For people with lupus, oral health is a top priority. In addition to dealing with lupus symptoms like joint pain and hair loss, many MyLupusTeam members must also contend with dental procedures like root canals and tooth extractions. “I have had a lot of trouble with my teeth. I have had root canals, crowns, and teeth pulled,” one member shared.

So, are people with lupus more likely to experience dental health problems that would require a tooth extraction or root canal? Are there any special precautions you and your dentist need to take for these dental treatments due to lupus?

Here we explore whether people with lupus are more prone to developing dental issues and if dental procedures present any additional risks for people with this autoimmune disease.

Lupus and Tooth Decay

Many MyLupusTeam members have discussed their experiences with their teeth and dental procedures. “I have had several problems with my teeth since I was diagnosed,” one member wrote. “I have had mouth sores. My gums would swell or become irritated just from me eating. I’ve also had a few of my teeth pulled due to cavities.”

Oral manifestations of lupus are common. A 2023 review found that people with lupus often have several teeth affected by decay — usually between four and fourteen on average — showing that cavities are common but not universal.

A 2020 study from India looked at about 500 people with lupus and found that 87.6 percent had tooth decay. Because the study was done in a hospital, where patients often have more severe lupus, and because dental health can differ between countries, the number may be higher than what’s seen in the United States. Still, it supports other research showing that people with lupus are more likely to have cavities than those without the disease. One theory is the dry mouth common to people with lupus can compromise tooth health.

Periodontal disease (gum disease) is also common in people with lupus. Gum disease can make your gums swollen and painful, and they may bleed easily. In some cases, it’s possible to lose teeth. The same 2020 study from India found that 85 percent of people with systemic lupus erythematosus (SLE) had severe gum disease.

Treating Tooth Decay

Your dentist will recommend treatments based on the severity of your tooth decay. Possible treatment options include a standard cavity filling, a crown placement, a root canal, or a tooth extraction. If tooth decay is caught early, your dentist may try fluoride treatments instead of something more invasive.

Crowns (coverings over a decayed tooth), root canals, and extractions are reserved for more serious cases. A root canal is a procedure to save a tooth with infected pulp (tissue inside the tooth). In an extraction, your tooth is fully removed, and then possibly replaced with a dental implant.

Dental Considerations for People With Lupus

If you’re preparing to have a crown placement, root canal, or tooth extraction, talk to your rheumatologist and your dentist about how lupus may affect your dental care. You may have a higher risk of infection, inflammation, and irritation. Here are some things to consider.

Mouth Sores

Mouth sores — sometimes called mouth ulcers or oral lesions — are seen in about 40 percent of people with lupus. Dental procedures can increase your risk for these oral ulcers if your gums and mouth are irritated during the dental work. Let your dentist know if you’re prone to mouth sores. They can take precautions to prevent irritation and provide you with tips for aftercare.

Dry Mouth

Lupus puts you at increased risk for mouth problems such as xerostomia (dry mouth) and angular cheilitis (cracking and bleeding at the corners of the mouth). These symptoms can make it uncomfortable to keep your mouth open for a long dental procedure. Ask your dentist how they can keep you comfortable during your visit.

Neuropathy

People with lupus are already at risk for neuropathy (nerve damage), which may be increased in dental procedures. One member asked, “Has anyone else had painful neuropathy after a root canal?”

Although rare, neuropathy is a risk for anyone undergoing a dental procedure like a root canal. This is because the teeth hold nerve endings that may be disrupted during the procedure. Imaging before dental procedures usually shows the dentist what areas to avoid and what procedures are necessary to reduce long-term pain.

Infection Risk

People with lupus have a higher chance of infection after dental work, especially if they take medicines that weaken the immune system. But antibiotics before dental procedures are not usually needed unless you have specific heart problems, such as a heart valve replacement or a history of endocarditis (a serious heart infection). Talk with your dentist and rheumatologist to decide if you need antibiotics before your visit.

Photosensitivity

The overhead lights in a dentist’s office may increase your risk for photosensitivity. Don’t be afraid to use sunglasses and full-coverage clothing when sitting under that bright dental lamp during your extraction, root canal treatment, or any regular dental checkup.

Medications

People with lupus may also have to alter their medication schedule before a dental procedure. Whether or not you’ll need to make adjustments depends on the type of medication you’re taking. One member shared, “I had to be off my meds for a certain amount of time before my dental work. Check with your rheumatologist, and see if it makes any difference. It all depends on what you’re on.”

Never stop taking your lupus medication without first speaking with your rheumatologist. Also, make sure to tell your dentist about all the medications you’re on before your dental procedure. This could be especially important if you take blood thinners or immunosuppressive medications, such as corticosteroids. Work together with your dentist and your rheumatologist to decide the safest medication plan before and after your dental procedure.

Sedation and Local Anesthesia

Cavity fillings, crown placements, root canals, and tooth extractions are generally performed using a local anesthetic, such as lidocaine. This means the dentist will use a needle to inject the medication into your mouth. Ask your dentist about their plan for local anesthesia, and check with your rheumatologist to ensure there are no concerns.

Sometimes people want to be sedated during their dental procedure. Nitrous oxide — sometimes called “laughing gas” — is commonly used. However, nitrous oxide may not be appropriate for everyone.

Though lupus itself isn’t an indication against use of nitrous oxide, you may have other medical conditions for which nitrous oxide isn’t recommended. In particular, those with lupus who have a very congested nasal passage and can’t breathe through their nose and those who aren’t able to use a nose mask shouldn’t have nitrous oxide during dental procedures. Certain other medical conditions may also preclude you from being sedated with nitrous oxide, such as high blood pressure and severe anxiety or other psychiatric disorders.

If you’d like to be sedated during your procedure, talk with your dentist about your current medical conditions. Your provider can let you know if nitrous oxide is appropriate for you and review all your sedation options with you before your procedure.

Join the Conversation

On MyLupusTeam, people share their experiences with lupus, get advice, and find support from others who understand.

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