Lupus Australia, Queensland Inc

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Dental problems and the Lupus patient

Communication Communication between patient, physician and dentist is essential. Lupus patients should visit the dentist at regular intervals, usually every two to six months. The patient must tell the dentist about their current and past medical history. The dentist should also be supplied with a complete list of medications the patient is taking. The dentist also needs to know the dosage and any side effects of the medications. The patient's physician should in turn be made aware of any dental problems and the proposed treatment.

If the lupus patients needs dental surgery, open communication between physician and dentist is especially important. The surgical procedure may well require prophylactic (preventive) antibiotics if the patient has certain kinds of lupus heart diseases (the kind that effects the valves of the heart.) In such cases it must be necessary for the dentist to consult the patient's physician to decide on the best management. Post-operative exemptions for the lupus patient must be more frequent and extend over a longer period of time than would be the case for the non-lupus patient.

Self-examination Lupus patients should regularly perform self-examination of the mouth. Periodontal diseases, which cause the greatest amount of tooth loss in adults and affects almost everyone, usually does not cause pain and may not give warning until significant tissue breakdown has occurred. However, there are signs and symptoms of periodontal disease, which the patient can detect with self-examination. There are also certain procedures the patient can perform to prevent and help control periodontal disease. Periodontal disease is a group of inflammable conditions, which affect the gums (gingiva) and supporting bone around each tooth. The most common periodontal disorders are gingivitis (inflammation of the gingiva or gums) and periodontitus (inflammation affecting the bone under the gingiva). Any of the following signs and symptoms may indicate the prussic of gingivitis.

Bleeding gums: Gingiva, which bleed on eating or brushing teeth, or bleed without any obvious cause.

Swollen gums: Enlarged gingiva, which is not bound tightly around each tooth.

Red gums: Gingiva, which is red in colour. Dark coloured Gingiva due to naturally occurring melanin (the substance which colours the gums) is not an indication of inflammation.

Sensitivity gums: Gingiva, which is painful to brushing. Untreated Gingiva can progress into the tissues under the Gingiva and cause the bone, which supports the teeth to become weakened and resorb.

Periodontitis: Periodontitis is a form of dental disease, which is marked by bone loss and will eventually lead to loosening or loss of teeth. It is usually painless and may have the same signs and symptoms of gingivitis. If any signs or symptoms of gingivitis or periodontitis are noted the lupus patient should tell the dentist. A dentist can accurately diagnose and treat periodontal disease.

Prevention

Prevention is the best treatment for dental disease. The only way to prevent periodontal disease is by effective tooth-brushing techniques. Putting toothpaste on a toothbrush and swishing the brush around your mouth for 15 - 30 seconds one or twice a day is not effective tooth brushing. Tooth brushing must clean all five surfaces of each tooth. The most critical area of the tooth to clean is immediately adjacent or next to the gingiva or gums. Therefore the junction between the gum and tooth should be very carefully brushed. The area between the teeth cannot be cleaned by a toothbrush. Dental floss, dental tape, rubber tips, special (interproximal) brushes and stimulates are used to remove the dental plaque which is deposited between adjacent teeth. It should take approximately 3 minutes to brush your teeth thoroughly. Plaque which causes dental cavities and periodontal disease accumulates on all tooth surfaces and must be removed daily. Any areas of gingival sensitivity, tooth sensitivity and bleeding will get worse. If it hurts or bleeds it should be brushed harder.

Lupus patients should check the inside of their mouths regularly for any red or irritated areas. If such areas are noticed these should be brought to the attention of the physician and dentist. Approximately 25% of lupus patients have these kinds of oral problems, which are usually accompanied by a skin irritation or facial rash. Oral problems in lupus are also found on the lips and on the tissue inside the cheeks. Patients with active oral problems should not use denture powder or denture paste to hold in removable dentures. If toothpaste irritates the mouth, baking soda and water should be substituted for it.

With communication, self-examination and prevention the lupus patient can keep dental problems under control.

Reprinted with thanks from the Sussex Lupus Group newsletter No. 25, 1998

 

Updates

Why are new lupus drugs needed?

What should lupus patients and their families know about Benlysta? WebMD consulted Eric L. Gredinger, MD, chief of rheumatism and immunology at the University of Miami Miller School of Medicine, FDA briefing documents, and the FDA approval announcement.

 

Officially know as systemic lupus erythematosus (SLE), lupus ia an autoimmune disease. It's relatively common, affecting about one in 1,000 people. But some people with lupus have such mild disease they may never know they have it.

Others have relatively mild disease that can be controlled with current treatments. These include over-the-counter NSAIDs such as ibuprofen, corticosteroids such as prednisone, antimalaria drugs such as hydroxychloroquine, powerful immunosuppressants, and cancer chemotherapies. (Lupus is not caused by malaria and is not a cancer, but malarial drugs and chemotherapies suppress various manifestations of lupus).

Still other patients experience frequent lupus flare-ups and suffer devastating side effects from current treatments. And finally, there are patients with life-threatening lupus, at risk of major organ failure.

In all those cases, the current drugs while not perfect provide a good series of choices,” Greidinger says.

Patients with mild disease may not need treatment, or may be able to keep their symptoms under control with relatively safe antimalaria drugs.

Patients with the most severe disease – including lupus affecting the kidneys or brain – can benefit from more aggressive treatment.

But patients in the middle category are more difficult to treat, Greidinger says. They may not get relief from the safest lupus treatments. But stronger treatments, continued over time, may cause side effects that are worse than a patient's symptoms.

 

 

 

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