Immune Disorders

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.

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.

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.

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.