Introduction
Dry mouth, also known as xerostomia, is a common condition that occurs when salivary glands do not produce enough saliva to keep the mouth wet. While dry mouth can affect anyone, it is a common symptom in people with certain medical conditions like lupus. Lupus is an autoimmune disease where the immune system attacks healthy cells and tissues in the body. Understanding the connection between dry mouth and lupus can help people identify early symptoms and get proper treatment.
What is Lupus?
Lupus is a chronic autoimmune disease where the immune system becomes hyperactive and attacks healthy tissue, causing widespread inflammation and damage. The most common type is systemic lupus erythematosus (SLE), which can affect the joints, skin, kidneys, blood cells, brain, heart, and lungs. Lupus is more common in women, particularly during childbearing years, and is more prevalent in people of color. While there is no cure, lupus can be managed with medications and lifestyle changes.
Symptoms of Lupus
Some common symptoms of lupus include:
- Fatigue and fever
- Joint pain, stiffness, and swelling
- Butterfly-shaped rash on the face
- Skin lesions and sensitivity to sunlight
- Chest pain when taking deep breaths
- Dry eyes and mouth
- Headaches, memory issues, and confusion
Symptoms may come and go over time, and their severity can fluctuate. Mild lupus may have limited effects, while severe lupus can be debilitating or even life-threatening. Early diagnosis and treatment is key to prevent complications.
What Causes Dry Mouth?
Dry mouth occurs when the salivary glands do not produce enough saliva. Saliva plays a critical role in digestive function, lubricating the mouth, protecting tooth enamel, and preventing infection. When saliva production drops below normal levels, it leads to dry mouth.
Some common causes of dry mouth include:
Medications
Many prescription and over-the-counter drugs can reduce saliva flow as a side effect. Common culprits include antihistamines, decongestants, antidepressants, pain medications, diuretics, and muscle relaxants.
Medical Conditions
Dry mouth can be a symptom of certain illnesses like diabetes, hypertension, anxiety disorders, HIV/AIDS, Alzheimer’s disease, and autoimmune disorders. Sjogren’s syndrome is an autoimmune disease characterized by severe dry mouth and dry eyes.
Radiation Therapy
Radiation treatments to the head and neck area can damage salivary glands, decreasing their ability to make saliva. This is a common side effect of cancer treatments.
Aging
As we get older, there is a natural decrease in saliva production. Elderly people are more prone to dry mouth.
Nerve Damage
Damage or trauma to the nerves that stimulate salivary gland secretion can greatly reduce saliva production and cause dry mouth.
Dehydration
Not drinking enough fluids can lead to dehydration and dry mouth.
Smoking
Chemicals in tobacco can irritate salivary glands. Smoking or chewing tobacco raises the risk of dry mouth.
Breathing Through Mouth
Breathing through your mouth frequently dries out the mucus membranes.
Is Dry Mouth a Symptom of Lupus?
Yes, dry mouth is a very common symptom of lupus. Between 40-70% of lupus patients experience frequent dry mouth. There are several reasons why lupus often causes a decrease in saliva:
Sjogren’s Syndrome
Many people with lupus also have Sjogren’s syndrome, which directly affects moisture production. Up to 50% of lupus patients also have secondary Sjogren’s. The immune system damages the glands responsible for tears and saliva.
Medications
Corticosteroids like prednisone are a primary treatment for reducing lupus inflammation and symptoms. They are immuno-suppressive medications. However, steroids also commonly cause dry mouth as a side effect.
Inflammation
The global inflammation seen with lupus can directly involve the salivary glands. This glandular inflammation hampers their normal function and saliva secretion.
ANAs
Most people with lupus have anti-nuclear antibodies (ANAs) circulating in their blood. Research indicates that some ANAs may react directly with muscarinic receptors on salivary gland cells. This autoimmune reaction inhibits normal gland function.
Nerve Damage
Lupus can sometimes cause nerve inflammation or vasculitis. This nerve damage may indirectly impair salivary gland function.
