erythematosus) activity was detected, as a result of decrease in periodontal parameters after periodontal treatment. This suggests that treating periodontal disease can improve lupus symptoms due to better inflammatory control due to lessening or preventing the activation of inflammatory mediators. Although few studies have been conducted on the exact of connection between the two, there is adequate information to rationalize how these disorders affect the other.”
With periodontal disease rampant in The Bahamas and the precursor to many other chronic diseases, she said all at-risk persons should be assessed and managed by their dentist or hygienist, who would determine the presence of the disease, its extent and the specific treatment needs. In the case of a periodontitis diagnosis, she said treatment could range from deep cleanings to periodontal surgery and in some cases extractions depending on the severity of the disease.
Common signs of periodontal disease in most cases she said is the cement-like deposits on the teeth that may vary in color — tooth-colored, yellow, brown, black and in some instances green. She said spacing between teeth that may not have been spaced previously is another sign, and the teeth appear elongated and may become rotated due to bone loss. Mobility she said is another definitive sign of periodontal disease, and that halitosis (bad breath) is common as well, due to deep pocketing — the space between teeth and gums below the gum line which harbor bacteria and food resulting in bad breath.