Rheumatoid arthritis is a disease characterized by inflammation. Because this
condition affects the joints, your jaw
joint (the temporomandibular joint) may be affected, which can cause
discomfort and difficulty chewing. If your rheumatoid arthritis affects
your hands, you may have difficulty brushing and flossing. Your dentist
can tell you about special brushes and procedures that make it easier
to clean your teeth.
Some people with rheumatoid arthritis also have Sjögren's syndrome,
a disorder of the salivary and tear glands that causes dryness of the mouth
and eyes. This may make it difficult for you to chew your food and can cause
heavy plaque deposits on your teeth, increasing the risk of tooth decay and gum disease.
You also may have problems wearing dentures because of the dryness.
Some of the medications used to treat rheumatoid arthritis can cause mouth
irritation and inflammation. Also, many medications taken for rheumatoid
arthritis can cause dry
mouth, so good oral hygiene is important. Your dentist can talk to you
about agents to help reduce the dryness and may prescribe a topical fluoride treatment
to reduce the risk of decay.
If your temporomandibular (jaw) joint is involved in your arthritis, it
may be difficult for you to undergo very long dental procedures. You can
have a few short appointments instead of one long one, or if the appointment
is for elective dental care, you can wait until you feel better.
Steroid therapy is also common in people with rheumatoid arthritis. People
on long-term steroid therapy may not be able to cope with stress as well
unless they take a replacement dose of steroids. If you have been on steroids
for more than a few weeks or if you have a history of such reactions after
dental treatment, you may need to take additional steroids before long or
stressful treatment.
If you have had joint replacement, your dentist may give you antibiotics
before dental treatment to prevent a bacterial infection in the joint. If
you are scheduled for joint-replacement surgery, consider having all necessary
dental surgeries before the replacement.
Lupus Erythematosus
Oral Effects
Lupus is an autoimmune disease that affects multiple organs, including the mouth.
Various studies report that more than 50% of lupus patients get sores on their
lips, palate, and on the insides of their cheeks. Many also have soreness or
burning of the mouth and experience a lack of saliva (dry
mouth or xerostomia). People with lupus also commonly have salivary-gland
disease, which can cause dry mouth, or are taking medications that can cause
dry mouth. Dry mouth increases the risk of
tooth
decay because
saliva normally washes away food particles, sugars and bacteria that can lead
to cavities.
At the Dentist
Because lupus affects the entire body, it requires special attention by your
dentist. People with lupus may have low platelet counts, which can increase
the risk of bleeding. Some people with lupus have heart murmurs because they
have problems with their heart valves. If you have a heart murmur, you may
need antibiotics before any dental treatment that might introduce bacteria
into your bloodstream.
A common treatment for lupus is the use of steroids. If you are taking
long-term steroids, you may need an extra dose of steroids before a long
or stressful dental appointment. When you take steroids for an extended time,
your adrenal glands — which normally produce hormones that respond
to stress — don't work as well. This means that your body is less able
to respond to stress, which can cause serious problems.
Some medications for lupus also can suppress your immune system, so you
may need antibiotics before or after dental treatment. Because these medications
can affect your blood counts, give a copy of your most recent blood tests
to your dentist as often as it is available.
Many medications can make lupus worse or make you more prone to shock or
infection. Give your dentist a list of the medications you are taking and
let him or her know about any drug sensitivities or allergies you may have.
Scleroderma (Progressive Systemic Sclerosis)
Oral Effects
Scleroderma is a disease that causes hardening of the skin, especially on the
hands and face. In people with scleroderma, the lips and tongue can become
rigid and the mouth narrows. The folds of skin around the mouth disappear,
giving the face a masklike appearance. If tissues around the temporomandibular
joint are affected, jaw movement is reduced. If the face is severely tightened,
the resulting pressure can damage the lower jaw.
If you have scleroderma, the narrowing of your mouth and the rigidity of
your lips and tongue can make it difficult for you and your dentist to access
your mouth, particularly your back teeth. As the disease gets worse, it can
become more difficult for your dentist to prepare dentures, crowns and appliances.
Therefore, it is important to make every effort to keep your teeth and gums
healthy to avoid tooth loss.
People with scleroderma also may have oral problems because of the drugs
they take. Common problems are dry
mouth (xerostomia),
gum overgrowth and an increased susceptibility to cavities and periodontal
disease.
At the Dentist
If you have scleroderma, your dentist should be aware of the medications you
are taking and the symptoms you have to ensure that proper precautions are
taken to minimize bleeding, infection and other negative side effects. Because
this disease affects the whole body, your dentist needs to know if any of your
organs are affected because this may affect how he or she provides dental care.
