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Lupus and dental issues


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Lupus and dental issues

  1. 1. Lupus and the Mouth Stuart A . Green MD Chief of Rheumatology
  2. 2. ACR Criteria
  3. 3. Acr criteria
  4. 4. SLE <ul><li>Oral Ulcers </li></ul><ul><li>Dry Mouth (Sicca) </li></ul><ul><li>Infections </li></ul><ul><li>Medications </li></ul>
  5. 5. Oral Ulcers <ul><li>Hard Palate; tongue and buccal mucosa </li></ul><ul><li>Painless typically, but can be painful </li></ul><ul><li>20% at onset; 54% at any time </li></ul><ul><li>Kenalog in Orabase </li></ul>
  6. 6. SJOGREN’S SYNDROME <ul><li>Sjogrens Syndrome; Primary and Secondary </li></ul><ul><li>Auto immune disease that effects the lacrimal and salivary glands </li></ul><ul><li>RA </li></ul><ul><li>SLE </li></ul>
  7. 7. Basic Mouth Anatomy
  8. 8. Sicca
  9. 9. Parotid Swelling
  10. 10. Sicca <ul><li>Dental Care </li></ul><ul><li>Water </li></ul><ul><li>Saliva substitutes( glycerate polymer preparations) </li></ul><ul><li>Pilocarpine 5mg tid </li></ul><ul><li>Cevimilene 30mg tid </li></ul>
  11. 11. Infections/mouth <ul><li>Candida </li></ul><ul><li>H. Simplex </li></ul>
  12. 12. Herpes simplex
  13. 13. Herpes Simplex
  14. 14. H. Simplex <ul><li>Anti Viral, </li></ul><ul><ul><li>Acyclovir,Valacylovir, Famciclovir </li></ul></ul><ul><ul><li>Topical: Acyclovir or Penciclovir </li></ul></ul>
  15. 15. Oral Candida <ul><li>Steroids </li></ul><ul><li>Sicca </li></ul><ul><li>Anti Fungal Agents </li></ul><ul><ul><li>Oral Solutions </li></ul></ul><ul><ul><li>Systemic </li></ul></ul>
  16. 16. Oral Candida
  17. 17. Bisphosphonates <ul><li>Osteoporosis medications: </li></ul><ul><ul><li>Alendronate, Risendroante and ibandroante </li></ul></ul><ul><ul><li>Zoledronic Acid </li></ul></ul><ul><li>Effect Osteoclast activity </li></ul>
  18. 18. Osteonecrosis of the Jaw <ul><li>Most common (rare) in cancer patients with frequent infusions of potent nitrogen containing bisphosphonates </li></ul><ul><li>Painful jaw pain, usually the mandible, with area of exposed bone. </li></ul><ul><li>Dental exam before starting therapy? </li></ul>