Decreased saliva formation occurs in many people with SLE and Sjogren’s disease causing tooth decay (cavities), gingivitis, and periodontitis. This allows bad bacteria to take over. Most people do not notice dry mouth until after they lose teeth. As I update this post (September 18, 2021), I just had another SLE patient this week have this problem.
Another problem is that these harmful bacteria (and yeast, like Candida found in thrush), grow around the teeth and gums, replacing healthy bacteria. We call this collection of organisms the “biofilm.” This harmful bacteria-inhabited biofilm can interact with the immune system. This has been associated with autoantibodies such as anti-SSA (found in most Sjogren’s patients and in 30% of SLE patients). If you could increase your saliva, improve your biofilm back to a health bacteria-containing biofilm, there is the possibility you may help your immune system. This is all theoretical right now, but it makes sense. Think of it as the mouth’s version of “leaky gut syndrome.”
Below are recommended actions you can take to increase saliva flow and lower your chance of tooth loss from SLE, Sjogren’s, RA, and related disorders.
SHARE with everyone who suffers from autoimmune diseases. Can lupus cause tooth decay?: “Yes!”
|Measures to improve mouth moisture and decrease tooth decay, gingivitis, and periodontitis when you have dry mouth related to SLE, Sjogren’s, rheumatoid arthritis (and other disorders such as after radiation therapy for cancer)|
– Stay adequately hydrated, yet avoid excessive fluids close to bedtime since this will result in going to the bathroom frequently during sleep, thereby contributing to fatigue. It will also wash away the mucous components of saliva that help keep your mouth feeling moist.
– Avoid dehydrating fluids such as alcohol and caffeine.
– Avoid smoking, which dries out the mouth, eyes, and nose.
– Use a humidifier in each room of your house where you spend significant time, especially in the bedroom. Keep air humidity about 55% – 60%. Clean and dry out humidifiers daily to prevent mold and fungus. A better option is to have a centralized humidifier installed in the furnace. Also, consider a central air UV light plus filter to decrease the risk of spreading infections such as fungus and mold throughout the house.
– A cool humidifier near the bed is a must (we spend more time in bed than anywhere. Our eyes dry out more when asleep). Have it running for at least an hour before going to bed.
– Sip just enough water to keep your mouth moist. Alternatively, let small ice chips melt in your mouth. Avoid drinking large amounts of water since this will dilute the remaining viscous saliva and increase the likelihood of getting up a night to urinate.
– To decrease having to get up at night to urinate: don’t drink several hours before bed.
– Avoid salty, spicy, acidic foods (including fruit juices) as well as carbonated beverages if they irritate your dry mouth.
– Avoid caffeine and alcohol. These contribute to dry mouth.
– Avoid frequent and prolonged exposure of teeth to fermentable carbohydrates since they contribute to dental decay and poor dental health.
– Treat nasal congestion. It contributes to mouth breathing, making dry mouth worse. Do all in table 14.9. Try Flonase (fluticasone) for a few weeks every day.
– For thick mucus, take guaifenesin (e.g., Mucinex).
– To decrease a metallic or bad taste in your mouth, consider products such as MetaQil.
Stimulation of saliva flow
– Use xylitol-containing gum, mints, and lozenges regularly. They stimulate saliva and decrease bacteria. Examples: Ice Chips candies, Spry, Salese lozenges, and Starbucks gum and mints.
– Xylitol gum-chewing tips: Saliva production reaches a maximum at 5 minutes, then declines. Change gum frequently for maximal effect. Larger pieces are more effective than smaller ones. Chew slowly to decrease the risk for TMJ (temporomandibular joint) pain.
– Place two Xylimelts adhering discs between cheek and gum each night before bed. Use as needed in the daytime (stimulates saliva and decreases bacteria).
– Ask your doctor to prescribe either pilocarpine (Salagen), cevimeline (Evoxac), or bethanechol to stimulate saliva flow (see text).
– To maximize mouth moisture for speaking events, social gatherings, etc., take pilocarpine 1-hour beforehand and cevimeline 2 hours before.
– Use lubricating sprays and saliva substitutes regularly, such as Biotene Moisturizing Spray/Gel/or Rinse, Oasis Moisturizing Mouth Spray, Oral7 gel, BioXtra gel, Lubricity, and Mouth Kote. Keep some on your bedside stand, next to the telephone, and while traveling.
– Use artificial saliva before bed and in the middle of the night instead of water. This will decrease the need to drink water right before bed and then get up during the night to urinate.
– Tip for using lubricating solutions: cover all inner mouth areas (inside lips, under the tongue, front of the tongue, inner cheeks, palate, and so on). The dryness sensation has a lot to do with the mucosal surfaces not sliding easily over each other. You want this lubricating sensation everywhere in the mouth.
– A cheap saliva substitute alternative is some water mixed with olive oil or coconut oil.
– If you suffer from dysgeusia (metallic or abnormal taste), use MetaQil mouth rinse and don’t forget to brush you tongue at least once daily.
– Eat soft, moist food if you have trouble swallowing.
– Eat smaller, more frequent meals to stimulate saliva flow more regularly.
