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› ´Lupusµ is Latin for ´wolfµ

› ´Erythro" is derived from ŢŬŰťŬŷŭ, Greek for


"red.´

› Malar rash is a typical


symptom

› Origin for term is varied


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› Ô chronic autoimmune disease that occurs
when the body's immune system attacks its
own tissues and organs.
› Inflammation caused by lupus can affect
many different body systems, including
joints, skin, kidneys, blood cells, heart and
lungs
› Characterized by ´flaresµ and ´remissionsµ
› More common in women and non-Europeans
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Œypes of lupus:
› ºystemic lupus erythematosus (ºLD)
› Cutaneous or discoid lupus erythematosus
(DLE)
› Drug-induced lupus erythematosus (DILE)

Of these, systemic lupus erythematosus is the


most severe form of lupus.
G 
    
Malaise
Fever
Joint and Muscle Pain
Weight Loss
Neurological ºymptoms
Butterfly-ºhaped Rash
ºkin Photosensitivity
Hair Loss
Painful Oral Ulcers
Heart Problems
Pulmonary ºymptoms
Loss of Vision
Kidney Disease
Ônemia and Iron Deficiencies
¦ 
 

› Usually discoid lupus
erythematosus
› Oral lesions occur in 25-
50% of patients with DLE
versus 7-26% of patients
with ºLE.
›Lesions usually begin as
an irregular whitish area
that extends peripherally. Buccal mucosa exhibiting irregular
white areas of ulceration.
¦ 
 

ºpecific Mucosal Lesions
Oral apthae (canker sores)
› Can be from other diseases
› Less than 1cm
› Painful
› Occur on buccal mucosae
› Lasts 2 to 3 weeks
› ºtrong association with flares
¦ 
 

ºpecific Mucosal Lesions
Lip Lesions
› Resemble red plaques with
white areas
› ºimilar to lichens planus
¦ 
 

ºpecific Mucosal Lesions
Bullous ºLE
› Very rare
› Ôntibodies attack own tissue
in the mouth and skin
› Diagnosed with skin biopsy
and blood tests
› Grouped blisters on head,
neck, body
› Vesicles and crusting around
mouth
› Extensive erosions
¦ 
 

Non-ºpecific Mucosal Lesions

› Herpes simplex labialis (fever blisters)


› º  º
   ºº
› Oral candidiasis (thrush)
› ¦  
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› Communication

› ºelf-Examination

› Prevention
¦ G


 
Communication
› Regular dental visits from 2
to 3 months apart
› ºhare current and past
medical history
› Give complete list of
medications
› Notice of dental problems
and treatments
¦ G


 
ºelf-Examination
› Make it a habit
› Check for:
› Bleeding gums
› ºwollen gums
› Red gums
› ºensitive gums
› Rashes and sores on mucosal
tissue
¦ G


 
Prevention
› Proper brushing techniques
› Cleaning between teeth
› Check their technique
  

  

[   


    (NºÔIDs)
Ôspirin
naproxen sodium (Ôleve)
ibuprofen (Ôdvil, Motrin, others)

ºide effects:
stomach bleeding
kidney problems
increased risk of heart problems
  

  

Ô   (NºÔIDs)


Hydroxychloroquine (Plaquenil)

ºide effects:
vision problems
muscle weakness
  

  

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betamethasone (Celestone)
dexamethasone
hydrocortisone (Cortef)
methylprednisolone acetate (Depo-Medrol, Medrol)

ºide effects:
weight gain
easy bruising
thinning bones (osteoporosis)
high blood pressure
diabetes
risk of infection
  

  
   
Ôzathioprine
Mycophenolate
Cyclophosphamide
Methotrexate

ºide effects:
Birth defects
Lowered white blood cell counts
Risk of infection
Hair thinning
ºkin rash
Nausea
Diarrhea
Kidney damage
Increased cancer risk
Liver damage
Π

› Œ     
What treatments you may consider depend on your signs and symptoms. Œreatments for specific signs and
symptoms include:
› -   Pain in your joints may be initially controlled with NºÔIDs. If you experience more
significant joint pain, you and your doctor may consider antimalarial drugs or corticosteroids.
› º  Ôvoid skin rashes by staying out of the sun, wearing sunblock year-round and keeping your skin
covered. Despite your best attempts to avoid the sun, even indoor fluorescent lighting can trigger skin rashes in
people with lupus. ºkin rashes are sometimes treated with topical corticosteroids. Œhese creams are applied to
the affected area to reduce the inflammation in your skin cells. Oral steroids or antimalarial drugs also can be
used.
›  Fatigue is treated by determining the underlying cause. Your fatigue may be caused by difficulty
sleeping, depression or poorly controlled pain. In these cases, your doctor would treat the underlying cause. If
you and your doctor can't determine a cause for your fatigue, you may consider medications, such as
corticosteroids and antimalarial drugs.
› º    ºwelling around your heart and lungs that causes chest pain may be
controlled by NºÔIDs, antimalarial drugs or corticosteroids.
Π

› Œ   
Life-threatening cases of lupus ³ those including kidney problems, inflammation in the blood vessels, and
central nervous system problems, such as seizures ³ may require more aggressive treatment. In these cases,
you and your doctor may consider:
›  
     High-dose corticosteroids can be taken orally or administered through a vein in your
arm (intravenously). Ô high-dose regimen of corticosteroids may help control dangerous signs and symptoms
quickly but can also cause serious side effects, including infections, mood swings, high blood pressure and
osteoporosis. Œo minimize side effects, your doctor will give you the lowest dose needed to control your signs
and symptoms and then reduce the dosage over time.
›    Drugs that suppress the immune system may be helpful in serious cases of lupus but
can cause serious side effects. Œhe most commonly used immunosuppressive drugs include cyclophosphamide
(Cytoxan) and azathioprine (Imuran, Ôzasan). Less commonly, the immune protein gamma globulin and the
disease-modifying anti-rheumatic drug methotrexate ³ normally used to treat rheumatic arthritis ³ may be
used to control severe, treatment-resistant symptoms. Œhe drug mycophenolate (CellCept), another
immunosuppressant, can be used to treat lupus-related kidney problems. Depending on the drug,
immunosuppressive medications may be taken orally or intravenously. ºide effects include an increased risk of
infection, liver damage, infertility and an increased risk of cancer.
Π

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› 2 to 3 months maintenance care
› Hand scaling may be preferable to other
techniques
› Ômerican Heart Ôssociation indicates the
use of antibiotics only under specific
circumstances, even in patients with
systemic lupus
› Risk of bleeding disorders in patients with
ºLE
G

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› Brush and floss 2x per day
› ºoft brush and Waterpik
› Ôvoid spicy/acidic foods and drinks
› Orajel/Orabase ointment to promote
healing of sores
› Backing soda and hydrogen peroxide rinses
to prevent infections
D
  

Lupus Foundation of Ômerica


www.lupus.org

National Institute of Ôrthritis and


Musculoskeletal and ºkin Diseases
www.niams.nih.gov/health_info/lupus
D
  

Lupus Foundation of Ômerica


North Œexas Chapter
info@lupus-northtexas.org
D

  
Notable Cases
› Michael Jackson

› Louisa May Ôlcott

› Ferdinand Marcos

› ºtephanie ºmith

› Lucy Vodden
¦   
What Lupus Is
› Chronic autoimmune disease
› ´Œhe Great Imitatorµ
› Often undiagnosed
What Œo Do
› Increased dental visit frequency
› ºelf-examination
› Good oral hygiene practices
› Drug concerns
› Communication