Autoimmune Conditions and Oral Health

Scleroderma and vasculitis have a significant, life-long effect on oral health. Long standing oral health conditions may become worse over time. Treatments may not be curative, and may only improve the patients' quality of life. A timely diagnosis can prevent tooth loss as well as any further complications associated with it.

Oral health issues associated with scleroderma, vasculitis and myositis include:

• Xerostomia
• Microstomia
• Periodontal (gum) disease
• Idiopathic root resorption
• Temporomandibular joint disorders

Xerostomia

Xerostomia, or dry mouth, is caused by salivary gland dysfunction due to a variety of causes including medications such as antidepressants and antihypertensives, lip incompetence (the upper and lower lip may not meet together at rest), sleeping habits, or mouth breathing.

Xerostomia increases the risk of dental decay (caries), gum inflammation (gingivitis), fungal infections (e.g. thrush), oral malodor (halitosis), and can reduce or alter taste sensation. Mouth sores can also develop, especially in denture wearers. A lack of saliva can also decrease denture retention.

Management

• Perform oral hygiene as instructed
• Avoid sugary food and drinks
• Frequently sip fluids
• Avoid caffeine
• Use a humidifier
• Monitor your mouth for oral candidiasis (thrush)
• Use sugar-free saliva stimulants
• Mouth moisturizers
• Alcohol free mouth rinses
• Toothpastes high in fluoride (PreviDent 5000)

Microstomia

Microstomia is caused by severe sclerosis of the facial skin around the mouth, creating a limited mouth opening. It can occur in patients with scleroderma.

There is a high risk for dental problems due to limited oral access, challenging oral hygiene and dental rehabilitation.

Due to lip incompetence associated with severe microstomia, patients are more prone to develop severe xerostomia.

Management

• Daily mouth opening exercises, using tongue depressors and /or Therabite, Orastretch devices
• Perform exercises 20 min prior to your dental appointment
• Choose toothbrushes with smaller heads (toothbrushes for kids)
• Use interproximal toothbrushes instead of floss to maintain periodontal (gum) health

Periodontal (gum) disease

Periodontal (gum) disease is caused by the bacteria accumulated in dental plaque not being efficiently removed.

Periodontal disease manifests by bleeding and swollen gums, and tooth loss which can make chewing uncomfortable.

Management:

• Excellent oral hygiene
• Deep cleanings by your dentist
• Use of interproximal dental brushes and/or Waterpik
• Periodontal surgery to eliminate gum infection and prevent teeth from loosening

Idiopathic (unknown cause) root resorption

Idiopathic root resorption, or the loss or damage of the root of a tooth, is commonly found in patients with scleroderma. It can only be determined on dental x-rays, so regular dental visits are crucial.

Temporomandibular Joint Disorders

Temporomandibular Joint Disorders include a set of conditions characterized by pain in the jaw joint, the surrounding tissues and a limitation in jaw movement.

Symptoms may include pain in the jaw muscles, pain in the neck and shoulders, chronic headaches, jaw muscle stiffness, limited movement or locking of the jaw, ear pain and pressure, painful clicking, popping or grating in the jaw joint when opening or closing the mouth, and a bite that feels "off".

Management:

• Night guard fabricated by your dentist
• NSAID’s (e.g. Ibuprofen)
• Muscle relaxants (Flexeril)
• Warm compresses
• Limited mouth opening
• Avoid chewy foods

Other conditions associated with Scleroderma and Vasculitis include an increased risk of fungal infections, painful mouth ulcers, dysphagia or difficulty swallowing, and dysgeusia or altered taste.

While Visiting Your Dentist

Make sure to get regular dental visits for early detection and prevention of the conditions mentioned above.

Ask for short dental appointments and schedule them for the morning when you are less tired.

Ask your dentist to select a toothbrush that is easy to use especially if you have an impaired manual dexterity due to sclerodactyly (tightness in your fingers).

Make sure to provide the list of all the medications you are currently taking as well as the medications you had taken in the past.

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