Lupus: Precautions? Contraindication for Implants?

Anon asks:
I have a 55 year old female patient with Systemic Lupus Erythematosus. I would like to treatment plan her for dental implants. Are there any lab tests I should order? What should I ask her physician to comment on? Any absolute contraindications for implants? Any special precautions? I have been having difficulty getting information on this. What are your recommendations for implant treatment of this patient?

7 thoughts on “Lupus: Precautions? Contraindication for Implants?

  1. Lupus is a chronic inflammatory auto-immune disease. Inflammation caused by lupus can affect many different body systems, including joints, skin, kidneys, blood cells, heart and lungs.Four types of lupus exist(systemic,discoid,drug-induced,neonatal), of these, systemic lupus erythematosus is the most common and serious form of lupus.Patients with lupus are vulnerable to infection because both the disease and its treatments, corticosteroid and cytotoxic drugs affect the immune system, although, infection can bring on a lupus flare, increasing the risk of infection even more.Lupus increases the risk of cancers like non-Hodgkin’s lymphoma, lung cancer; and liver or bile duct cancers.Avascular necrosis of bones may occure and lead to multiple pathologic fractures. Three types of drugs are commonly used to treat lupus; nonsteroidal anti-inflammatory drugs, corticosteroids and immunosuppressives.Recently, stem cell transplant and Rituximab (a B-lymphocyte decreasing agent) has been used to control the disease.When thinking about placing implants in a patient suffering from the disease, the above mentioned data should always be considered.Merry Christmass, happy new year and my best wishes for everybody.

  2. An additional comment is that very often these patients end up on bisphosphonates to treat the osteoporosis that the steroids cause. Typically you might of a window of time when the lupus has calmed down enough that the dosages of the immunosupressant drugs are lower and the patient is not yet on the bisphosphonates. Absolutely consult with m.d. and lay out the risks.

  3. I am 63 years old and require multiple titanium implants. My local dentist won’t even send for an implant consultation because he states that the lupus prohibits this. I have rarely taken steroids (my doctor said it would destroy my kidneys) I have had heart and lung problems but no problems with my bones. I have a series of dental problems because of at 12 years old I fell off a pogo-stick. My bone density tests all come back negative for any bone loss. Isn’t the question of continuing infections from torqued or ill fitting bridges more serious than other possible infection from implants?

  4. I have the same dilemma as Anon, except I am the patient. Really hard to locate published research on topic. Even worse, there are many (myself included) who are young and having significant work done (4x RCT, and apico for periapical abscess – age 24; now I am 35 and all my endos are failing and I will have molars missing bilat). No one wants to tackle it (so far), though I appreciate that some of you are noticing this.

    I knew last year it was coming, now I am abscessed, and no one has any expertise here. Worse, I am looking at $6k OOP since it is dental only; any tips how this would be a medical problem which I have met my OOP for? It’s stupid how they act as if the mouth is disconnected from the body. My rheumy thinks this is connected to the autoimmune stuff.

  5. One contraindication is that you should definitely avoid prescribing any sulfa drugs to lupus patients.
    You should contact Dr. Daniel J. Wallace in Los Angeles. He is a renowned expert regarding lupus.
    Most MDs are relatively clueless about lupus, except for very basic “cut and paste” information.
    I had this procedure done with a titanium implant a year ago, in basically the same age range, and I have SLE. I had no problems as a result of the procedure that I know of, with the exception of extended and “unusually high bruising,” which lasted close to a month, rather than for just the expected couple of weeks.
    When it comes to lupus, each patient is different, due to the course of the individual patient’s case, how active the disease is, which antibodies the patient has been diagnosed with, and which organs are being affected by the disease.
    Additionally, the outcome depends on the dentist that is doing the procedure. How competent the the dentist is, and his expertise also comes into play.
    In any event, you should consult with a lupus specialist, not just any MD.
    If it was cancer, you would not just contact any MD. You would consult an oncologist. The same should hold true for lupus.
    As far as the osteoporosis, it is not solely because of the steroids. It commonly occurs at a younger age in female lupus patients than it does among those who don’t have the disease. Part of the reason for this is that systemic lupus is a connective tissue disorder, as well as an immune disorder.
    Thank you for taking the time to make sure with this patient first. Lupus can be a life-threatening disease, and the disease should be taken into consideration before any major medical procedure or even when prescribing drugs.
    I hope this is helpful to any and all readers.

  6. I am a 65 year old woman, slight build with Lupus, Hashimotoes Disease, Osteoperosis, Celiac Disease, and Pre- diabetes. I have always taken good care of my teeth but recently my dental visits have been a nightmare. I lost both back molars on the right side to abses and decay under a capped tooth. Had no idea there was any problem. Now will probably loses both molars on the upper right side. This is all within a month.

    The only real problems I’ve had with Lupus has been joint aches, terrible fatigue, and mouth sores plus dry mouth and eyes. (I had to go out on disability and give up teaching.)

    The oral surgeon said he won’t do a bone graft therefore no implant because of my conditions. I am getting a second opinion. What do you think? Agree with the oral surgeon?

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