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Immune Disorders

Rheumatoid Arthritis

Oral Effects
Rheumatoid arthritis is a disease that causes inflammation of the joints. If your jaw joint (the temporomandibular joint) is affected, you may have discomfort and problems with chewing. If rheumatoid arthritis affects your hands, you may have problems with brushing and flossing. Special brushes and procedures can make it easier to clean your teeth. Your dentist, dental hygienist or occupational therapist can tell you about them.

Some people with rheumatoid arthritis also have Sjögren's syndrome. This is a disease of the salivary and tear glands. It causes dryness of the mouth and eyes. It can cause problems with chewing and lead to heavy plaque deposits on the teeth. Plaque increases the risks of tooth decay and periodontal (gum) disease. You also may have problems wearing dentures because of the dryness. A dry mouth also can increase the chance of yeast/fungal infections.

Some of the medicines used to treat rheumatoid arthritis can irritate the mouth and/or cause dry mouth. Good oral hygiene is important. Your dentist can talk to you about rinses, gels and drugs to help reduce the dryness. He or she may apply fluoride to your teeth to reduce the risk of decay.

At the Dentist
Many patients with rheumatoid arthritis take high doses of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs can increase and prolong bleeding after dental procedures. Some medicines prescribed for rheumatoid arthritis can weaken the immune system or have oral side effects. These include:

  • Methotrexate
  • Etanercept
  • Hydroxychloroquine
  • D-penicillamine (Cuprimine)
  • Steroids
  • Certain other drugs

These medicines can affect your blood counts. Whenever you get blood tests, give a copy to your dentist.

If your jaw joint is involved in your arthritis, it may be difficult for you to keep your mouth open for very long. Your dentist may avoid scheduling long appointments. Instead, you may have more visits that are shorter.

Steroid therapy is also common in people with rheumatoid arthritis. People on high-dose, long-term steroid therapy may not be able to cope with stress well unless they take an extra dose of steroids. They may need an extra dose before long or stressful dental treatment.

If you have had joint replacement, your dentist may give you antibiotics before dental treatment to prevent a bacterial infection in the joint. If you are scheduled for joint-replacement surgery, you should strongly consider having all necessary dental treatment before the replacement.

Lupus Erythematosus

Oral Effects
Lupus is an autoimmune disease that affects multiple organs. It may affect the mouth. More than half of lupus patients get sores on the lips, palate and inside the cheeks. Many also have soreness or burning of the mouth and experience a lack of saliva (dry mouth or xerostomia). People with lupus often have salivary gland disease. This often causes dry mouth. Many also take medicines that can cause dry mouth. Dry mouth increases the risk of tooth decay and yeast/fungal infections. That's because saliva normally washes away bits of food, sugars and bacteria that can lead to cavities.

At the Dentist
Because lupus affects the entire body, it requires special attention by your dentist. People with lupus may have low platelet counts, which can increase the risk of bleeding. Some people with lupus have heart murmurs because they have problems with their heart valves. If you have had a heart infection known as infective endocarditis or you have an artificial heart valve, you will need to take antibiotics before some dental procedures. Your dentist may need to speak with your physician before starting certain dental procedures.

Steroids are a common treatment for lupus. If you are taking long-term steroids, you may need an extra dose before a long or stressful dental appointment. Your adrenal glands normally produce hormones that help you respond to stressful situations. When you take steroids for a long time, these glands may not work as well. This means that your body is less able to respond to stress, which can cause serious problems.

Some medicines for lupus also can suppress your immune system. You may need antibiotics before and/or after dental treatment. The reason is that you may not have enough blood cells (neutrophils) to help fight infections. Drugs for lupus can affect your blood counts. Whenever you get blood tests, give a copy to your dentist.

Tell your dentist and physician about all the medicines you take. This should include over-the-counter vitamins and herbal supplements. Also, let your dentist know if you have had a sensitive or allergic reaction to any medicine.

Scleroderma (Progressive Systemic Sclerosis)

Oral Effects
Scleroderma is a disease that causes hardening of the skin, especially on the hands and face. The lips and tongue can become firm or hard. The mouth doesn't open as wide. This makes it more difficult to keep your back teeth clean. The folds of skin around the mouth disappear, so the face looks like a mask. If skin and/or muscles around the jaw joint are affected, the jaw will move less easily.

Scleroderma can make it difficult for your dentist to examine and provide dental care for you. As this disease gets worse, the mouth becomes narrower and the lips and tongue grow more rigid. In these conditions, it can be difficult for your dentist to prepare dentures, crowns and appliances. Therefore, be sure to make every effort to keep your teeth and gums healthy to avoid tooth loss.

People with scleroderma also may have oral problems because of the drugs they take. Common problems are dry mouth (xerostomia), gum overgrowth and a higher risk of cavities and periodontal disease.

At the Dentist
Tell your dentist what medicines you take and what symptoms you have. This will allow your dentist to take precautions to reduce bleeding, infection and other negative side effects. Your dentist also needs to know if the disease has affected any of your organs. This may change your dental care. For example, if your scleroderma has affected your kidneys, you may not be able to process medicines as well.

Scleroderma has many effects on dental care. For example, you may need extra visits to complete dental procedures because it may be hard for you to keep your mouth open for longer appointments.

Selective Immunoglobulin Deficiencies

Oral Effects
Immunoglobulin deficiencies affect a type of white blood cell called a B cell. B-cells make antibodies against bacteria and other foreign agents to help fight infection. People with immunoglobulin deficiencies are missing one or more types of immunoglobulins, or antibodies. They are more prone to bacterial infection. The most common deficiency is of immunoglobulin A, which normally appears in secretions, such as saliva. People with immunoglobulin A deficiency are at risk of long-term (chronic) sinusitis, chronic lung infections and digestive problems. They also are more likely to have other autoimmune diseases, such as lupus and rheumatoid arthritis.

At the Dentist
If you have immunoglobulin deficiency, your dentist will make every effort to reduce the risk of infection. You may be given antibiotics before or after treatment, or both, to prevent infection. Tell your dentist about all the medicines you take. This should include over-the-counter vitamins and herbal supplements. Also, let your dentist know if you have had a sensitive or allergic reaction to any medicine.