While everyone is encouraged to visit their dentist twice per year, it is imperative that lupus patients do so as well, and those with active lupus disease are urged to visit the dentist in three month intervals, according to Dr. Shamika Strachan.
The associate dentist, who practices out of Impressions Dental, Harbour Bay, says there should be communication between the dentist and the attending rheumatologist or medical doctor to keep updated on the management of the individual, and for the dentist to consult before prescribing any medication for oral conditions that may arise.
"Lupus is a chronic, inflammatory, autoimmune disease, sometimes associated with mucocutaneous lesions, with or without systemic involvement. This disease is an ongoing condition. It results in swelling within mucous membranes [the inner lining of most body cavities] and the skin [cutaneous], which may or may not affect other organs. Lupus is classified as an autoimmune condition because the affected individual's immune system attacks their own tissues/cells; lupus may affect multiple organs (Systemic Lupus Erythesatosus-SLE) or it may only involve the skin and oral cavity (Discoid Lupus Erythematosus-DLE)."
Although it is believed that the disease may be genetic, environmental factors such as smoking, hormonal changes, ultraviolet (UV) radiation and viral infections are thought to increase the likelihood of developing the condition in those who are already genetically susceptible.
The dentist said that the more common of the two forms of lupus is the discoid type and it is found most commonly in middle-aged women. She said the person affected with the discoid form of lupus may be recognized extra-orally by the characteristic butterfly patterned lesions that appear above the neck -- much like singer Seal. Toni Braxton and Selena Gomez are living with the systemic form of the disease. Lady Gaga has been tested borderline.
"Approximately 40 to 50 percent of lupus patients develop mouth sores. These may or may not be painful, but their presence usually indicates active lupus disease," said Dr. Strachan. "That's not to say all mouth sores indicate that a person has lupus. Mouth sores may develop from a range of things -- from stress, trauma, hormonal changes, certain foods and even ingredients in toothpastes. However, in a known lupus patient, all mouth lesions should be biopsied to check for active disease."
The dentist said mouth sores usually appear on the gums, cheeks, inner lip and roof of the mouth; and are characteristically red, ulcerated lesions with a white "halo" and white lines that spread from the center. It is also important to highlight that in some instances the presence of oral lesions may be a direct reaction to medications taken by lupus patients. Changes in the pigment (color) of the oral tissues, or opportunistic oral infections (such as fungal infections), may also develop as a side effect to various medications taken by lupus patients.
Apart from oral lesions and opportunistic infections, the dentist said the patients are also at an increased risk of developing tooth decay due to dry mouth, which may also be accompanied by a burning mouth sensation.
"According to Dr. Paul Freedman in an article written by Colgate, 20 to 30 percent of people with lupus develop Sjogren's Syndrome (SS). SS is an autoimmune disease that attacks salivary glands and other moisture producing glands (including the lacrimal gland that keep the eyes moist, thus dry eyes can result as well). A decrease in salivary flow means a decrease in the antibacterial and antifungal components of saliva, which cleanses the mouth and fights oral bacteria. Reduced production of saliva can contribute to oral fungal infections as referenced previously."
She said SS can be diagnosed through various blood tests, and that a telltale sign of the condition is bilateral (both sides) enlargement of the face due to swelling of the major salivary glands.
Dr. Strachan said there is currently no cure for SS, but that the resultant dry mouth (xerostomia) can be managed; and that stimulation of saliva is encouraged by chewing sugar free gum or candy, or using medications such as pilocarpine from which there are side affects, and as such, she said patients should be advised by a medical doctor when taking. And that there are saliva substitutes available such as biotene, xerostom and aquoral to name a few. Mouth sores in lupus patients are usually treated with topical steroids such as prednisone, more resistant lesions are treated with antimalarials such as plaquenil.
To maintain a healthy month, the dentist recommends that lupus patients avoid direct sunlight (especially for those people whose lesions are triggered by exposure to sunlight); keep stress levels at a minimum; get lots of rest; eat a well-balanced diet that's low in sugar, and avoid foods that they know may activate mouth blisters; take medication as prescribed; take small sips of water; carry out meticulous oral hygiene; and visit their dentist regularly.
Millions of people worldwide struggle with the often debilitating health consequences of lupus, a potentially fatal autoimmune disease capable of damaging virtually any part of the body, including the skin, heart, lungs, kidneys and brain.
While some groups of people develop lupus more frequently than others, lupus develops in people of all ages, races, ethnicities and genders.
Lupus is a hard to diagnose disease, which mimics other diseases. It can be debilitating when a sufferer experiences a flare.
As Lupus Awareness Month is observed during May to increase public understanding of this cruel and mysterious disease that ravages different parts of the body, Dr. Strachan encourages people to be health conscious and to get tested if they are suffering but don't know why.
"To all those in the fight against lupus -- patients, family and friends -- stay healthy and keep strong. You are true fighters. Please pass your knowledge of lupus and its effects on the oral cavity with someone today. #POP"

Formation of support group
The Lupus 242 group offers support to those diagnosed with lupus and their families. Lupus 242 was originally the idea of Debbie Humes who got very sick and was unable to pursue the idea of putting the group together. In 2011-2012, Shanelle Brennen had a rough bout with the disease that put her out of work for almost six months. During that time, she decided to get the group up and running. They launched in April 2012 with Brennen as president and her younger sister Shonalee King Johnson, who does not have the disease, as her vice president and public relations coordinator.
Brennen wanted to start the support group so that fellow sufferers did not feel alone, and to let them know they had support. She felt that a lot of people suffered in silence and came up with the theme, 'Breaking the Silence, Supporting the Cure', which is their motto. The group has regular meetings and provides education. She wanted it to be such that someone who was on the other side of a lupus experience could speak to it.
Brennen lost her two decades battle with the disease on March 2. King Johnson is continuing her sister's mission to break the silence and support the cure.

LUPUS 242 EVENTS (including P.O.P. -- Put on Purple Fridays in support of lupus fighters)
Saturday, May 27: Health talk with rheumatologist Dr. K. Neil Parker at the Harry C. Moore Library at the University of The Bahamas.
To support the cause, persons can attend events and purchase Lupus 242 t-shirts, wristbands or car bumper stickers. Proceeds go towards local awareness initiatives and global research. For more information on the group and upcoming events, visit www.facebook.com/lupus242, email lupus242@outlook.com or call 242-525 9967.

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