Lupus and the MouthLupus and the MouthStuart A . Green MDStuart A . Green MD

Chief of RheumatologyChief of Rheumatology

ACR CriteriaACR Criteria

Acr criteriaAcr criteria

SLESLE

• Oral UlcersOral Ulcers

• Dry Mouth (Sicca)Dry Mouth (Sicca)

• InfectionsInfections

• MedicationsMedications

Oral UlcersOral Ulcers

• Hard Palate; tongue and buccal mucosaHard Palate; tongue and buccal mucosa

• Painless typically, but can be painfulPainless typically, but can be painful

• 20% at onset; 54% at any time20% at onset; 54% at any time

• Kenalog in OrabaseKenalog in Orabase

SJOGREN’S SYNDROMESJOGREN’S SYNDROME

• Sjogrens Syndrome; Primary and SecondarySjogrens Syndrome; Primary and Secondary

• Auto immune disease that effects the lacrimal Auto immune disease that effects the lacrimal and salivary glandsand salivary glands

• RARA

• SLESLE

Basic Mouth AnatomyBasic Mouth Anatomy

SiccaSicca

Parotid SwellingParotid Swelling

Sicca Sicca

• Dental CareDental Care

• WaterWater

• Saliva substitutes( glycerate polymer Saliva substitutes( glycerate polymer preparations)preparations)

• Pilocarpine 5mg tidPilocarpine 5mg tid

• Cevimilene 30mg tidCevimilene 30mg tid

Infections/mouthInfections/mouth

• CandidaCandida

• H. SimplexH. Simplex

Herpes simplexHerpes simplex

Herpes SimplexHerpes Simplex

H. SimplexH. Simplex

• Anti Viral, Anti Viral, • Acyclovir,Valacylovir, FamciclovirAcyclovir,Valacylovir, Famciclovir• Topical: Acyclovir or PenciclovirTopical: Acyclovir or Penciclovir

Oral CandidaOral Candida

• SteroidsSteroids

• Sicca Sicca

• Anti Fungal AgentsAnti Fungal Agents• Oral SolutionsOral Solutions• SystemicSystemic

Oral CandidaOral Candida

BisphosphonatesBisphosphonates

• Osteoporosis medications:Osteoporosis medications:• Alendronate, Risendroante and ibandroanteAlendronate, Risendroante and ibandroante• Zoledronic AcidZoledronic Acid

• Effect Osteoclast activityEffect Osteoclast activity

Osteonecrosis of the Osteonecrosis of the JawJaw

• Most common (rare) in cancer patients with Most common (rare) in cancer patients with frequent infusions of potent nitrogen frequent infusions of potent nitrogen containing bisphosphonatescontaining bisphosphonates

• Painful jaw pain, usually the mandible, with Painful jaw pain, usually the mandible, with area of exposed bone.area of exposed bone.

• Dental exam before starting therapy?Dental exam before starting therapy?