Oral Manifestations of Autoimmune Diseases

1. Introduction

Normally our immune system fights against foreign pathogens to protect our body from diseases. But in autoimmune diseases, the immune system affects our body cells. Many autoimmune diseases mostly show oral manifestations which play an important role in diagnosing the condition earlier. Most autoimmune diseases have dry mouth as their oral manifestation and other oral manifestations of autoimmune diseases include mouth ulcers, swelling of salivary glands, alteration in taste sensation etc.

2. Common Oral Manifestation of Autoimmune Disease

• Dry Mouth

Dry mouth also known as Xerostomia is the most common oral manifestation of autoimmune diseases. Some autoimmune diseases like Systemic lupus erythematosus and rheumatoid arthritis show dry mouth and Sjogren’s syndrome as their oral manifestation.

• Mouth Ulcers.

Mouth ulcers are signs of serious autoimmune diseases like celiac disease which appear as mouth sores or aphthous ulcers. Mouth ulcers are also oral manifestations of lupus erythematosus, pemphigus vulgaris etc. Lupus mouth rash is a clinical manifestation of lupus erythematosus.

• Swollen Glands.

Swollen salivary glands are oral manifestations of autoimmune diseases like Sjogren’s syndrome, rheumatoid arthritis and lupus erythematosus. In celiac disease, the cervical lymph nodes are swollen and some research shows that non-Hodgkin’s lymphoma are diagnosed in people with celiac disease and clinically appear as a swollen mouth.

• Altered taste sensation

Autoimmune disease affecting taste buds is an oral manifestation of autoimmune diseases. Diseases like Sjogren’s syndrome is the most common condition that cause alteration in taste sensation due to decreased salivary production leading to dry mouth, which is the reason behind the change in taste sensation. Other autoimmune diseases that manifest altered taste sensations are type 1 diabetes mellitus and systemic lupus erythematosus.

3. Specific Autoimmune Diseases and their Oral Manifestations

1. Sjögren’s Syndrome

Sjogren’s syndrome is a condition in which the body’s immune system attacks the salivary glands, this leads to a decrease in the production of saliva thereby causing dry mouth and dry mouth as oral manifestations of sjogren’s syndrome. Dry mouth and sjogren’s syndrome are closely interrelated. Sjogren’s syndrome has two forms: primary form and secondary form. 

The primary form of Sjogren’s syndrome does not have any underlying condition whereas in the secondary form of Sjogren’s syndrome, systemic lupus erythematosus and rheumatoid arthritis are the underlying conditions which cause dry mouth leading to swollen salivary glands, this salivary gland inflammation decreases the flow of saliva leading to increased incidence of dental caries.

2. Lupus Erythematosus

It is an autoimmune disease. Most common oral manifestation of lupus erythematosus is mouth ulcer. The incidence of mouth ulcer is due to the decreased salivary flow rate and it is also the underlying condition in sjogren’s syndrome. The ulcer appears as oral discoid lesions. The classical clinical feature of this condition is the appearance of malar rash, also known as butterfly rash.

3. Scleroderma

Oral manifestation of scleroderma is microstomia (small mouth), which occurs due to tightening of soft tissues around the mouth, it thereby affects the salivary flow rate causing dry mouth. Due to the reduced salivary flow rate the food easily sticks to the teeth as the cleansing property of the saliva is affected it may result in tooth decay and the food deposits between gums causes gingivitis thereby increasing the chances of halitosis (bad breath).

4. Pemphigus Vulgaris

It is a life threatening autoimmune disease. Formation of bulla and ulcers in the mucous membrane is the most common oral manifestation of pemphigus vulgaris. The oral ulcer in this disease will have a white pseudomembrane which can be peeled, and erythematous ulcer beneath the yellowish membrane will bleed on palpating and this is referred to as Nikolsky’s sign.

5. Rheumatoid arthritis and oral health

Rheumatoid arthritis is an autoimmune disease that affects bones and joints, it shows oral manifestations like periodontal diseases which affect the bone around the teeth leading to tooth loss. The most common oral manifestation of rheumatoid arthritis is Temporomandibular joint dysfunction leading to difficulty in eating. Rheumatoid arthritis is also an underlying condition in sjogren’s syndrome that causes dry mouth.

6. Dental problems with Hashimoto’s 

It is an autoimmune disease that affects the gut. But the mouth is also a part of the gastrointestinal tract, so it also affects the oral cavity. Dental problems with Hashimoto’s include mouth infections leading to gingivitis, periodontitis and abscesses.

4. Medications for autoimmune diseases 

Salivary substitutes and salivary stimulants, mouthwashes are effective medications for autoimmune diseases causing dry mouth. Corticosteroids and immunosuppressants like azathioprine, cyclophosphamide and methotrexate are advised by physicians for autoimmune diseases. Oral corticosteroid gels are advised to apply over oral ulcers caused by autoimmune diseases.

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