Other Oral Symptoms of Lupus
Along with dry mouth, lupus can trigger several other problems in the mouth and dental region:
Mouth Ulcers
Many lupus patients get painful canker sores on the soft tissues of the mouth. These recurrent ulcers are thought to be caused by vasculitis lowering the mouth’s resistance to trauma.
Taste Changes
Since taste buds require saliva to function properly, decreased saliva in lupus can distort taste perception. Things may taste more bland or metallic.
Gum Disease
With less saliva present, the gums are more susceptible to bacteria and plaque buildup, leading to gingivitis and other periodontal diseases.
Tooth Decay
Reduced saliva also removes the teeth’s primary defense against cavities and tooth decay. The enamel weakens and decays faster.
Jaw Pain
Some lupus patients experience temporomandibular joint pain caused by inflammation of the jaw muscles and joints. Chewing difficulties are also common.
Oral Yeast Infections
The normal oral fungal flora can grow out of control when saliva levels drop. This leads to a white tongue or Thrush overgrowth of Candida yeast.
Oral Symptom | Cause |
---|---|
Dry Mouth | Impaired saliva production due to autoimmunity against salivary glands |
Mouth Ulcers | Vasculitis reduces tissue resistance to trauma |
Taste Changes | Saliva is vital for proper taste bud function |
Gum Disease | Plaque and bacteria buildup without saliva flushing |
Tooth Decay | Loss of saliva eliminates enamel’s protective barrier |
Jaw Pain | Inflammation of jaw muscles and TMJ joint |
Oral Yeast Infections | Fungal overgrowth without saliva’s regulation |
Diagnosing Dry Mouth from Lupus
Distinguishing dry mouth caused by lupus versus other factors can be challenging. Doctors may investigate for other possible causes or conditions like:
- Medications known to reduce saliva
- Diabetes
- Snoring or sleep apnea
- Sjogren’s syndrome antibodies
- Nerve injury tests
- Salivary gland biopsy
They will also examine the pattern and timing of dry mouth in relation to other lupus disease activity and flares. The mouth itself may also show signs of lupus involvement, like ulcers or vasculitis. Overall, dry mouth from lupus is a diagnosis of exclusion after ruling out other potential causes.
Diagnostic Tests
Some tests that may help diagnose dry mouth related to lupus include:
- Lab tests: ANA, SS-A/Ro, SS-B/La antibodies
- Imaging: Salivary gland ultrasound, CT scan, sialography
- Measuring saliva flow: Sialometry and scintigraphy
- Salivary gland biopsy: Examining glandular tissue under a microscope
Treating Dry Mouth from Lupus
While dry mouth cannot be cured in lupus, various treatments can help provide relief and improve symptoms. Treatment approaches aim to increase saliva production while limiting the damage dry mouth can cause in the mouth.
Treating the Lupus
The immunosuppressant medications used to control lupus inflammation and autoimmunity may help some secondary symptoms like dry mouth. Lowering disease activity improves gland function.
Saliva Substitutes
Artificial saliva sprays and gels can temporarily coat and lubricate the mouth, helping speak and swallow easier. However, these provide only short-term relief.
Sugar-Free Gum/Candies
Chewing gum or sucking on hard candies stimulates mild saliva production by making the mouth think food is coming. Sugar-free options help avoid tooth decay.
Medications
Drugs like pilocarpine or cevimeline can directly stimulate the salivary glands to produce more saliva. Side effects like sweating may occur.
Biotene Products
Toothpastes, mouthwashes, and gels containing enzymes that help bind and retain existing moisture in the mouth.
Avoid Irritants
Curb tobacco, alcohol, caffeine, and antihistamines to limit dry mouth aggravators. Drink more water and use a bedroom humidifier.
Oral Hygiene
Practice meticulous dental care with flossing, brushing, medicated mouthwashes, and regular cleanings to prevent complications.
