A sore on the roof of the mouth that does not hurt is easy to ignore, but in someone with lupus it can be one of the more telling signs. Mouth changes are common in systemic lupus erythematosus: a 2023 meta-analysis of 113 studies by Du and colleagues in BMC Oral Health estimated that about 31% of people with lupus have lesions of the mouth lining, and about 30% have oral ulcers.
Lupus is an autoimmune condition, meaning the immune system targets the body's own tissues. The lining of the mouth is one of the places that activity can show, and the medicines used to control lupus can affect the mouth too. Both matter when it comes to looking after your teeth and planning dental care.
Lupus ulcers are often painless and often on the palate
Most everyday mouth ulcers sting, especially with salty or acidic food. Lupus ulcers frequently do not. In a study of 182 people with lupus published in Arthritis and Rheumatism in 1978, Urman and colleagues found that oral ulcers were usually painless (82%) and most often on the hard palate (89%), and that they tended to appear when lupus was more active overall. Painful ulcers can still occur, and ulcers can also form on the inner cheeks, gums, tongue and lips.
Because a painless sore can go unnoticed, it helps to look at the roof of your mouth now and then with a torch and a mirror. Our guide to cold sores and mouth ulcers explains how common ulcers usually look and behave.
Other changes a dentist may notice
Lupus can also cause red patches, white lacy or plaque-like patches, small blood spots and cracking at the corners of the lips. Some of these can look like other conditions, such as lichen planus or thrush, that are managed differently. A dentist may refer to an oral medicine practitioner, and sometimes a small biopsy is needed to be sure what a patch is.
Gum disease also appears to be more common in people with lupus than in people without it, so regular cleaning between the teeth matters. Our guide to bleeding gums covers the home care that helps. If gums keep bleeding after 3 to 4 days of careful brushing and flossing, it is worth seeing a dentist or OHT.
A dry mouth raises the risk of decay
Some people with lupus make less saliva. This can come from lupus itself, from Sjögren's disease occurring alongside it, or from medicines. Saliva rinses away food, neutralises acid and helps repair early enamel damage, so a dry mouth can mean faster decay, more gum problems and a higher chance of thrush.
Things that can help include:
- sipping water through the day and keeping a bottle by the bed
- sugar-free gum or lozenges to encourage saliva
- a higher-strength fluoride toothpaste if your dentist recommends one
- keeping sugary snacks and drinks to mealtimes
- more frequent check-ups, so problems are found while small
People with lupus share some of the gum disease risks seen in other inflammatory conditions. Our post on rheumatoid arthritis and gum disease looks at that link.
A sore that has not healed in 3 weeks needs a look
Any ulcer, red area or white patch in the mouth that has not healed or has changed within 3 weeks should be checked by a dentist or GP. For someone with lupus there is an extra reason: new mouth ulcers can coincide with lupus becoming more active, so it is worth letting your rheumatologist know as well.
Planning dental treatment around lupus
Dental care is generally safe for people with lupus, and keeping the mouth healthy is part of looking after your overall health. It does need some planning.
Bring an up-to-date list of your medicines. Long-term corticosteroids can slow healing and, at higher doses, may affect how the body copes with the stress of surgery. Other immune-suppressing medicines can raise the risk of infection after an extraction or surgery. Some people with lupus also take blood thinners. Never stop, skip or delay any of these yourself. For an extraction or surgery, the dentist will confirm the plan with your rheumatologist, GP or prescriber.
Timing helps too. Routine and elective work is usually more comfortable during a settled period than during a flare. If a tooth is causing problems, our guide to root canal or extraction explains how that decision is weighed.
Questions about lupus and the mouth
Should I see a dentist or my doctor about a mouth ulcer?
Either is a good start. A dentist can examine the ulcer and the rest of the mouth, and if it looks related to lupus activity, they will suggest you also update your rheumatologist.
Can gum disease affect lupus?
Gum disease is a source of ongoing inflammation. Treating it is sensible for your mouth and general health, although it is only one small part of managing lupus.
Is it safe to have a tooth out?
Usually, yes, with planning around your medicines and disease activity, and with your rheumatologist or GP involved where needed.
The team at Lumi Dental can work alongside your rheumatologist to plan care around your condition. Learn more about general dental care at our Melrose Park practice, see our current deals page, or book a check-up.
This article is general information and not a substitute for personal dental or medical advice.
