What is lupus?
Lupus is a chronic autoimmune disorder. If you have an autoimmune disorder, your immune system mistakenly attacks the healthy cells in your body, which causes inflammation. Symptoms include extreme fatigue, hair loss, skin rashes, cognitive dysfunction, severe muscle and joint pain, and ulcers in the mouth or nose. If lupus is left untreated, it can harm the organs and lead to other serious health problems, which can be fatal.
There are a number of people with lupus who only have mild symptoms. The disease can be survived but you have to learn how to live with it. To prevent significant organ damage, the symptoms must be controlled through treatment. You can prevent further damage to your organs through regular checkups with the doctor, rest, workouts, and proper medications.
What is a lupus mouth sore?
The usual information about lupus emphasizes how it affects major organs in the body such as the heart, kidneys, and lungs. Although such pieces of information are quite important, it is also good to point out that some patients with lupus deal with problems in the digestive system, which includes oral health.
One of the most common symptoms of lupus is mouth sores. They are also referred to as mouth ulcers or oral lesions, which can occur in about 40-50 percent of individuals with lupus.
Mouth sores due to lupus are not considered life-threatening. However, they can lead to discomfort and low self-esteem, which can affect the overall health of the affected individual. Lupus mouth sores are often seen on the roof of the mouth, but they can also occur inside the cheeks, gums, or lips.
Although few may experience slight pain, most of the time, lupus mouth sores are painless, which makes them different from other types of mouth sores such as canker sores. The oral lesions due to lupus are usually red-colored and surrounded by a white halo along with white lines that radiate from the center of the ulcer. These lesions are called discoid lupus lesions.
Individuals dealing with lupus also complain of burning sensations and soreness in the mouth along with mouth dryness due to the lack of saliva production. Such condition usually happens due to an overlapping disease with lupus known as Sjogren’s syndrome. This autoimmune disorder is known to affect the salivary glands as well as other glands that produce moisture.
Causes of Lupus Mouth Sores
Certain lupus medications can cause oral health problems. Below are five drug categories that can cause oral problems in lupus:
- COX-2 inhibitors
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Antimalarial drugs such as quinacrine or hydroxychloroquine
- Rituxan (rituximab)
- Immunosuppressive drugs such as methotrexate, cyclosporine, azathioprine, and cyclophosphamide.
These drugs can potentially cause oral health problems. However, such problems must not be automatically assumed as a result of lupus. Below are three main categories of drug reactions:
- Certain changes in the pigment of the lining in the mouth
- Opportunistic oral infections, which usually affect individuals with impaired immunity
- Drug reactions due to other medications
Lupus is not the only reason for the development of mouth sores as there are a number of other causes, which include:
- Stress or Anxiety Attack: Stress has been considered as one of the major culprits of any disease. Stress tends to aggravate any condition even if an individual looks fine. Too much of emotional, mental, or physical stress can lead to mouth ulcers as well.
- Certain Food Items: Food items such as processed or junk foods are readily available in every nook and corner. Foods such as peanuts, chocolate, cheese, tomatoes, strawberries, wheat flour, almonds, and coffee may cause mouth sores.
- Quitting Smoking: When an individual stops smoking, the body is dealing with a lot of hormonal and chemical changes leading to the occurrence of mouth ulcers. However, such changes are usually temporary and with proper care, the oral lesions would slowly heal on their own.
- Hormonal Changes: It has been observed that certain women develop mouth ulcers during their regular menstrual cycle since there are hormonal changes happening in the body during that period. These changes are also temporary and tend to go away on its own.
- Additives Present in Toothpaste: Few individuals tend to be more sensitive toward sodium lauryl sulfate, which is found in certain kinds of toothpaste. The toothpaste additive may cause oral lesions to some people.
- Trauma to the Mouth: Any kind of trauma to the mouth such excessive brushing, accidentally biting one's cheek, and chewing hard or sharp food items can cause sensitivity to the gums leading to mouth ulcers.
