Autoimmune & Connective Tissue
Dental Management of Patients with Systemic lupus erythematosus (SLE)
SLE / lupus — assess renal, cardiac & clotting
Systemic lupus can involve the kidneys (drug dosing), heart (Libman–Sacks endocarditis) and clotting (antiphospholipid syndrome), and patients are often immunosuppressed. Oral ulcers are common.
Emergency vs routine management
If EMERGENCY — what to do
- • Check FBC (thrombocytopenia, leucopenia) and renal function before surgery; assess steroid cover.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • Libman–Sacks lesions alone do not need endocarditis prophylaxis.Ref: Wilson WR et al. Prevention of Viridans Group Streptococcal Infective Endocarditis — AHA Scientific Statement. Circulation 2021;143:e963–e978
If ROUTINE — what to do
- • Routine care with rheumatology liaison; manage oral ulcers and photosensitivity.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
Clinical precautions
- • Assess renal involvement — adjust drug doses to kidney function; avoid NSAIDs if nephropathy
- • Ask about antiphospholipid syndrome / anticoagulation (both bleeding and thrombosis risk)
- • Oral ulcers are common — distinguish lupus lesions from infection
- • IE prophylaxis only if a specific AHA 2021 cardiac indication exists (not for lupus per se)
- • Review current corticosteroid / methotrexate / biologic therapy
- • Consider stress-dose steroids for major surgery (see the steroid-cover note)
- • Meticulous infection control
Information & tests to request
- • Daily prednisolone-equivalent dose (mg) — This patient's condition/therapy is commonly associated with long-term corticosteroids, which can suppress the adrenal response to surgical stress. Enter the daily dose (0 if none) to determine whether supplementary stress-dose cover is needed.
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION SLE / lupus — assess renal, cardiac & clotting |
| Supragingival scaling / polish | MODIFY / CAUTION SLE / lupus — assess renal, cardiac & clotting |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION SLE / lupus — assess renal, cardiac & clotting |
| Root canal treatment | MODIFY / CAUTION SLE / lupus — assess renal, cardiac & clotting |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION SLE / lupus — assess renal, cardiac & clotting |
| Surgical / bony extraction | MODIFY / CAUTION SLE / lupus — assess renal, cardiac & clotting |
| Implant placement | MODIFY / CAUTION SLE / lupus — assess renal, cardiac & clotting |
References
- Autoimmune / connective tissue disease — dental management
- Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- Wilson WR et al. Prevention of Viridans Group Streptococcal Infective Endocarditis — AHA Scientific Statement. Circulation 2021;143:e963–e978
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.