Autoimmune Disease and Oral Manifestations: A Clinical Overview

Autoimmune diseases and syndromes occur when the defense mechanism of our own body fails to recognize itself and attacks itself. This leads to self-destruction of our body’s own cells, causing disease in a healthy individual.

Why autoimmune diseases affect the oral cavity

The oral cavity is vulnerable to autoimmune diseases due to its

• Rich vascular and immune supply

• High cell turnover rate

• Constant exposure to bacterial pathogens

• Presence of salivary glands

Autoimmune activity targets oral epithelium, connective tissue, salivary glands, or basement membrane structures, resulting in chronic inflammation and mucosal breakdown.

Common oral manifestations of autoimmune diseases

• Xerostomia (dry mouth)

• Recurrent aphthous ulcers

• Desquamative gingivitis

• Erythematous or erosive mucosal lesions

• Oral candidiasis

• Burning mouth sensation

• Dysgeusia (altered taste)

Autoimmune diseases affecting oral cavity

Sjögren syndrome

It is a chronic systemic autoimmune disease that attacks the moisture-producing glands such as eyes and oral cavity.

Oral manifestations

• Severe dry mouth (xerostomia)

• Difficulty chewing and swallowing

• Rampant dental caries

• Oral candidiasis

• Atrophic oral mucosa

Clinical significance

Dentists are usually the first to detect this syndrome. Unexplained long-term dry mouth is often the first sign. Clinicians should consider lacrimal and salivary flow testing and referral.

Systemic Lupus Erythematosus (SLE)

It is a dermal and mucosal autoimmune disease characterized by a butterfly-like rash over the middle part of the face due to immune complex deposition.

Oral manifestations

• Painless oral ulcers

• Erythematous or lichenoid lesions

• Cheilitis

• Secondary infections due to immunosuppressive therapy

Clinical significance

Oral ulcers are included in SLE diagnostic criteria and may resemble oral lichen planus.

Oral Lichen Planus

It is a T-cell-mediated autoimmune disease affecting the oral cavity.

Oral manifestations

• Reticular white striations (Wickham striae)

• Erosive or ulcerative lesions

• Burning sensation or pain

• Desquamative gingivitis

Clinical significance

Requires long-term monitoring due to malignant transformation risk.

Pemphigus vulgaris

Autoantibodies against structures anchoring cells together, which cause blistering.

Oral manifestations

• Fragile vesicles that rupture easily

• Painful erosions and ulcers

• Oral lesions often occur before skin involvement

Clinical significance

• Early oral diagnosis is lifesaving

• Positive Nikolsky sign, where the outer layer of skin gets detached from the inner layer after rubbing

Mucous membrane pemphigoid

Autoantibodies against basement membrane components.

Oral manifestations

• Desquamative gingivitis

• Chronic blistering and erosions

• Scarring in severe cases

Clinical significance

Gingival involvement is common.

Rheumatoid arthritis

Systemic inflammatory autoimmune disease affecting joints, especially knee joints.

Oral manifestations

• Temporomandibular joint involvement

• Dry mouth

• Periodontal disease association

Clinical significance

Bidirectional relationship between periodontitis and rheumatoid arthritis. Periodontal inflammation may influence systemic disease activity.

Celiac disease

Immune-mediated reaction to gluten.

Oral manifestations

• Recurrent aphthous ulcers

• Enamel hypoplasia

• Delayed tooth eruption

• Glossitis and angular cheilitis

Clinical relevance

Oral signs may appear before gastrointestinal symptoms. Pediatric dental findings are particularly important.

Impact of immunosuppressive therapy on oral health

Many autoimmune patients receive:

• Corticosteroids

• Methotrexate

• Biologic agents

Oral implications

• Increased risk of opportunistic infections

• Delayed wound healing

• Masking of inflammatory signs

Role of dental professionals

• Early recognition of abnormal or persistent oral lesions

• Differentiation between autoimmune disease and common oral conditions

• Timely referral to rheumatology, dermatology, or oral medicine

• Preventive care essential due to high caries and periodontal risk

Key references

• Neville BW et al. Oral and Maxillofacial Pathology

• Scully C, Porter S. Oral mucosal disease: autoimmune disorders

• Fox RI. Sjögren’s syndrome. Lancet

• European Association of Oral Medicine. Clinical guidelines

• Aliko A et al. Oral lichen planus and autoimmune mechanisms