“What’s the best time to visit the dentist?......2:30”
Last week I spent an hour in the dentist’s chair having a broken tooth fixed. I have no idea how I broke the tooth. One minute I had a perfectly healthy molar and the next I had a molar with hole in it. The hole felt like a huge crater, but in reality it was just a small chip.
I’m not fond of visiting the dentist but I do make sure that I have regular check-ups. Until recently, my teeth have been in pretty good health; a few fillings but no major issues. In fact, dentists have often commented on how well I look after my teeth.
My current dentist is very good but I had a bad experience in my twenties which makes me very nervous in the dentist’s chair. I am certain that this previous dentist was a Sadist – he gave me four fillings in one session with no anaesthetic. He said that the fillings were small and that it would be better for me not to have a numb mouth after he had finished. The ‘Sadentist’ seemed to revel in the pain and discomfort that he was causing and he took his sweet time drilling each tooth. The worst part of the whole experience was the slow drill. The noise and vibration was awful and only served to heighten my pain. I shudder just thinking about the whole experience.
And so it was with great trepidation that I lay down in the dentist’s chair last week to have my broken tooth fixed. To my great relief the first thing the dentist did was to numb my mouth. I gripped my hands firmly across my stomach as she started work on the broken tooth. I closed my eyes and tried to think of something relaxing. I imagined that I was swimming in the ocean with dolphins. I could feel their soft skin as they swam past…. The spell ended abruptly when the dentist cracked out her slow drill. Suddenly I was back in the 'Sadentist' chair! My hands started to shake first, then my whole body started shaking. The poor dentist must have thought I was some kind of nutter! In any event, she put down the drill and started to work on the tooth with a different tool. I closed my eyes once more and tried to go back to my relaxing ocean scenario but it didn’t work. The once peaceful dolphins were now dressed as dentists and they were grinning wildly!
After the drilling and scraping was finished the dentist got to work rebuilding the tooth. My jaw was aching. Holding your mouth open for an hour is really hard! We had just got to the final polishing stage when I let out the most monstrous scream! My lupus sent a huge stabbing pain through my left kidney and sent my body into spasm. My back arched right off the chair. It felt like I had been hit by a bolt of electricity. It scared the crap out of the dentist and her assistant! When the pain finally subsided, there were tears in my eyes and I felt very embarrassed. I hurriedly explained that the pain was caused by my lupus and not the dental work. Fortunately the dentist was very understanding and asked if there was anything she could do to help.
After my trip to the dentist it occurred to me that I have had more problems with my oral health since my lupus became more active three years ago. I have already written a blog post about lupus and mouth ulcers but in the past few years I have also developed a few other problems including tooth grinding, receding gums and bleeding after brushing. And now this broken tooth…. Some of these problems could be down to the natural ageing process but I wondered whether lupus could have exacerbated matters? Could there be a link between my recent dental issues and the increased activity of my disease?
I didn’t have to look very hard to find the answer. A quick internet search informed me that lupus can cause or exacerbate many oral health issues including the problems that I have been experiencing (teeth grinding, bleeding gums and cavities).
Around 40% of lupus warriors experience mouth ulcers. Ulcers often develop on the roof of the mouth but can occur in any part of the mouth, including the lips. This week I have noticed at least three mouth ulcers: one on the roof of my mouth, one on the inside of my bottom lip, and another on the side of my tongue.
Lupus can also cause a decrease in the production of saliva leading to oral dryness (Xerostomia). Decreased saliva production can be caused by abnormal saliva gland function or as a side effect of certain medicines used to treat lupus symptoms. Saliva is important to oral health because it removes food particles and neutralises acids present in the mouth. A reduction in saliva production can therefore result in an increase in mouth acidity, plaque build-up, tooth decay and inflammation of the gums (gingivitis). Oral dryness affects many lupus warriors but can also be caused by Sjögrens syndrome, another auto-immune disease. Sjögrens syndrome can occur as a primary condition (i.e. the main disease affecting a patient) or as a secondary condition that overlaps with lupus.
Several studies have identified a link between lupus (SLE) and gum disease (periodontitis). A recent study by Hao-Jie Zhong et al (2020) identified “a significant association between periodontitis and SLE”. The study also showed that lupus patients with gum disease were more likely to experience bleeding gums and tooth loss. Another study (Bagvant et al, 2019) has identified a link between plaque-based bacteria from gum disease and increased lupus disease activity.
The main takeaway from my research is that good oral hygiene is very important for lupus warriors. Good dental practices such as frequent brushing, flossing, and regular check-ups can:
- protect teeth and gums,
- reduce the potential for bacteria to affect other parts of the body, and
- help to prevent flares.
References
Benli M, Batool F, Stutz C, Petit C, Jung S, Huck O (2021). Orofacial manifestations and dental management of systemic lupus erythematosus: A review. Oral Diseases. Volume 27, Issue 2, pp 151-167.
Durcan R, Fu W, Petri M (2015) Oral Ulcers in Systemic Lupus Erythematosus: Characterization and Clarification of an Important Clinical Manifestation. Arthritis Rheumatology. Volume 67 (suppl 10).
Hao-Jie Zhong, Hui-Xin Xie, Xiao-Min Luo and Er-Hua Zhang (2020). Association between periodontitis and systemic lupus erythematosus: a meta-analysis. Lupus An International Journal. Volume 29, Issue 10.
Kaleidoscope Fighting Lupus (https://kaleidoscopefightinglupus.org/the-impact-of-lupus-on-oral-and-dental-health)
Lupus Foundation of America (https://www.lupus.org/resources/oral-health-issues-with-lupus)
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