Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. This systemic inflammation can affect virtually any part of the body, and the oral cavity is frequently involved. Lupus often directly impacts the gums and surrounding oral tissues through specific lesions, heightened susceptibility to periodontal disease, and side effects from necessary treatments. Recognizing these oral manifestations is an important step in managing the overall health of a person with lupus.
Direct Signs of Lupus in the Mouth
Lupus can cause distinct and visible manifestations directly on the gums, cheeks, tongue, and palate, which often signal active disease or a flare-up. The most common direct signs are oral ulcers, sometimes referred to as lupus stomatitis, which occur in up to 45% of patients with SLE. These ulcers are a direct result of the autoimmune attack on the mucosal lining of the mouth.
Lupus-specific lesions frequently appear as reddish spots surrounded by a white, halo-like border, sometimes with fine white lines radiating outward. They are often located on the hard palate, inside the cheeks (buccal mucosa), and on the lower lip. Unlike common canker sores, lupus-related ulcers can be entirely painless, making regular self-examination and professional dental checks important.
A more specific type of lesion is the chronic discoid lupus erythematosus (DLE) lesion, which can manifest in the mouth as well as on the skin. These lesions are generally well-defined, red, and may be atrophic or ulcerated. The presence of these lesions is a direct clinical sign of autoimmune activity, and their appearance often prompts further investigation into the patient’s systemic disease status.
How Systemic Inflammation Affects Periodontal Health
Even without specific lupus lesions, the chronic inflammation inherent to SLE significantly contributes to a heightened risk and severity of gum disease. Lupus patients are more likely to have periodontitis, the advanced stage of gum disease, compared to the general population. The systemic nature of lupus means that inflammatory markers (such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)) are elevated throughout the body.
This continuous state of systemic inflammation can exacerbate the destruction of supporting gum tissue and bone caused by bacterial plaque. The immune system’s overreaction inadvertently worsens the body’s response to the bacteria that cause periodontitis. Studies have indicated that treating periodontitis in lupus patients can help reduce these serum inflammatory markers, suggesting a two-way link between oral health and systemic disease activity.
The chronic immune dysregulation in SLE can make the oral environment more susceptible to an aggressive inflammatory response, accelerating the progression from simple gingivitis to deep-pocket periodontitis. Maintaining meticulous oral hygiene is not just about preventing cavities, but also about controlling a source of inflammation that can potentially influence overall lupus activity.
Oral Side Effects of Lupus Medications
The medications used to manage lupus, while necessary for controlling the autoimmune response, can introduce their own set of oral health challenges. A frequent and significant side effect is xerostomia, or dry mouth, often caused by immunosuppressants and corticosteroids. Dry mouth increases the risk of tooth decay and gum disease because saliva is essential for washing away food particles and neutralizing acids.
The use of immunosuppressive drugs also increases a person’s susceptibility to opportunistic infections. One of the most common of these is oral candidiasis, or thrush, which is a fungal infection that appears as white, scrapable plaques on the tongue and inner cheeks. Long-term steroid use is particularly associated with this increased infection risk due to the suppression of the immune system’s normal defenses.
Certain medications, including antimalarials, may also cause changes in the pigmentation of the oral lining, typically appearing as dark or hyperpigmented spots on the hard palate or tongue. These drug-related complications require careful monitoring, as they can sometimes be mistaken for disease manifestations and complicate the overall clinical picture.
Treatment and Long-Term Management
The long-term management of oral issues in lupus requires a coordinated, multidisciplinary approach involving both the rheumatologist and the dental professional. For active lupus lesions, treatment often involves topical corticosteroids applied directly to the ulcers to reduce local inflammation. If the oral lesions are persistent or widespread, the rheumatologist may need to adjust the systemic lupus therapy to better control the underlying disease activity.
Managing medication side effects, particularly xerostomia, is a practical priority for preventing long-term damage like severe tooth decay. Patients can use over-the-counter saliva substitutes, such as sprays or gels, and chew sugar-free gum containing xylitol to stimulate natural saliva flow. Regular, aggressive oral hygiene, including fluoride rinses and frequent brushing, is necessary to combat the increased risk of cavities and gum disease associated with dry mouth.
Frequent dental visits are necessary for patients with lupus, often requiring professional cleaning and examination every three to six months. Open communication between the patient’s medical and dental teams ensures that treatment plans are safely coordinated, especially before any invasive dental procedures.