A Case‐Control Comparison of Salivary pH, Dental and Periodontal Health, and Bacterial Counts of Porphyromonas gingivalis and Streptococcus mutans in Patients With Systemic Lupus Erythematosus

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Abstract
Background: Patients with systemic lupus erythematosus (SLE) may exhibit increased oral health vulnerabilities. This study aimed to compare salivary pH, dental and periodontal health, and salivary Streptococcus mutans and Porphyromonas gingivalis counts between SLE patients and healthy controls. Materials and Methods: A case‐control study included 20 SLE patients and 20 healthy controls matched for age, sex, socioeconomic status, and geographic region. All SLE patients had at least one year since diagnosis and met the Lupus Low Disease Activity State (LLDAS) definition (SLEDAI ≤4, no major organ activity, PGA ≤1, prednisone ≤7.5 mg/day, and no recent flare). Medication profiles were not systematically recorded, although patients maintained standard‐of‐care therapies as per their rheumatologists’ prescriptions. Participants brushed at least once daily; smokers and individuals with xerostomia were excluded. Dental (DMFT) and periodontal (GBI, CAL) indices and plaque index were assessed. Unstimulated saliva was collected to measure pH and quantify S. mutans and P. gingivalis counts using PCR. Results: No significant differences were observed in overall DMFT, decayed or filled teeth, GBI, CAL, or P. gingivalis counts ( p > 0.05). Within the limits of the sample size, SLE patients had a higher number of missing teeth and significantly increased S. mutans counts ( p < 0.05). Salivary pH was significantly lower in the SLE group ( p < 0.05). Conclusion: Tooth loss in SLE may be related to caries rather than periodontal disease, potentially influenced by lower salivary pH and elevated S. mutans levels. Altered salivary composition may contribute to increased caries risk even in the absence of xerostomia. Clinical relevance: These findings emphasize proactive caries prevention in SLE. Strategies such as hydration guidance, pH‐regulating mouthwashes, and xylitol‐containing products may be beneficial, although their efficacy in SLE populations was not tested.

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