Oral health

Vasculitis can affect all parts of the body and the mouth is no exception. Large, persistent and excruciatingly painful mouth ulcers are sometimes a characteristic of active Wegener’s Granulomatosis as is severe toothache that moves around the mouth, especially in the upper jaw.

When patients are severely ill with vasculitis (or any other disease) it is essential that their dental care is not neglected, as a period of neglect can cause permanent damage to teeth and gums. This can also apply where patients are suffering from restricted use of their hands or upper limbs.

Obviously, those taking immuno-suppressing drugs must take care as the mouth is one of the places where invading bacteria can most easily gain the upper hand. Some medication, especially some types used to control high blood pressure, can have the side-effect of making the gum tissues swollen so that they bleed and are more prone to infection.

Pre-existing dental disease, in the teeth or gums, may get worse due to steroids or immuno-suppression, so these need immediate attention by the dentist.

The vasculitis patient should tell their dentist that they have vasculitis. Also if the patient is taking steroids, immunosuppressing drugs or drugs to prevent osteoporosis, they must tell their dentist. The drugs used to counteract osteoporosis, such as the bisphosphonates or alendronates, can cause serious problems if a tooth has to be extracted.

Like in vasculitis generally, damage once done, cannot always be reversed. The best remedy, as usual, is prevention.

The proven most effective toothbrushing regime is to use an electric toothbrush with a rotary oscillating head, such as the Braun Oral B. Couple this with a toothpaste containing both fluoride and triclosan, such as Colgate Totalcare. If possible use dental floss or dental tape regularly or interdental brushes. For gum problems, use an antiseptic mouthwash containing a low dose of chlorhexidine, such as “Corsodyl”. This may be used daily for a short term, but in the long term, only as a weekly mouthwash as it can cause staining of the teeth, although this is easily removed.