Autoimmune diseases occur when the body’s immune system mistakenly attacks its own tissues. Within the oral cavity, this condition can give rise to various lesions such as ulcerations, erosions, plaques, vesicles, or even persistent mucosal changes. This indicates the direct involvement of the immune system in pathological processes affecting the oral cavity. This article discusses the role of the immune system in autoimmune oral diseases, including underlying mechanisms, clinical manifestations, and implications for dental and oral care.
Immune Mechanisms in Autoimmune Oral Diseases
Several immune system mechanisms involved in oral autoimmune diseases include:
- The production of autoantibodies that attack the body’s own tissues, as seen in pemphigus vulgaris, in which antibodies target desmoglein, resulting in mucosal blisters and erosions.
- Dysfunction of T cells and B cells, leading to chronic inflammation and damage to the oral mucosa.
- Impaired mucosal immune tolerance, causing the immune system to lose its ability to recognize self-tissues as “safe.”
- Secondary effects of immunosuppressive therapy, which is often used in autoimmune patients and may reduce the natural defenses of the oral mucosa, increasing susceptibility to opportunistic infections.
Clinical Manifestations in the Oral Cavity
Oral manifestations in autoimmune patients vary widely, depending on the type and severity of the disease. A study entitled “Profil lesi oral pada penderita penyakit autoimun” published in Jurnal Majalah Kedokteran Gigi Indonesia by Indah Suasani Wahyuni, Tenny Setiana Dewi, Erna Herawati, and Dewi Zakiawati found that the most common type of oral lesion was erosion (78.8%), with the most frequent location being the buccal mucosa (69.7%). Autoimmune diseases most commonly associated with oral lesions include Systemic Lupus Erythematosus (SLE), Oral Lichen Planus (OLP), and Pemphigus vulgaris (PV).
Common characteristics of these lesions include:
- Shallow or deep erosions accompanied by pain, particularly during eating.
- White or erythematous plaques, vesicles, or bullae that rupture easily.
- Commonly affected sites include the buccal mucosa, lips, floor of the mouth, gingiva, and soft palate.
- Occurrence is more frequent in women, across a wide age range from childhood to older adulthood.
Diagnosis and the Role of Dentists
The diagnosis of autoimmune oral diseases requires a multidisciplinary approach, including:
- A thorough medical history to identify symptom progression, systemic diseases, and medications used.
- Routine intraoral examinations, as oral lesions are often early indicators of autoimmune disease.
- Histopathological and immunological examinations to confirm the presence of specific autoantibodies.
- Interprofessional collaboration among dentists, internists, and immunology specialists to ensure comprehensive management.
The study also emphasized the importance of routine intraoral examinations as part of standard care for autoimmune patients to enable early detection of oral manifestations.
Implications for Dental and Oral Care
Dental health professionals should pay special attention to autoimmune patients by implementing measures such as:
- Maintaining optimal oral hygiene to prevent secondary infections.
- Using non-irritating restorative materials and performing minimally invasive procedures.
- Managing side effects of systemic therapy, such as xerostomia or fungal infections.
- Providing patient education regarding the importance of regular follow-up visits and early detection of new oral symptoms.
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The immune system plays a crucial role in the development of autoimmune oral diseases, particularly through the production of autoantibodies and dysregulation of mucosal immunity. Common manifestations include erosions and ulcerations, especially on the buccal mucosa. Research indicates that routine intraoral examinations are essential for early detection and prevention of complications. Through a multidisciplinary approach and continuous patient education, the quality of life of patients with autoimmune diseases can be maintained.
References
MKGI, Indah Suasani Wahyuni, Tenny Setiana Dewi, Erna Herawati, Dewi Zakiawati, “Profil lesi oral pada penderita penyakit autoimun.” https://journal.ugm.ac.id/mkgi/article/view/11311
Author: Rizky B. Hendrawan | Photo: Freepik
