Plaquenil (hydroxychloroquine or HCQ) is a medication frequently prescribed for managing chronic autoimmune conditions like rheumatoid arthritis and systemic lupus erythematosus. Patients often rely on this treatment long-term to control disease activity and reduce inflammation. Because HCQ is taken for extended periods, patients often become concerned about potential systemic effects, including how it might alter their oral health and dental structures. Understanding how HCQ and the underlying diseases affect the mouth allows patients to take proactive steps to protect their teeth and gums.
Recognized Oral and Dental Side Effects
One of the most frequent oral complaints among patients with autoimmune conditions is xerostomia, commonly known as dry mouth. While hydroxychloroquine itself is not consistently identified as a direct cause of reduced saliva flow, the diseases it treats (such as lupus and Sjögren’s syndrome) are strongly linked to salivary gland dysfunction. The resulting reduction in saliva is a significant health concern because saliva acts as a natural buffer, neutralizing acids and washing away food particles and bacteria.
A lack of sufficient saliva removes this protective mechanism, creating an environment where dental issues can proliferate rapidly. Patients with xerostomia face a significantly increased risk of developing rampant dental caries, which are aggressive cavities often forming at the gumline. The decrease in natural cleansing also heightens the risk of periodontal disease (gum infection) and oral candidiasis, a fungal infection often presenting as white patches. Some patients also report dysgeusia, an altered or metallic taste perception, which is a less common sensory side effect associated with several systemic medications.
Addressing Pigmentation and Staining
A visually noticeable side effect associated with long-term hydroxychloroquine use is the development of hyperpigmentation in the oral cavity. This drug-induced discoloration is not a stain on the tooth enamel, but rather a change in the color of the soft tissues. It is estimated that 7% to 13% of patients taking HCQ may experience pigmentation changes on the skin or mucous membranes.
The discoloration is caused by the drug stimulating melanin production or by the deposition of drug metabolites in the tissue cells. The appearance is often described as a bluish-gray, gray-brown, or dark purple patch on the oral tissues. These patches most commonly affect the hard palate (the roof of the mouth), but can also be observed on the gums and other areas of the oral mucosa. Although these changes are generally cosmetic, any unexpected changes in oral pigmentation should be brought to the attention of a dental professional to rule out other possible conditions.
Strategies for Maintaining Oral Health
Mitigating the risks of dental decay and gum disease in patients taking hydroxychloroquine largely centers on managing the effects of dry mouth and maintaining rigorous hygiene.
Managing Xerostomia
The primary defense against xerostomia-related issues is frequent hydration, which involves consistently sipping plain water throughout the day to help lubricate the mouth. Patients should also consider using over-the-counter saliva substitutes, such as sprays or gels, to provide sustained moisture, particularly at night. To stimulate residual salivary flow, chewing sugar-free gum or sucking on xylitol-containing lozenges can be beneficial, as the physical action encourages the glands to produce more natural saliva. It is also important to avoid substances that contribute to dryness, such as excessive caffeine, alcohol, and tobacco products.
Hygiene and Professional Care
A meticulous daily oral hygiene routine is paramount, consisting of brushing twice daily with a fluoride toothpaste and flossing once a day to remove plaque buildup. Patients should use dental products formulated specifically for dry mouth, which are less abrasive and contain fluoride to strengthen the teeth against decay. Due to the underlying risk factors, regular professional dental check-ups and cleanings are strongly advised, ideally every three to four months instead of the standard six. Furthermore, patients must ensure their prescribing physician and their dentist communicate about their medication regimen to ensure a coordinated and proactive approach to oral and systemic health management.