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Oral Health and Autoimmune Disorders - An Overview

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Patients with autoimmune illnesses may first exhibit symptoms in their mouths before other body parts. Read below to know more.

Medically reviewed by

Dr. Shweta Sharma

Published At November 1, 2023
Reviewed AtFebruary 27, 2024

Introduction

An increasing amount of data suggests that the incidence of autoimmune diseases in which the body targets its own cells has increased recently. These illnesses are starting to occur as frequently as cancer and allergies. Infections are becoming less common in Western society. Before these illnesses manifest elsewhere in the body, dentists frequently spot early warning signs of them in the mouth. Early disease detection can be facilitated by dentists, which will result in better and more efficient treatments.

What Are Autoimmune Disorders?

An autoimmune disorder is a condition in which the immune system mistakenly attacks healthy body tissues. This can lead to a variety of symptoms, depending on the organs or tissues that are affected. Autoimmune disorders can be mild or severe, and some can be life-threatening. There is no cure for most autoimmune disorders, but treatment can help manage symptoms and improve quality of life.

What Is the Relationship Between Oral Health and Autoimmune Disorders?

The relationship between oral health and autoimmune disorders is complex and can have a significant impact on an individual's overall well-being. Autoimmune disorders are conditions in which the immune system mistakenly targets and attacks the body's own tissues and organs. Oral manifestations in some autoimmune disorders include:

1. Systemic Lupus Erythematosus

The autoimmune disease known as systemic lupus erythematosus (SLE) is a severe and chronic condition. It can lead to several health issues and it primarily affects women. In SLE, the immune system which ordinarily defends the body inadvertently targets its own cells. This causes damage and inflammation in several organs.

Oral Manifestations:

  1. Oral Ulcers: These are shallow, painful sores that can appear anywhere in the mouth, including the tongue, gums, and inner cheeks. Oral ulcers in SLE are typically small and round, with a white or gray center and a red border.

  2. Dry Mouth (Xerostomia): This is a common symptom of many autoimmune disorders, including SLE. It can be caused by inflammation of the salivary glands or by certain medications used to treat SLE.

  3. Cheilitis: This is inflammation of the lips, which can cause dryness, cracking, and redness.

  4. Gingivitis: This is inflammation of the gums, which can cause redness, swelling, and bleeding.

  5. Periodontitis: This is a more severe form of gum disease that can lead to tooth loss.

Diagnosis: Examining the patient's symptoms and checking the blood for certain antibodies are necessary for the diagnosis of SLE. A biopsy, which involves removing a tiny sample of affected tissue, may be necessary for clinicians to provide a definitive diagnosis because it can be difficult to distinguish SLE from other skin illnesses at times.

Treatment: The goals of treatment are to control symptoms, lessen inflammation, and stop flare-ups. Commonly used medications include corticosteroids, immunosuppressants, and hydroxychloroquine. It is also critical to shield the skin from sunlight to stop symptoms from getting worse.

2. Sjogren Syndrome

Sjogren syndrome is a medical disorder in which the body's tear and salivary glands are unintentionally attacked and damaged by the immune system. This results in less saliva production which causes xerostomia, or dry mouth, and xerophthalmia, or dry eyes. It primarily affects women and affects between 0.5 and 3 percent of the population. The illness can manifest on its own or in conjunction with other autoimmune conditions such as rheumatoid arthritis (chronic inflammatory disorder affecting many joints, including those in the hands and feet).

  • Oral Manifestations:

    • Dry mouth.

    • Dry lips (cheilitis).

    • Difficulty chewing and swallowing.

    • Increased risk of tooth decay and gum disease.

    • Painful mouth sores.

    • Fungal infections of the mouth (thrush).

  • Diagnosis: Specific blood tests, saliva flow analysis, and symptoms such as dry mouth and eyes are used by doctors to make the diagnosis of Sjögren syndrome.

  • Management:

    • Artificial saliva, eye drops, and proper dental care all aid in the treatment of dry mouth. For joint discomfort, doctors may give anti-inflammatory medications.

    • Immunosuppressive drugs may be necessary in extreme situations. Patients with Sjogren syndrome should have regular check-ups because they may develop further health problems.

3. Pemphigus Vulgaris

A persistent illness that affects the skin and mucous membranes is called pemphigus vulgaris. Blisters on the skin and in the mouth are the result of the immune system of the body attacking specific proteins.

  • Oral Manifestations:

    • Blisters: Blisters can appear anywhere in the mouth, including the tongue, gums, inner cheeks, and roof of the mouth. The blisters are typically thin-walled and easily break open, leaving painful sores.

    • Bleeding: The sores can bleed, which can lead to infection.

    • Difficulty swallowing: The sores in the mouth can make it difficult to swallow, which can lead to weight loss and dehydration.

