Oral health: ‘Purple or brown’ mouth lesions could be sign of autoimmune disease

Dentist reveals how much toothpaste you should use

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The Global Burden of Disease Study 2019 estimated that oral diseases affect close to 3.5 billion people worldwide, with cancers of the lip and oral cavity among the top most common cancers worldwide. Yet, some of these conditions can be caught early, treated or even prevented if individuals are aware of the various tell-tale signs that occur in the mouth signalling something more serious. Express.co.uk chatted with Dr Deborah Lee from Dr Fox Pharmacy about the signs in the mouth that could signify something more serious.

Although dentists are mostly concerned about identifying and treating dental caries (tooth decay), periodontal disease (gum disease), tooth loss, and mouth cancers, Dr Lee expresses that the following symptoms may be signs of other medical conditions, and should therefore never be ignored:

  • Pain in your mouth, teeth, or jaw
  • Bleeding from your gums
  • Loose teeth, or tooth loss
  • Bad breath
  • Sores in your mouth, mouth ulcers
  • Lumps in your mouth, cheeks, or tongue
  • Dry mouth, lips and tongue.

One of the main groups of conditions that can be diagnosed through changes in the mouth include autoimmune diseases, of which 100 are currently known.

Autoimmune disease happens when the body’s natural defence system can’t tell the difference between your own cells and foreign cells, causing the body to mistakenly attack normal cells.

The most common autoimmune diseases can include rheumatoid arthritis, psoriasis and lupus, but Dr Lee warned of some other, more rare conditions that can cause changes in the mouth.

This includes one specific condition known as oral lichen planus – a chronic inflammatory skin condition that affects around one to two percent of the adult population.

The condition can affect any or all areas inside of the mouth and is often triggered by psychosocial stress or trauma. The condition can present in two main forms, or can be a mixture of both: Reticular lichen planus and Atrophic or erosive lichen planus.

The former causes the following symptoms:

  • Symmetrical white lace-like pattern on buccal mucosa (inner aspects of cheeks)
  • May affect tongue or gums
  • May ulcerate.

Whereas the latter can cause some slightly different symptoms, including:

  • Red lesions often with a whitish border
  • My cause erosions (superficial ulceration)
  • Most often affects the gums (gingiva) and lips
  • Can be very painful
  • May be associated with erosive lichen planus affecting genital sites.

Oral lichen planus can be very painful and ulceration may lead to scarring. Sometimes eating is so uncomfortable that the affected person is unable to maintain the adequate nutrition recommended for an adult.

As well as autoimmune diseases, signs in the mouth can also be signs of cancers, known as neoplastic diseases. One of these is Kaposi’s sarcoma, a disease in which cancer cells are found in the skin or mucous membranes that line the gastrointestinal (GI) tract, from mouth to anus, including the stomach and intestines.

If any individual has any symptoms of Kaposi sarcoma it is important to seek a medical opinion, who will be able to check for the condition using a skin biopsy or bronchoscopy.

Initially these tumours appear as purple or brown patches or nodules on the skin and mucous membranes. In the past it was far more common for the condition to develop into more advanced stages, but today only around 20 percent of patients have tumours beyond their skin or lymph nodes.

The above conditions are only two in a whole list of other conditions that could cause changes or symptoms to appear in the mouth. The NHS recommends that if you or someone you know has experienced the following for three weeks or more, they should either seek advice from their GP or dentist:

  • Painful mouth ulcers
  • Lumps in the mouth
  • Enlarged lymph glands in your neck.

When asked if there are certain foods, drinks or lifestyle habits that can increase the risk of certain mouth conditions, Dr Lee said: “Eating and drinking certain food and drink can increase the risk of poor mouth health. It’s important to try and maintain a low sugar diet, not to smoke or chew tobacco, and to reduce your alcohol consumption.

“Tobacco is highly carcinogenic. Smoking increases the risk of mouth cancer by a factor of 10. It also increases the risk of at least 12 other cancers. Alcohol is also a carcinogen. Drinking alcohol and smoking increases your risk of mouth cancer by a factor of 30.

“Fluoride is also required for healthy teeth, so drink fluoridated water, and use fluoridated toothpaste.”

Dr Lee continued to explain how treatable some of the conditions explained above are, and what a course of treatment entails: “Mouth conditions linked to medical conditions affecting the whole body can be very difficult to treat.

“Some, such as oral candidiasis, respond well to antifungal treatment, but if the underlying cause persists, such as a weak immune system due to an underlying medical condition, symptoms can be troublesome.

“Chronic mouth conditions such as lichen sclerosus and lichen planus often respond well to steroids, either used topically or systemically. They are likely to wax and wane. Rare conditions such as SLE and systemic sclerosis require specialist management and are likely to require sophisticated immunotherapy, using drugs such as rituximab or belimumab.

“Many UK adults do not visit the dentist. In June 2021, only 41 percent of adults had visited a dentist in the previous two years. Only 32.8 percent of children had seen the dentist in the previous 12 months. This is very sad.

“Visiting the dentist is one of the very best things you can do to improve your health. This should be in the form of regular dental check-ups.”

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