For example, if your scleroderma has affected your kidneys, you may not be
able to process medications as well.
The oral implications of scleroderma are many and varied. If your lower
jaw has been affected by scleroderma, the bone may be more likely to fracture
when you have more rigorous dental treatments, such as a tooth extraction.
Dental procedures may take a little longer to perform because it may be more
difficult for you to open your mouth. Your dentist may encourage you to have
more frequent cleanings to help prevent tooth decay and periodontal (gum)
disease.
Selective Immunoglobulin Deficiencies
Oral Effects
Immunoglobulin deficiencies are a group of disorders that affect a type of white
blood cell called a B cell. People with immunoglobulin deficiencies are missing
one or more types of immunoglobulins, or antibodies. They are more prone to
bacterial infection. The most common deficiency is of immunoglobulin A, which
normally appears in secretions, such as saliva. People with immunoglobulin
A deficiency are at risk of chronic sinusitis, chronic pulmonary infections
and digestive problems. They also are more likely to have other autoimmune
diseases, such as lupus and rheumatoid arthritis.
At the Dentist
If you have immunoglobulin deficiency, your dentist will make every effort to
reduce the risk of infection. You may be given antibiotics before or after
treatment, or both, to prevent infection. Give your dentist a list of the medications
you are taking, and let him or her know about any drug sensitivities or allergies
you may have.
Thymic Hypoplasia
Oral Effects
People with thymic hypoplasia, or DiGeorge's syndrome, have the
following disorders: poorly functioning immune system, poorly functioning
parathyroid glands and congenital heart defects. People with thymic
hypoplasia have an immune system that is deficient in a type of
white blood cell called a T cell. Therefore, they are prone to
viral and fungal infections, especially in the mouth. A common
fungal infection is oral candidiasis, or
thrush. A common viral
infection is herpes simplex, which appears as a
cold sore.
In addition, people with thymic hypoplasia may have defects of the mouth
and jaws, including cleft
palate, a split uvula, a receding chin and a shorter-than-normal distance
between the nose and the upper lip.
At the Dentist
If you have thymic hypoplasia, your dentist will make every effort to reduce
the risk of infection. You may be given antifungal therapy or if you have a
cold sore, you may be given antiviral drugs to fight the infection. You might
also need antibiotics before or after treatment, depending on your health status.
Give your dentist a list of the medications you are taking and let him
or her know about any drug sensitivities or allergies you may have.
Dermatomyositis
Oral Effect
Dermatomyositis is an inflammatory disease of the muscles. The most common sign
of dermatomyositis affecting the head and neck is muscle weakness, which can
cause difficulty in swallowing and chewing. Children with dermatomyositis may
have calcified nodules in their facial tissues and tongue that can be seen
up on dental X-rays.
At the Dentist
People with dermatomyositis usually don't need special modifications to their
dental care. Even so, you should give your dentist a list of the medications
you are taking and their doses and tell him or her about any drug sensitivities
or allergies you may have.
X-Linked Agammaglobulinemia
Oral Effects
A hereditary disease of male children, X-linked agammaglobulinemia (XLA) — also
called Brutons agammaglobulinemia — is caused by a defect in the function
of a type of white blood cell called a B cell. People with XLA cannot produce
all the antibodies they need, so they are very susceptible to bacterial infections.
If you have XLA, you probably will have recurrent bacterial infections,
some of them oral infections. You also may have chronic sinusitis. Your dentist
should treat any dental or oral infection immediately. Good oral hygiene
is extremely important, because any oral infection that occurs can worsen
very quickly.
At the Dentist
People with symptomatic B-cell abnormalities usually are given monthly therapy
of concentrated human gamma globulin. Before you go to the dentist, your gamma
globulin level should be checked to ensure it is at least 200 milligrams per
deciliter (mg/dl). If you need oral surgery, you should have extra gamma globulin
the day before your appointment.
Give your dentist a list of the medications you are taking, and let him
or her know about any drug sensitivities or allergies you may have.
Ataxia Telangiectasia
Oral Effects
Ataxia telangiectasia is a disorder characterized by:
- Ataxia, or difficulty controlling voluntary muscles
- Telangiectasias, or lesions of the skin or eyes
- Immune system malfunction
The immune system doesn't function properly in people with this disease
because of abnormalities in two types of white blood cells — T cells
and B cells. Because of these deficiencies, people with ataxia telangiectasia
are more prone to bacterial, fungal and viral infections.
At the Dentist
If you have ataxia telangiectasia, your dentist should make every effort to minimize
the risk of infection. You may be given antifungal therapy or antibiotics before
or after treatment, or both, to avoid new infections or spreading existing
ones.
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