Sore lips and mouth
– Use an ointment (better than balm or chapstick) that contains ceramides or hyaluronic acid (moisturizing ingredients) along with a sealer (lanolin or petrolatum) on your lips regularly throughout the day; use a lot (you can’t use too much, but you can use too little). Avoid flavored brands, menthol, peppermint, and so on. Do not lick your lips. Replace your lip balm every 3 months.
– Apply vitamin E oil to sore, dry parts of your mouth. You can squirt out the gel from vitamin E gel capsules or use vitamin E oil.
– If you have a sore tongue, sores on the edges of your lips, or swollen lips, see your doctor for a possible Candida infection
– Use fluoride-containing moisturizing toothpaste and mouthwashes (such as Biotene or TheraBreath products) two to three times a day. Avoid any mouthwash containing alcohol or witch hazel, which dry out the mouth.
– Avoid whitening toothpaste—they may irritate teeth and gums.
– Consider using an electric toothbrush, especially if you have arthritis and difficulty using a regular one.
– Floss at least daily to decrease plaque, the risk of periodontal disease (gum infection), and cavity formation.
– Daily use of an oral irrigator can remove food particles from crevices unreached by floss and toothbrushes (Waterpik, Liberex, Akunbem, and many others). But these should be used along with flossing.
– Ask your dental hygienist to teach you how to brush and floss. Most people do not floss and brush correctly (we can all keep learning).
– Rinse your mouth with a fluoride mouth rinse twice a day. Examples are Act, Crest Pro-Health, Closys, Colgate Total Pro-Shield, FluoriGard. These are available over the counter and help to prevent cavities.
– If you get cavities, ask your dentist for a fluoride tray or high-fluoride toothpaste (such as Denta 5000, Prevident 5000 Booster Plus, and Clinpro 5000). Apply half of a pea-sized amount to teeth after brushing twice daily, move around your teeth with your tongue, spit out the excess, do not rinse. See your dentist more often than twice a year to receive fluoride treatments and maintain better oral hygiene.
– If you get cavities, consider crowns from your dentist instead of fillings.
– Brush or scrape your tongue at least once a day to remove harmful bacteria and fungus (Candida). If you have furrows on the tongue, use an oral irrigator daily to clean out food particles.
Candidal infections of the mouth
– If you get recurrent Candida (thrush) infections, consider eating yogurt that contains live cultures (probiotics) daily; it may help to decrease the amount of Candida.
– Your doctor may prescribe an anti-fungal treatment, either a pill to take daily for up to 14 days or a topical treatment in the form of a troche, lozenge, tablet that adheres to the gums, or suspension.
– Remove and disinfect dentures, which can harbor bacteria and fungus, daily. You should not sleep with your removable dental appliances in your mouth at night. When out of your mouth, you may place it in a container with denture cleaners. If you get Candida, ask your doctor for an anti-fungal powder to use on your dentures as well (in addition to the usual anti-fungal treatments)
Dry mouth care table reviewed and edited by:
Dr. Ava Wu, DDS; Sjögren’s Clinic, University of California San Francisco and member of the National Board Sjögren’s Foundation
Vidya Sankar, DMD, MHS Division Director of Oral Medicine Tufts University School of Dental Medicine, Boston MA and member of the National Board Sjogren’s Foundation
Alan N. Baer, MD Professor of Medicine, Johns Hopkins University School of Medicine; Director, Jerome L. Greene Sjögren’s Syndrome Clinic, Baltimore, Maryland; Chair, Medical and Scientific Advisory Council of the Sjogren’s Foundation
Can lupus cause tooth decay?: “Yes!”
Numerous studies show that people with gum inflammation with bad bacteria (periodontitis) are much more prone to developing the related autoimmune disease, rheumatoid arthritis.
The Sjogren’s Foundation recommends BasicBites, and other xylitol-containing “candies” to help decrease the risk for dental cavities and tooth loss for people with decreased saliva formation.
NOTE: Dr. Donald Thomas gets no financial reimbursements from BasicBites. I just realize it is a good product.
Recommended by leading dental professionals, multi-action BasicBites® are essential for individuals with dry mouth. Dry mouth can wreak havoc on your teeth by creating an acidic oral environment that also favors harmful plaque bacteria. BasicBites® work differently than other oral care and dry mouth products. These delicious soft chews coat and replenish teeth with key nutrients also found in healthy saliva – arginine bicarbonate and calcium carbonate. These vital teeth protecting nutrients can be in very short supply if you have dry mouth.
BasicBites® supercharge your mouth’s natural defenses… just like healthy saliva.
- Nourish beneficial pH-raising bacteria discovered in dental plaque
- Counteract and buffer harmful sugar acids
- Enrich and fortify enamel
- Maintain a healthy oral pH environment
- Now available in chocolate and caramel flavors
Donald Thomas, MD
Lupus Educator and author of “The Lupus Encyclopedia”
Dry Mouth Care Table above comes from the submitted manuscript for the 2nd edition of “The Lupus Encyclopedia.” It has not been reviewed by Johns Hopkins Press yet.