If dry mouth is severely impairing nutrition and quality of life, some last resort options include acupuncture, medications like oral interferon, or even surgery to remove and redirect salivary ducts. Thankfully, most cases can be managed with more conservative symptomatic therapies.
Outlook for Dry Mouth from Lupus
The prognosis for lupus-related dry mouth depends on the disease severity and proper treatment. With medications, lifestyle changes, and dental care, many people find their dry mouth and related symptoms are controllable. However, symptoms may come and go with periodic lupus flares. Key things that can improve the outlook include:
- Identifying and modifying/avoiding drugs that worsen dry mouth
- Consistent lupus treatment to lower autoimmune activity
- Frequent sipping of water or sugar-free drinks
- Using saliva substitutes and moisture-retaining oral products
- Practicing good oral hygiene to prevent complications
- Incorporating humidifiers, both personal and room types
- Avoiding irritants like cigarettes, alcohol, and coffee
- Raising awarenss of the mouth’s health each day
- Chewing sugar-free gum to stimulate saliva flow
While dry mouth may never fully resolve, there are many ways to manage the symptoms and improve comfort levels. With diligence and treatment compliance, most people find they can keep their dry mouth under relative control and prevent major oral health deterioration. Being aware this is a possible lupus symptom allows for early intervention.
Preventing Lupus Dry Mouth Complications
If left untreated, the reduced saliva of dry mouth can lead to significant oral health problems like:
- Tooth decay and cavities
- Gum disease and gingivitis
- Fungal infections like thrush
- Mouth sores and ulcers
- Bad breath (halitosis)
- Loss of teeth over time
- Chewing and swallowing difficulties
- Change in facial profile from tooth loss
- Taste disorders like dysgeusia
- Increased dental bills and interventions
Thankfully, being proactive can help avoid most of these complications. Some key prevention tips include:
Using Saliva Substitutes
Frequently swishing, spraying, or applying gel saliva replacements helps coat the tissues. Look for long-lasting, pH-balanced products.
Staying Hydrated
Sipping water or sugar-free beverages throughout the day keeps the mouth from drying out.
Controlling Lupus Activity
Work closely with your doctors to find the most effective lupus treatments and keep autoimmunity minimized.
Oral Hygiene
Brush thoroughly twice a day, floss once daily, and see your dentist every 6 months. Use fluoride toothpaste and antibacterial mouthwash.
Dental Visits
Get professional cleanings and exams every 6 months to catch problems early. Report symptoms to your dentist.
Avoid Irritants
Stop smoking and limit alcohol, caffeine, acidic foods, sticky sweets, and antihistamines that worsen dry mouth.
Humidifiers
Use portable or home humidifiers, especially in the bedroom, to introduce moisture into the air you breathe.
Medications
Ask your doctors about prescriptions like pilocarpine that directly stimulate more saliva flow.
Sugar-Free Gum/Candies
The chewing motion wakes up salivary flow. Pick options with xylitol to limit tooth decay.
With some diligence, lupus patients can help control dry mouth and avoid most of its damaging complications in the teeth and gums. Working closely with your medical and dental teams ensures the best outcome.
Conclusion
Dry mouth is a very common symptom of lupus, experienced by 40-70% of patients. Lupus can directly impair saliva production due to autoimmune activity against the salivary glands. Medications used to treat lupus may also worsen dry mouth as a side effect.
People with lupus need to be proactive about managing dry mouth symptoms to limit complications like tooth decay, gum disease, ulcers, and infections. Using saliva substitutes, staying hydrated, controlling lupus activity, practicing good oral hygiene, and seeing a dentist regularly can all help reduce problems.
While dry mouth may not be fully curable in lupus patients, its severity can be reduced with proper treatment. Work closely with your medical doctors and dentist to find an optimal management plan for your individual case. With a good regimen, dry mouth can be controlled, and oral health preserved. Be aware of this correlation between dry mouth and lupus.