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What's Up Doc? Flu and Oral Health

From the Winter 2010 Issue of the Scleroderma Voice

Flu Shots

Q: Is it recommended for a scleroderma patient to receive a flu shot?

A: Dr. Thomas A. Medsger, Jr., Professor of Medicine, Division of Rheumatology and Clinical Immunology, and Director of the Scleroderma Research Program at the University of Pittsburgh responds, “The best time to get the flu shot is in the fall of each year (late September or early October) when the vaccine becomes available. Even January or February is not too late to receive protection for the end of the flu season.

It is recommended that all patients with chronic systemic diseases get flu shots. Therefore, all persons with systemic sclerosis (not localized forms of scleroderma) should receive an annual flu vaccination. The vaccine is safe since it is composed of killed rather than live virus particles. Persons with egg allergy should not receive the flu vaccine, since the virus used to prepare the vaccine is grown in eggs. Also, if you have or suspect that you have an infection, it is best to wait until the infection has passed before receiving a flu shot. Some patients develop a low-grade fever and muscle aching, particularly at the site of the shot, during the first several days after the flu injection, but serious reactions are extremely rare. The primary problem with getting the flu is that it is capable of causing pneumonia. Scleroderma patients with any form of pre-existing lung disease are especially at risk. Furthermore, viral infections such as influenza are frequently followed by bacterial infections, which can be even more damaging. Patients who produce watery, clear phlegm during a viral illness are at risk to next develop thick/discolored (green, yellow, brown, or gray) phlegm, which may be a sign of bacterial infection. If you have a cold or other respiratory infection that results in discolored phlegm, be sure to ask your physician if you need antibiotic treatment.

For each scleroderma patient, a physician must make a decision about whether the flu shot should or should not be given and must order the vaccinations. I have provided general guidelines above, but each physician has his/her own approach to the issue. You should discuss this topic with your rheumatologist or primary care physician.

Oral Health

Q: What would be the recommended “oral health check list” for a patient living with scleroderma?

A: Oral Health Check List for Patients with Scleroderma from Dr. David Leader, Associate Clinical Professor, Tufts University of School of Dental Medicine

Patients with scleroderma have oral health issues particular to the illness. Because scleroderma is a chronic disease, oral health issues can be life-long. Long standing oral health conditions may become worse over time. Treatments may not be curative, and only improve the patient’s condition.

Xerostomia (dry mouth) is very common in scleroderma. This may be due to the disease itself or a side effect of medication. Microstomia (small mouth) is a common feature of scleroderma. Home care (brushing and  flossing) may be complicated by microstomia and sclerodactyly (tightening of the skin of the hands and fingers.) Gastro-esophageal reflux disease (GERD) is common in scleroderma. Acidic stomach contents will cause tooth decay and erosion.

  • Choose a dentist who is patient. The dentist must either be familiar with scleroderma, or willing to learn about the condition.
  • Scleroderma patients should return to the dentist or dental hygienist for checkups every 3 months. Annual x-ray exams are recommended. (Dress warmly to prevent Raynaud Syndrome flare ups during dental appointments.)
  • The dentist should test the patient for xerostomia (dry mouth) regularly and record the results. Treat if necessary.
  • Patients with sclerodactyly and microstomia should speak with the dentist of dental hygienist about strategies and tools for improved brushing and flossing.
  • The use of professionally applied fluoride and prescription fluoride products is essential.
  • Perform daily exercise to maintain and increase maximum jaw and mouth opening.


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