Lupus Disease and Teeth Grinding: The Immune System’s Attack on the Jaw

Do you feel pain in your jaw muscles when you wake up in the morning? Could you be clenching or grinding your teeth throughout the night? If you have lupus (SLE), the cause of these complaints may not be just stress—there may be much more specific medical reasons behind them. Unfortunately, many doctors overlook this connection, and patients are often dismissed for years with the advice to “just wear a night guard.”

What Is Bruxism and Why Is It So Important?

Bruxism is the involuntary clenching, grinding, or overuse of the jaw muscles during sleep or while awake. This condition not only damages the teeth but can also lead to:

• Permanent damage to the temporomandibular joint (TMJ)
• Chronic head and neck pain
• Significant deterioration in sleep quality
• Social withdrawal due to embarrassment from jaw noises
• Loss of chewing function

So why is this condition different in lupus patients?

Systemic Lupus Erythematosus (SLE): The Immune System’s Attack on the Jaw

Jaw Involvement in Lupus

TMJ involvement is much more common in patients with SLE and stems from the systemic nature of the disease.

Specific Findings:

Morning Stiffness:
Just like other joints, the jaw becomes stiff in the morning. Difficulty opening the mouth is common during the first 30–60 minutes.

Increase Parallel to Systemic Flares:
When the disease becomes active, jaw pain also increases. This appears alongside other lupus symptoms.

Mucosal Ulcers:
Aphthous lesions in the mouth impair chewing function and increase pain.

Sicca Syndrome:
Dry mouth disrupts chewing and places additional stress on the TMJ.

Impact on Quality of Life

• Jaw fatigue during long conversations
• Avoiding hard foods
• Leaving social events early due to jaw pain
• Dry mouth compounded by medication side effects
• Difficulty eating breakfast in the morning
• Longer intervals between meals

How Do We Identify Bruxism in Lupus?

In bruxism caused by SLE, the following findings stand out:

• Pronounced morning stiffness: the first hours are the most difficult
• Parallel course with systemic disease activity: jaw pain increases during lupus flares
• Accompanying oral mucosal lesions: aphthous ulcers are common
• Similar symptoms in other joints: pain in hands, wrists, and knees
• Fatigue and weakness: a general feeling of exhaustion

Treatment Points That Require Special Attention

Immunosuppressive Medications and Dental Procedures

Medications used in lupus treatment increase the risk of infection:

• Prophylaxis may be required before dental procedures
• Oral hygiene becomes more critical
• Regular dental check-ups are essential
• Even minor infections can lead to serious complications

Corticosteroid Use

• Affects bone density
• Can cause problems in the jawbone
• Risk of osteonecrosis (especially at high doses)
• Delays wound healing

Coordination With a Rheumatologist

Local treatments become insufficient if systemic therapy is not optimized:

• Disease activity must be brought under control
• Immunosuppressive therapy must be optimized
• DMARD effectiveness should be reviewed
• Biological agents should be added if necessary

Revolutionary Treatment Approaches

1. Treat the Underlying Cause First!

Optimization of SLE Treatment:

• Control systemic inflammation: monitor CRP and ESR
• DMARDs (methotrexate, sulfasalazine): reduce disease activity
• Biological agents (TNF blockers): for resistant cases
• TMJ intra-articular injections: reduce local inflammation
• Hydroxychloroquine optimization: one of the cornerstone treatments

2. Concurrent Protective Therapies

Stabilization Splint (Night Guard):

• Should be made of hard acrylic material
• Soft splints may increase muscle activity
• Follow-ups every 3–6 months
• Nighttime use is sufficient
• Must be cleaned daily for oral hygiene

Physiotherapy and Exercises – Daily Routine:

• Morning: 5 minutes of jaw massage (reduces morning stiffness)
• Noon: Neck stretching exercises
• Evening: Warm compress application
• Night: Relaxation techniques

3. Advanced Treatment Options

Botulinum Toxin A (Botox):

• Indication: Severe cases resistant to conservative treatment
• Application: Masseter and temporalis muscles
• Dose: 50–100 units total (depending on muscle size)
• Duration: 3–6 months
• Results: 80–90% reduction in pain, 60–70% reduction in muscle activity

Who Should Consider Botox?

