Communication between patient, physician and dentist is essential. Lupus patients should visit the dentist at regular intervals, usually every two to six months. The patients 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-effcts of all the medications. The patient's physician should in turn be made aware of any dental problems and the proposed treatment.

If the lupus patient needs dental surgery, open communication between physican and dentist is especially important. The surgical procedure may well require a change in the dosage of any steroid medications and may require prophylactic antibiotics if the patient has certain kinds of lupus heart disease. In such cases it may be necessay for the dentist to consult the patient's physician to decide on the best management. Post-operative examinations 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 dental patient.

SELF EXAMINATION

Self-examination of the mouth should regularly be performed by lupus patients. Periodontal disease, which causes the greatest amount of tooth loss in adults and affcts 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 inflammatory conditions which affect the gums and supporting bones around each tooth. The most common periodontal disorders are gingivitis (inflammation of the gingiva or gums) and periodontitis (inflammation affecting the bone under the gingiva). The presence of any of the following signs and symptoms may indicate the presence of gingivitis.

1. Bleeding gums: gingiva which bleeds on eating or brushing teeth, or bleeds without any obvious cause.
2. Swollen gums: enlarged gingiva which is not bound tightly around each tooth.
3. Red gums: gingiva which is red in colour. Dark coloured gingiva due to naturally occuring melanin (the substance which colours the gums) is not an indication of inflammation.
4. Sensitive gums: gingiva which is painful to brushing. Untreated gingivitis can progress into the tissues under the gingiva and cause the bone which supports the teeth to become weakened and resorb.

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 as gingivitis. If any signs or symptoms of gingivitis or periodontitis are noted, the lupus patients should tell his/her dentist. A dentist can accuratley 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 in your mouth for 15 to 30 seconds once 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 the tooth should be very carefully brushed. The area between the teeth cannot be cleaned by a toothbrush. Dental floss, dental tape, rubber tips, special brushes and stimulators are used to remove the dental plaque which is deposited between adjacent teeth.

It should take approximately three minutes to brush your teeth thoroughly. Plaque which causes dental caries 9 cavities) and periodontal disease accumulates on all tooth surfaces and must be removed daily. Any areas of gingival sensitivity, tooth sensitivity or gingival bleeding require efective brushing or the sensitivity and bleeding will get worse. If it hurst or if it 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.

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