  • Diagnosis: To differentiate pemphigus from other similar disorders, medical professionals employ a variety of procedures, such as immunofluorescence and microscopic examination.

  • Treatment: To control symptoms and avoid complications, treatment includes immunosuppressive medicines and corticosteroids. Tracking antibody levels aids in evaluating the course of the illness and the efficacy of treatment. To identify and treat oral issues early on, dentists are essential.

4. Mucous Membrane Pemphigoid Disease (MMP)

The chronic illness known as mucous membrane pemphigoid disease (MMP) is characterized by blisters in the mouth and other mucous membrane regions such as the genitalia and eyes that develop when the immune system unintentionally targets the body's own tissues.

  • Oral Manifestations: The oral manifestations of mucous membrane pemphigoid (MMP) are the most common, occurring in over 80 percent of patients. The lesions can be found anywhere in the mouth, but they are most common on the gums, tongue, and inner cheeks. The lesions typically begin as small, red blisters that quickly break open to form painful erosions. The erosions can be shallow or deep, and they can be covered with a white or yellow pseudomembrane. The oral lesions of MMP can be very painful, making it difficult to eat, drink, and talk. They can also lead to bleeding, infection, and malnutrition.

  • Diagnosis: Histological samples and a clinical examination are used to diagnose MMP. Examining tissues, doctors look for signs of epithelium (the layer of cells on the surface) being separated from the connective tissue underneath. A particular lab method called direct immunofluorescence aids in diagnosis confirmation, particularly in cases when tissue sample quality is questionable. This technique is essential for differentiating MMP from other illnesses such as systemic lupus erythematosus, pemphigus, lichen, and periodontal disease.

  • Treatment and Prognosis: Although MMP has a benign prognosis, it is a chronic disorder that needs to be continuously managed. The severity of the lesions determines the course of treatment. Topical corticosteroid gels are given to the afflicted areas in milder situations. These gels are occasionally used in conjunction with drugs like Dapsone. Systemic therapy covering the whole body may be required for severe types. It is crucial to remember that MMP can be difficult to cure and that therapy may not work quickly. It is also important to regularly check for eye diseases in order to stop ocular damage such as corneal or eyelid injuries. MMP does not pose a life-threatening hazard, but it does require constant monitoring and care to properly manage symptoms.

5. Behcet Syndrome

An autoimmune multisystemic disease with an unclear etiology is called Behcet Syndrome. Oral ulcers, vaginal ulcers, and ocular inflammation are its most common presentations. Although it was first connected to skin problems, it frequently affects the vascular and neurological systems. People in their 30s are mostly affected, and populations in Asia and the Mediterranean region especially Turkey are more likely to experience it. Its autoimmune character is indicated by the presence of certain autoantibodies and genetic markers (HLA configurations B5 and B51).

  • Oral Manifestations:

    • Painful Mouth Sores: These sores are similar to canker sores, but are often larger, more numerous, and more painful. They can occur anywhere in the mouth, including the tongue, cheeks, lips, gums, and palate.

    • Burning or Tingling Sensation in the Mouth: This can be a precursor to the development of mouth sores or can occur on its own.

    • Dry Mouth: This is due to inflammation of the salivary glands.

    • Difficulty Swallowing: This can be caused by pain from mouth sores or inflammation of the tongue or throat.

  • Diagnosis: Based on a set of criteria, the diagnosis is made when at least two primary symptoms (oral, genital, or ophthalmic lesions) are present. Because Behcet Syndrome frequently causes oral ulcers, it might be difficult to distinguish it from other illnesses. Behcet Syndrome can be distinguished from other illnesses such as HIV (human immunodeficiency viruses), Crohn's disease, sarcoidosis, and SLE by its distinct dual-site-specific ulcers.

  • Prognosis and Treatment: Immunosuppressive medications are frequently taken in conjunction with locally or systemically administered corticosteroids. Especially in the active stages of the disease, preventing oral lesions is essential to slowing its course and averting permanent organ damage. Vascular involvement can result in an aneurysm (ballooning and weakened area in an artery) rupture and thrombosis (formation of a blood clot ) which makes prompt and effective care crucial.

Conclusion:

In conclusion, there is a strong link between autoimmune diseases and dental health. Oral symptoms like lesions and ulcers are frequently a sign of conditions like Behcet Syndrome and mucous membrane pemphigoid. Better treatment outcomes result from early detection, which is a critical role played by dentists. It is crucial to monitor and care for the mouth properly since autoimmune disorders can occasionally be detected by oral health, which highlights the significance of routine dental exams and practicing excellent oral hygiene.

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Dr. Ashwini Kumar

Dentistry

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systemic lupus erythematosusautoimmune disorder
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