Lupus in Children

Published on 3 June 2023 at 15:44

I want to kick off the dental health topics with an article I wrote recently.  It was inspired an 8 yo patient I treated who had been recently diagnosed with Lupus.  She is being raised by her grandfather and he had no idea how Lupus affects the mouth and what, if anything could be done to help.  A quick Google Scholar search confirmed my suspicion....the oral effects of Lupus are similar in children and adults.  I grabbed some letter head and a pen and scribbled out some instructions for Grandad.  The following weekend I did a deeper dive into evidence-based care for kiddos with Lupus and wrote an article for parents.  

Check out my first attempt at parent education and let me know what you think!!!  Janel

As dental healthcare providers....

What should we be doing for our pedo patients with Systemic Lupus Erythematous (SLE)?

Here's what is known:

  • SLE is an autoimmune disorder which can damage any tissue, organ, or system in the body 

  • While rare in children, it can be life threatening in some cases
  • SLE is commonly managed with immunosuppressants
  • Common flare-up triggers include UV exposure, stress, fatigue, illness, and low vitamin D levels.
  • Lupus Foundation of America has excellent information and resources for both providers and parents.

What this means to treatment goals is multi-fold.  Safety first: consults and disclosures from rheumatology are a must before sedation and treatment.  If the kidneys are affected, N2O/O2 is contraindicated since it is metabolized in the renal systemLiver involvement means conservative use of almost any other drug. Endocrine changes from SLE may complicate the way patients tolerate treatment as well.

Prevention is foremost, as always.  Immunosuppressants put patients at higher risk of infections.  The gingivae and periodontium may have exaggerated reactions to pathogens and irritants.  Reduced salivary flow and poor hygiene are also potentially complicating factors.

Treatment planning and documentation should include:

  • 3 month recall: Evaluate often and diagnose oral complications of SLE early!
  • Periodontal evaluation and record keeping for early detection of attachment loss
  • Radiographic examination with attention to bone levels, cortical bone pattern, and TMJ integrity and stability
  • Patient and parent education.  Feel free to use the parent article I created.

Of course, my favorite part of any treatment planning is collaboration.  The dental body of knowledge is rapidly expanding, and our field is in need of conscientious providers who can examine, interpret, and transform new data into everyday practice.  Do not be afraid to ask, research, learn or reach out....our patients deserve our best efforts ~ Janel

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