Oral Manifestations of Systemic Lupus Erythematosus Patients in Qatar: A Pilot Study

Abstract

Objective The purpose of this pilot study was to assess the prevalence of oral manifestations among systemic lupus erythematosus (SLE) patients in Qatar, in order to warrant future studies that would investigate each one of these manifestations with detail and further scrutiny. Methods Study procedures took place between November 2014 and April 2016. All patients visiting the outpatient rheumatology clinics at Hamad General Hospital, Doha, Qatar, were asked to join. The American College of Rheumatology (ACR) 1997 criteria of SLE were used. The patients were examined initially by a rheumatologist and were later scheduled for an appointment with a dentist at the same institution. A total of 77 patients were recruited for the study. Results Prevalence rates for the different oral manifestations ranged from 2.4% for soft palate ulcers, cheilitis, and oral candida to 88.1% for the presence of cavitation. Gingivitis, periodontal disease, cavities, and missing teeth were observed in more than 50% of the sample. The prevalence of periodontal disease and missing teeth was higher among those with an SLE duration > 8 years. On the contrary, the prevalence of gingivitis and cavities was higher among those with an SLE duration ≤ 8 years. Conclusion This study found high rates of gingivitis, periodontal disease, cavities, and missing teeth among SLE patients in Qatar. It is recommended that healthcare providers of such patients monitor the presence of any oral manifestations in order to arrange for early treatment and prevention efforts. Future prospective longitudinal studies with adequate sample size and power are needed in order to ascertain any causation factors or common etiology pathways.

Role of Lymphocytes CD4/CD8 Ratio and Immunoglobulin G Cytomegalovirus as Potential Markers for Systemic Lupus Erythematosus Patients with Periodontal Disease

“…Cytokine receptors and antibodies stimulate bone resorption by directly inducing proliferation of osteoclast progenitors and also inducing osteoclast maturation. 25,26 Prevalent theories concerning SLE patients believe that cytokines and antibodies are correlated with disease activity, and are also associated with a possible role in periodontitis. Cytokine serum levels were changing in adolescents with SLE compared with healthy subjects and correlated positively with the SLE activity index.…”

Periodontal disease defects and mandibular cortical index in lupus patients

“…Although it is well established that lupus may lead to dysfunction of multiple organs [26], few studies have investigated association with periodontal disease [26,27] and none have examined mandibular bone mineral density using MCI assessment. To our knowledge, this is the first investigation using the mandibular cortical index in this group of patients.…”

“…Previous studies have shown that patients with lupus have a higher risk [26,32] or prevalence [27] of periodontal disease and have suggested that periodontal disease seems to develop earlier [33]. However, other studies using clinical examination had contradictory results and concluded that rates of periodontal disease are similar in patients with lupus and healthy patients [32].…”

“…Some studies of patients with lupus showed that these patients have more periodontal complications [26,27,32]. Periodontal complications are associated with higher level of pro-inflammatory cytokines and a heightened count of Actinobacillus actinomycetemcomitans.…”

Systemic Lupus Erythematosus and implications for the oral cavity

“…Studies indicate that SLE has a prevalence of 30 to 50 cases per 100,000 inhabitants and its incidence ranges from 0.9 to 3.1% per 100,000 inhabitants per year. Women between 30 and 40 years of age are the most affected, with a 10:1 ratio to men (8,10).…”