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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Oral Manifestations, continued

Autoimmune Disorders

Autoimmune disorders include:

  • Systemic Lupus Erythematosis (SLE)
    Systemic Lupus Erythematosus is rare in children, but increasingly common in teenagers and adults, especially females. Prevalence ranges from 4 to 30 per 100,000 children, varying by race and ethnicity. Oral lesions are seen in 9% to 45% of patients with SLE, with prevalence depending on the form of lupus. Oral ulcers are the most common manifestation and often present as painless, palatal lesions.  Mucosal atrophy can also occur. Parotid involvement of SLE can result in xerostomia.
Xerostomia: Abnormal dryness of the mouth due to insufficient saliva production.
  • Inflammatory Bowel Disease (Crohn’s Disease and Ulcerative Colitis)
    Oral findings occur in 8% to 10% of patients with Crohn’s Disease and may precede gastrointestinal involvement. Aphthous ulcers and angular cheilitis are found in Crohn's Disease and Ulcerative Colitis. IBD associated ulcers are painful; in contrast to the painless ulcers seen in SLE.

    Cobblestoning or mucosal nodularity of the buccal mucosa and gingiva is unique to Crohn's Disease. Pyostomatitis vegetans, a condition of punctuate pustules on the labial and buccal mucosa, is primarily seen in Ulcerative Colitis.
Aphthous ulcer: Disintegration and necrosis of epithelial tissue on a mucous membrane; usually painful.
Cheilitis: Inflammation of the lip.
  • Sjogren’s Disease
    Sjogren’s Disease is characterized by recurrent parotid gland enlargement and xerostomia. Decrease in saliva production results in difficulty swallowing and eating, taste and speech alterations, and increased risk of dental caries.

    Primary Sjogren’s is very rare in childhood, but Sjogren’s is more common as a secondary complication of another autoimmune disorder (e.g. rheumatoid arthritis, lupus).

  • Xerostomia
     Xerostomia is a common side effect of antidepressants, diuretics, antihypertensives, and anticholinergics (e.g. Glycopyrrolate). Patients experiencing this side effect should be monitored and encouraged to maintain good oral hygiene and frequent dental visits.

    Recommend frequent sips of water and non-sugary drinks. Sugar-free lemon drops and sugar-free chewing gum can stimulate saliva production. Lubricating mouth rinses and toothpastes (e.g. biotene®) can also provide xerostomia relief.

Fast Facts
Many systemic conditions are known to adversely affect the mouth or teeth, and these patients require additional oral care and management.
Oral findings may be the only presenting symptom for leukemia and hystiocytosis.
Early tooth loss, especially mandibular molars, should prompt consideration of Langerhans cell histiocytosis.
Xerostomia may occur in SLE, Sjogren's Disease, and Diabetes Mellitus.
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