By John Mills, BDS, DGDP UK, Chairman, Vasculitis UK
Vasculitis can affect all parts of the body and the mouth is no exception. Large, persistent and excruciatingly painful mouth ulcers are sometimes a characteristic of active GPA Wegener’s as is severe toothache that moves around the mouth, especially in the upper jaw.
When patients are severely ill with vasculitis (or any other disease) it is essential that their dental care is not neglected, as a period of neglect can cause permanent damage to teeth and gums. This can also apply where patients are suffering from restricted use of their hands or upper limbs.
Obviously, those taking immuno-suppressing drugs must take care as the mouth is one of the places where invading bacteria can most easily gain the upper hand. Some medication, especially some types used to control high blood pressure, can have the side-effect of making the gum tissues swollen so that they bleed and are more prone to infection.
Pre-existing dental disease, in the teeth or gums, may get worse due to steroids or immuno-suppression, so these need immediate attention by your dentist.
Do remember to tell your dentist that you have vasculitis. If you are taking steroids, immuno-suppressing drugs or drugs to prevent osteoporosis, you must tell your dentist. The drugs used to counteract osteoporosis, such as the biphosphonates or alendronates, can cause serious problems if you need to have a tooth extracted.
Like in vasculitis generally, damage once done, cannot always be reversed. The best remedy, as usual, is prevention.
1) The proven most effective toothbrushing regime is to use an electric toothbrush with a rotary oscillating head, such as the Braun Oral B.
2) Couple this with a toothpaste containing both fluoride and triclosan, such as Colgate Totalcare.
3) If possible use dental floss or dental tape regularly or interdental brushes.
4) If you do have gum problems, use an antiseptic mouthwash containing a low dose of chlorhexidine, such as “Corsodyl”. This may be used daily for a short term, but in the long term, only as a weekly mouthwash as it can cause staining of the teeth, although this is easily removed.
Reprinted from the Vasculitis UK Newsletter & Journal, Spring 2011, Issue No. 41