• Patients whose symptoms persist despite splint therapy
• Those with significant masseter hypertrophy
• Patients experiencing severe pain affecting daily life
• Patients whose systemic disease is under control

Important Note:
Immunosuppression status must be evaluated before administering Botox in lupus patients.

Nutritional Support: An Evidence-Based Approach

Vitamin D and Calcium

Who Should Receive It?

• Those with 25-OH vitamin D < 30 ng/ml
• Patients on chronic steroid therapy
• Individuals with chronic pain complaints
• Patients presenting with muscle cramps

Correct Dosage:

• Vitamin D: 1000–4000 IU/day
• Calcium: 1000–1200 mg/day (with food)
• Magnesium: 200–400 mg/day

Magnesium: The Forgotten Mineral

Magnesium plays a critical role in muscle relaxation:

• Regulates the muscle contraction–relaxation cycle
• Optimizes neural transmission
• Improves sleep quality
• Reduces stress hormones

Omega-3 Fatty Acids

Provides additional benefits in lupus patients:

• Anti-inflammatory effect
• Reduces joint pain
• Lowers overall disease activity

Warning Signs: When Is Emergency Intervention Needed?

Acute TMJ Locking:

• Inability to open the mouth
• Accompanied by high fever
• Rapidly developing swelling
• Difficulty swallowing

Systemic Lupus Flare:

• Signs of kidney involvement (urinary changes, swelling)
• High fever
• Widespread joint swelling
• Shortness of breath
• Chest pain

Treatment Algorithm: Step-by-Step Guide

1. Evaluation Phase (First 2 Weeks)

Laboratory Tests:

• ANA, anti-dsDNA
• Complement levels (C3, C4)
• CRP, ESR
• 25-OH vitamin D
• Total and ionized calcium
• Kidney function tests

2. Emergency Correction (2–4 Weeks)

• Control of SLE flare
• Optimization of immunosuppressive therapy
• Acute pain management
• Vitamin D and calcium replacement

3. Protective Therapies (1–3 Months)

• Preparation and adjustment of splint
• Start of physiotherapy
• Lifestyle modifications
• Nutritional supplementation
• Oral hygiene education

4. Advanced Therapies (3–6 Months)

• Botox evaluation
• Intra-articular injections
• Surgical consultation (if needed)
• Psychiatric support (for chronic pain)

Success Story: Real Patient Experience

Mr. Mehmet (35):
“I didn’t know lupus could affect the jaw. My rheumatologist and dentist worked together. Both my disease and my jaw pain came under control. Now I can eat breakfast comfortably in the morning. I’ve returned to my normal life.”

Tips for Improving Quality of Life

Daily Lifestyle Adjustments:

• Switch to a soft diet (during flare periods)
• Stress management techniques
• Regular sleep schedule
• Avoid smoking and alcohol
• Avoid chewing hard gum

Oral Hygiene:

• Brush teeth at least twice a day
• Use fluoride toothpaste
• Use saliva-enhancing products for dry mouth
• Regular dental check-ups (every 3–6 months)

Lupus Disease and Teeth Grinding Conclusion

In lupus patients, bruxism is not simply “stress-related teeth grinding.”
SLE causes specific inflammatory changes in the jaw joint system and requires specialized treatment approaches.

If you have lupus and are experiencing jaw problems, do not rely solely on a night guard. Seek treatment from a team that understands how your disease affects jaw health and works in coordination with both a rheumatologist and a dentist.

Remember: Accurate diagnosis + multidisciplinary treatment = a pain-free life

For an accurate diagnosis and the right treatment, get in touch with Dr. Tansu Uzel Clinic! Follow our Instagram page to see our patients.