Lupus Can Cause Tooth Decay: How to Prevent Dry Mouth and Cavities (October 2024 Update)

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.

Saliva substitutes

– 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.

Diet

– 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

Improve the microbiome (good vs bad bacteria/yeast etc)

– Consider eating yogurt that contains live cultures (probiotics) daily; it may help to decrease the amount of Candida and improve beneficial bacteria in your mouth.

– If you get gum inflammation, ask your doctor to consider giving you chlorhexidine. It kills bacteria in the mouth. The Sjogren’s Foundation oral hygiene and dental cavity prevention includes using chlorhexidine. It is a mouth rinse. Don’t use it every day. Follow the directions of your doctor.

Dental care

– 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.

– Ask your dentist for a fluoride tray or high-fluoride toothpaste (such as 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 (Thrush)

– 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)