Apart from lupus, there are also certain medical conditions that are associated with the formation of mouth sores:
- Crohn’s Disease: Individuals with Crohn’s disease may experience gum problems and dental cavities along with mouth sores.
- Immunodeficiency: Lupus medications are known to suppress the immune system, thus making it weak. Having an impaired immune system can often lead to the development of mouth sores.
- Iron Deficiency: When there is iron deficiency, there is also a reduction in the amount of oxygen that needs to reach the organs and tissues in the body. Such condition may lead to mouth ulcers.
Diagnosing Lupus Mouth Sores
Mouth sores or oral lesions can be of two types:
- Lesions that are not associated with an active disease such as lupus
- Lesions associated with an active disease
Not all mouth sores are due to an active lupus disease. The only reliable method to correctly diagnose the condition is through a biopsy, which will help identify if the oral lesions are due to an active disease or not. A biopsy is a procedure wherein a doctor takes an oral tissue sample for diagnosis.
The doctor would rotate a small bristled brush over the affected area, which would cause pinpoint bleeding or abrasion. The cells collected from the affected area are examined under the microscope by a pathologist. Approximately 40-50 percent of patients with lupus develop mouth sores as a side effect of lupus medication instead of being associated with an active lupus condition.
Doctor usually prescribe steroids such as prednisone, which can be directly injected into the lesion. However, the drug can also be topically applied. If the lesions are more resistant, then they can be treated with a certain antimalarial drug called Plaquenil (hydroxychloroquine). Moreover, the most important thing to do is to control the active form of lupus to help reduce the occurrence of oral lesions.
Individuals with lupus can lessen the occurrence of mouth sores by:
1. Lowering Stress Levels
To be diagnosed with the disease brings along a lot of stress and tension. However, you can relieve stress by carrying out relaxing activities such as meditation, breathing exercises, and yoga. You can also divert your mind by reading books, listening to soothing and calming music, along with participating in doing gentle forms of exercises such as walking or swimming. The important thing is to learn how to connect the mind and body in such instances to help reduce the symptoms and side effects of medications.
2. Making Dietary Changes
A large body of research shows that a healthy diet plays an important role when it comes to managing autoimmune diseases such as lupus. Since lupus is a chronic inflammatory condition, it is possible, although not proven, that consuming anti-inflammatory foods could help minimize the symptoms of lupus. Foods rich in antioxidants such as fresh fruits and vegetables have possible anti-inflammatory properties. Other foods that may help fight inflammation include fish, which contain omega-3 fatty acids, ground flaxseed, olive oil, and nuts.
3. Maintaining Good Oral Hygiene
Oral hygiene is very important to avoid any type of oral problems. Use a soft bristle toothbrush while brushing and avoid getting in contact with the affected area to prevent injury. You can also schedule an appointment with your dentist to better understand the importance of oral health after being diagnosed with lupus.
4. Taking Lupus Medications as Recommended
It is quite important to understand that medications cannot cure lupus. They can only control lupus symptoms as well as prevent or slow down organ damage. Moreover, lupus treatment usually depends on your signs and symptoms. You can discuss with your doctor regarding the risks and benefits of lupus medications.
Reach Out to Your Dentist
After being diagnosed with lupus, it becomes important to inform your dentist as soon as possible. Both your dentist and rheumatologist must be aware of your condition. The dentist should also be aware about your medical history to understand how lupus can affect your oral health. Inform the dentist if you had oral lesions in the past. You can also provide the dentist with a detailed list of your medications along with any dietary supplements or vitamins taken.
Dental procedures can be safely and effectively carried out if your dentist is aware and has a complete understanding of your medical history. Visit your dentist regularly to have a careful examination of the oral soft tissues. Schedule an appointment once in every three months as opposed to once in six months, which is normally recommended for individuals without lupus.
If you happen to have oral lesions or sores, your dentist can perform a tissue biopsy to determine what has caused your mouth sores.