Canker sores old and recurrent? Bad teeth? Beware of lupus finding your door with the latest review

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease whose etiology and pathogenesis are not fully understood
.
SLE often affects multiple systems and organs throughout the body, most commonly affecting joints, skin, lungs, kidneys, etc.
, and oral lesions such as mouth ulcers, dry mouth, and periodontal disease are also common
.
It is reported that more than 40% of SLE patients will have oral lesions, which seriously affect the quality of life of
patients.
The 2019 European Union Against Rheumatology (EULAR)/American College of Rheumatology (ACR) SLE classification standard highlights the importance of oral examination for patients with SLE by including mouth ulcers as one of
the diagnostic criteria.
To enhance the understanding of SLE oral lesions, the clinical manifestations and management of SLE will be described ^here1
.

What are the manifestations of SLE oral lesions?

Oral mucosa

Oral mucosal lesions are one of the most common oral manifestations of SLE and may be the only observable lesion in some cases
.
Oral lesions of SLE are typically white plaques with central erythema or telangiectasia with keratinizing lines at the margins, as well as lichenoidosis, leukoplakia, ecchymosis, purpura, and erythema, often located on the lip or buccal mucosa
.
Some cases may present similarly to oral lichen planus and can cause pain and chronic burns
.
The study by Orteu et al.
found that in addition to general oral manifestations, patients with SLE develop honeycomb plaques (scarred plaques, silvery-white) and cheilitis
.
It is important to note that mouth sores that do not respond to treatment carry a risk
of progression to squamous cell carcinoma.

Teeth and periodontals

In a study in which a large number of cariogenic bacteria (Streptococcus distalis and Streptococcus mutans were detected) in supragingival plaque samples from patients with SLE, it has been noted that caries formation is related
to the pH of the patient's saliva and the rate of saliva flow.
Among periodontal lesions, patients with SLE may have acute necrotizing ulcerative gingivitis and periodontitis
.
Studies have shown that SLE patients are more likely to develop periodontal disease
than healthy people.
In addition, the study by Corría et al.
showed that SLE patients lose more teeth than healthy people
.
The number of teeth is an important indicator of oral health, and tooth loss can directly affect the quality of
life of patients.

salivary glands

The study by Leite et al.
noted that more than 75% of SLE patients have decreased saliva production, which may lead to the development of xerostomia; Also, with age and SLE activity, saliva production decreases
.
Similarly, in a case-control study conducted by Manzano et al.
, a significant association between xerostomia and SLE patients was ^found2
.
SLE may also be associated
with secondary Sjogren's syndrome.

Temporomandibular joint

It is reported that temporomandibular joint (TMJ) involvement in SLE patients usually occurs in the early stage of the disease, and the most common symptoms are regular pain, and temporomandibular joint snapping, difficulty opening the mouth, and decreased
mouth opening can also occur.
Psychosocial status and long-term glucocorticoid use in SLE patients may be risk factors
for TMJ involvement.

How are SLE oral lesions managed?

The oral and facial manifestations of SLE are often not diagnosed early, and the corresponding symptoms are often masked
by other constitutional symptoms.
Therefore, the prevention and management of oral diseases in SLE patients is very important
.
However, there is currently no consensus on
the best oral management methods.

Systemic immunosuppressants, antimalarials, and topical glucocorticoids can all be used to treat SLE oral mucosal lesions, and infection should be suspected in painful or bleeding oral ulcers, and topical antibiotics and antifungals (e.
g.
, nystatin) may be considered if ^confirmed3
.
It is inevitable that some therapeutic drugs can adversely affect oral health, and regular oral examinations should be performed to adjust treatment strategies and avoid further complications
.
In life, patients are advised to avoid sun exposure, especially those suffering from cheilitis; Regular wet compresses can relieve pain, and the use of petroleum jelly ointment or lipstick (UV protection) can keep the lips moist; Good oral hygiene and mouthwashes containing chlorhexidine are also needed to prevent secondary bacterial infections
.
In addition, in addition to drug treatment, the patient's presence of risk factors
for oral health, such as smoking, should also be considered.

In patients with tooth loss, oral lesions and decreased saliva production may affect denture removal and placement, and wearing removable dentures has been shown to affect oral health-related quality of life
in SLE patients.
Therefore, fixed teeth may be a better option for these patients, and artificial saliva may be used as an adjunct treatment
.
In addition, dental management of SLE patients is challenging, requiring multidisciplinary intervention
due to tooth loss, severe caries lesions, bone densitocria, and side effects of SLE treatment drugs.

summary

The oral manifestations of SLE are one of the earliest signs and symptoms that aid in the early diagnosis and treatment of ^SLE2, most commonly oral ulcers, as well as periodontal, salivary glands, and temporomandibular joint involvement
.
Systemic immunosuppressants, antimalarials, and topical corticosteroids can all be used to treat oral lesions, but some drugs can also adversely affect the oral health of patients, and regular oral examinations should be performed to adjust treatment strategies
.

References:

1.
Benli M, Batool F, Stutz C, Petit C, Jung S, Huck O.
Orofacial manifestations and dental management of systemic lupus erythematosus: A review[J].
Oral Dis.
2021 Mar; 27(2):151-167.
doi: 10.
1111/odi.
13271.
Epub 2020 Mar 3.
PMID: 31886584.

2.
García-Ríos, P.
; Pecci-Lloret, M.
P.
; Oñate-Sánchez, R.
E.
Oral Manifestations of Systemic Lupus Erythematosus: A Systematic Review[J].
Int.
J.
Environ.
Res.
Public Health 2022, 19, 11910.
https://doi.
org/10.
3390/ijerph191911910

3.
Rodsaward P, Prueksrisakul T, Deekajorndech T, Edwards SW, Beresford MW, Chiewchengchol D.
Oral Ulcers in Juvenile-Onset Systemic Lupus Erythematosus: A Review of the Literature[J].
Am J Clin Dermatol.
2017 Dec; 18(6):755-762.
doi: 10.
1007/s40257-017-0286-9.
PMID: 28477309; PMCID: PMC5680373.