Scleroderma can impact oral care in many ways, so we’ve summarised our November Virtual Education Session (VES) on the topic. For more in-depth information, we recommend reading our free oral health brochure.
This session was led by Dr Tami Yap, a senior lecturer at the Melbourne Dental School with a wide range of experience with autoimmune conditions and oral health, including presently being part of the multidisciplinary dermatology team at the Royal Melbourne Hospital.
This article includes an overview of what being diagnosed with Scleroderma can mean for your mouth and oral care, how to look after your mouth, and what you are eligible for as a person with Scleroderma.
Different Causes of Oral Changes
The physical impacts of Scleroderma are varied and may not be true for every person with it, but it has been commonly found to impact saliva production, oral opening and blood vessels. With the way skin grows in and around the mouth, Scleroderma may also indirectly affect the shape of your jaw. If the muscles are affected we can sometimes see changes to the teeth that are related to not being cleaned well enough, also causing an indirect effect. Changes that affect the hands and digestion also impact your mouth, so the majority of patients do note changes in their oral health as it can be affected in such a wide range of ways.
Dry mouth is a common thing that can also be related to medications that are taken, such as high blood pressure medication. This is a natural side effect of their impacts and is something many people experience. Reducing your fluid intake, or even having sclerosis of the cellular celery glands themselves, can also change the ability of those glands to produce saliva.
You could also have a related second autoimmune condition called ‘Shogun Syndrome’, which, when paired with Scleroderma, result in a common cause of there being inflammation in the glands related to antibodies sitting in them. The most common area affected by Shogun Syndrome antibodies are solid glands in the mouth and the eyes, hence why a dry mouth and/or dry eyes are highly common.
When considering why you have a dry mouth, it is important to understand all of these different reasons so that you don’t conclude it is specifically from your Scleroderma.
Physical Impacts of Scleroderma
If the skin around the mouth and the muscles are affected there can be a reduction in oral opening. The technical term for this is called microstonia. When you have Scleroderma, the resting aperture of your lips is unchanged but the elasticity is reduced, potentially resulting in a reduced mouth opening that may impact your ability to thoroughly clean your teeth, among other things.
As for the jaw, Scleroderma may affect the skin of the face or the muscles of the face because we have large muscles that sit around the corners and angle our jaw. With Scleroderma, the right angles can become softer and more circular, or can even result in an indentation. You may also have changes to your gums that are completely unrelated to how well you brush your teeth. This can result in teeth loosening, and is why it is so important to be aware of the impacts Scleroderma can have on our mouths and let your dentists know.
Managing Oral Health in Scleroderma
Routine care plays a pivotal role in maintaining oral health in Scleroderma patients, making regular dental visits and transparency with dentists for early detection and management of potential issues one of the most important and effective things we can do to manage our oral health.
For example, another highly common problem for people with Scleroderma is a buildup of tartar in and around your teeth. If you can’t remove this yourself with the appropriate products, it can easily be professionally removed by a dentist at your next visit.
For more complex situations, Yap suggested consulting with specialists in oral medicine or dentists experienced in treating patients with special needs, ensuring that you receive the most appropriate and effective care. Symptoms and changes in oral health can vary significantly among individuals, so having one-on-one sessions with specialists will be extremely beneficial care tailored specifically to you and your needs.
Tools and Products for Oral Care
It is crucial to spend time researching and selecting oral hygiene products that cater to our specific needs, such as electric toothbrushes with small heads and high fluoride toothpaste for better protection. However, it is also important to ensure these products fit comfortably into our daily routines, because oral care needs to be a routine to be effective in the long term.
Increasing the load on our teeth, while common, also needs to be treated. This means we may have habits, like teeth grinding or resting our teeth together, that is separate from our Scleroderma but ultimately increases the severity of it.
For example, if you are someone who grinds their teeth at night, a night guard might be highly effective in ensuring you don’t increase the amount of loose teeth already caused by Scleroderma.
Flossing is also one of the best things you can do for your oral health, but traditional floss can be quite tricky, especially for people with Scleroderma. Instead, air or water flossers might be more beneficial for our teeth, so long as we are using them routinely.
Tackling Specific Challenges
For dry mouth, a common issue in Scleroderma we mentioned above, Yap suggested staying well-hydrated and using products specifically designed to stimulate saliva production. Saliva is crucial to good oral hygiene as it has numerous natural properties in it and is naturally produced all of the time. It’s like a 24/7 security system that combats acid, bacteria and dental decay, so increasing our production when it dips should always be a priority. Reducing your coffee intake can also help saliva production as caffeine is dehydrating.
Routine dental checkups are also one of the best things we can do for our oral health, such as managing gum recession and loose teeth. For these concerns, there may be underlying gum disease present that can’t be accurately identified without professional assistance.
It should be no surprise that maintaining rigorous oral hygiene practices prevents further complications, so find what works for you and stick to it!
Oral Health Eligibility
Numerous dentist and specialist appointments can be expensive and take a while to get into, so it’s important to know what you are eligible for as a person with Scleroderma.
For Victoria, if you have a healthcare or pension card, you should be eligible for public care. You can find your nearest community centre by going to https://www.dhsv.org.au/ and looking for the general health services. With this stream of care you have to put your name down and wait until you are at the top of the waitlist for an appointment.
However, there is also the option for emergency care. If you have a particular concern about pain, feeling like something is broken, or perhaps your tongue is getting scratched by something sharpening, you can access the Emergency Care scheme and they will see you within a few weeks for just the problem that you’re concerned about.
If you’re not on healthcare or rather if you prefer to go to private or you are not eligible for public care, you can select your private dental care provider of choice. Anyone who has a diagnosis of Scleroderma is eligible to go to the oral medicine clinic at the Royal Dental Hospital. On your first visit there you receive a skin check and a full checkup to find if there are any signs of potential oral harm. If you are planning to go to this clinic, you need a letter of referral from your GP or your overseeing Specialists that states that you have Scleroderma and that they would like you to be seen so you get into that care pathway faster.
There are many oral health paths to support people with Scleroderma, so never feel that you are alone in the challenges that may be faced with Scleroderma.
Conclusion and Recommendations
When it comes to oral health with Scleroderma, there are two types of care: proactive and preventative. While there are many different actions for each, the best for both is regular dental check-ups and specialist consultations. Remember, no matter the challenges we all face with our oral health and Scleroderma, there are numerous ways to combat and control them.
For those living with scleroderma, staying updated and informed can make a world of difference. Connecting with others can also be hugely beneficial. Click here to find out more about support in your area.
Our National Education Sessions or Virtual Education Sessions are offered at no cost. Virtual Education Sessions happen every month via Google Meet.
During these sessions, we’ve invited medical professionals and experienced legal experts to address frequent questions about Scleroderma and other topics related to it.
If you’d like to gain firsthand knowledge, our National Education Sessions and Virtual Education Sessions are available to you at no charge. Our Virtual Education Sessions are held every month through Google Meet.
These sessions provide an opportunity to engage with medical professionals and seasoned legal experts who will address common inquiries about scleroderma and related topics.