From the Guidelines
Lupus patients do not have absolute contraindications for dental procedures, but they require careful management and precautions to minimize risks. The 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus 1 provides guidance on the treatment of SLE, but does not specifically address dental procedures. However, it emphasizes the importance of minimizing glucocorticoid doses and using immunomodulating agents to reduce disease activity.
When considering dental procedures for patients with lupus, it is essential to take into account their increased susceptibility to infection and delayed healing due to both the disease itself and its treatments. Patients with lupus may require antibiotic prophylaxis before invasive dental procedures if they are taking immunosuppressive medications like prednisone, methotrexate, or biologics. The standard regimen is amoxicillin 2g orally one hour before the procedure, or clindamycin 600mg for those with penicillin allergies.
Some key considerations for dental care in lupus patients include:
- Avoiding dental treatment during lupus flares when possible
- Using local anesthetics containing epinephrine cautiously as they may interact with certain lupus medications
- Taking additional precautions for patients with lupus nephritis or on anticoagulants, including recent blood tests to check clotting factors and kidney function
- Accommodating joint involvement in lupus with shorter appointments or special positioning in the dental chair
Overall, careful coordination between the dentist and rheumatologist is essential for safe dental care in patients with lupus. By taking a cautious and individualized approach, dental procedures can be performed safely and effectively in patients with lupus.
From the Research
Systemic Lupus Erythematosus (SLE) and Dental Procedures
- SLE is a chronic, autoimmune disorder that can affect various organ systems, including the oral cavity 2, 3, 4, 5.
- Patients with SLE may experience symptoms such as fevers, arthralgias, and a characteristic rash, as well as more serious manifestations involving the cardiac, renal, and central nervous systems 2.
- Due to the valvular damage associated with SLE, prophylactic antibiotic premedication is recommended prior to invasive dental procedures 2.
Dental Management of SLE Patients
- Appropriate dental management of SLE patients requires an understanding of the etiology, clinical manifestations, current treatment recommendations, and psychological aspects of the disease 2.
- SLE patients are at a higher risk of compromised oral and dental health, exhibiting increased risk of periodontal diseases and temporomandibular joint disorders 4.
- The use of systemic drugs, especially immunosuppressive and anticoagulants, in SLE patients may influence their oral management 4.
- A multidisciplinary approach is needed for dental and medical management of SLE patients 4, 5.
Contraindications for Dental Procedures
- There is no consensus about the ideal oral management for SLE patients, and the disease can affect the provision of dental care 3, 4.
- Patients with SLE may experience bleeding, infection, endocarditis, adrenal insufficiency, and mucocutaneous disease, which can affect dental treatment 3.
- The use of anticoagulant therapy, such as warfarin, may require modifications to dental treatment plans 6.