Can Plaquenil cause teeth problems? Understanding the Impact on Dental Health

October 6, 2025 •

4 min read

While Plaquenil (hydroxychloroquine) is not known to directly cause tooth decay, some studies suggest it can lead to other oral health issues, such as gum discoloration, in a small percentage of patients. Furthermore, the underlying autoimmune conditions it treats, like lupus and rheumatoid arthritis, are independently linked to a higher risk of periodontal disease.

Quick Summary

An exploration of Plaquenil's effects on oral health reveals no direct harm to teeth, but potential for gum discoloration and mouth sores. Conditions treated by the medication, like lupus and rheumatoid arthritis, significantly increase dental risk.

Key Points

No Direct Harm to Teeth: Plaquenil (hydroxychloroquine) does not cause tooth decay or other structural damage to the teeth themselves.
Indirect Risk from Autoimmune Disease: The autoimmune conditions treated by Plaquenil, such as lupus and rheumatoid arthritis, independently increase the risk of oral health problems, including gum disease.
Oral Hyperpigmentation is Possible: A rare, but direct, side effect of Plaquenil is bluish-gray or brown discoloration on the gums and oral mucosa, especially with long-term use.
Watch for Mouth Sores: Swollen gums and mouth sores or ulcers have been reported and can be a sign of a less common, but serious, side effect like a blood disorder.
Proactive Dental Care is Key: Patients on Plaquenil should maintain strict oral hygiene and schedule regular dental check-ups to manage the risks associated with their autoimmune condition.
Severe Reactions are Rare: Extremely rare skin reactions (like SJS) that can affect the mouth and throat are possible but are medical emergencies.

Is Plaquenil to Blame for Your Dental Issues?

Plaquenil, the brand name for the drug hydroxychloroquine, is widely used to treat autoimmune conditions like lupus and rheumatoid arthritis. For many patients, it is an essential medication for managing symptoms. However, with any long-term treatment, concerns about potential side effects are common, and the question of dental health often arises. The good news for patients is that Plaquenil itself has not been directly linked to causing damage to teeth, such as cavities or enamel erosion. The issue is more nuanced, involving potential oral side effects and, more significantly, the impact of the very diseases the medication is treating.

The Indirect Link: Autoimmune Conditions and Oral Health

One of the most important things to understand is the connection between autoimmune diseases and oral health. Both rheumatoid arthritis (RA) and lupus increase a person's risk for various dental problems, including periodontal (gum) disease. Plaquenil is used to manage these conditions, so any observed oral issues may be symptoms of the disease, not side effects of the medication. This is a critical distinction, as managing the underlying condition is often a key step in controlling its related dental complications.

Lupus and Oral Manifestations

Systemic lupus erythematosus (SLE) can cause a range of oral issues, such as painful mouth sores, ulcers, and dryness. While Plaquenil can help control the systemic inflammation that contributes to these problems, the symptoms themselves are inherent to the disease. Lupus-related inflammation can affect the tissues inside the mouth, making it prone to sores that can be mistaken for a drug side effect. Patients who experience these should consult both their rheumatologist and dentist to determine the root cause and best course of action.

Rheumatoid Arthritis and Periodontal Disease

Similarly, rheumatoid arthritis is an inflammatory condition that can have widespread effects throughout the body. Research has established a strong connection between RA and periodontal disease, a serious gum infection that can damage soft tissue and destroy bone supporting the teeth. The chronic inflammation associated with RA can exacerbate gum inflammation, leading to a higher incidence and greater severity of gum disease. Therefore, a patient on Plaquenil for RA may experience gum problems not because of the medication, but because of their underlying arthritis.

Direct Oral Side Effects of Plaquenil

While Plaquenil does not harm the teeth, there are a few reported oral side effects that patients should be aware of. These are generally rare but can occur with long-term use.

Oral Hyperpigmentation

One of the most specific oral side effects linked to hydroxychloroquine is the development of oral hyperpigmentation. This appears as bluish-gray, brown, or dark purple discoloration on the gums, lips, or roof of the mouth. A 2020 study on lupus patients taking antimalarials found that a small percentage developed oral brown spots, with the occurrence linked to dosage and treatment length. The good news is that this pigmentation is generally harmless and can fade after stopping the medication.

Mouth Sores and Swollen Gums

Although less common, some patients taking Plaquenil have reported experiencing mouth sores, ulcers, or swollen and bleeding gums. These symptoms require attention, as they could be related to a blood disorder, a rare but serious side effect of Plaquenil. It is important to rule out other causes, such as the autoimmune disease itself or a separate infection. Any unexplained bleeding, swelling, or persistent sores should be reported to a doctor immediately.

Severe Skin Reactions

In extremely rare, but serious cases, Plaquenil can trigger severe skin reactions such as Stevens-Johnson syndrome (SJS). These conditions can cause widespread blistering and peeling of the skin, and importantly, can also involve ulcers and sores in the mouth and throat. This is a medical emergency and requires immediate attention.

A Comparison of Plaquenil's Oral and General Side Effects


Side Effect Type	Example	Link to Plaquenil	Management
Direct Oral Effect	Oral/Gingival Hyperpigmentation	Yes (Rare, dose/duration-dependent)	Report to doctor; may resolve after discontinuation.
Indirect Oral Effect	Periodontal Disease	Indirect (Linked to underlying RA/Lupus)	Strict oral hygiene, regular dental check-ups, treat underlying condition.
Direct Oral Effect	Mouth Sores/Ulcers, Swollen Gums	Yes (Less common, requires investigation)	Consult doctor to check for blood disorders or other causes.
Systemic Effect	Retinopathy (Eye Damage)	Yes (Requires regular monitoring)	Crucial regular eye exams with an ophthalmologist.
Systemic Effect	Nausea, Abdominal Pain	Yes (Common, often temporary)	Manage with food or take medication at a different time.

Managing Oral Health While on Plaquenil

For patients taking Plaquenil for a chronic autoimmune condition, proactive oral health management is essential. Here are some steps you can take:

Maintain excellent oral hygiene: Regular and thorough brushing and flossing are the best defense against gum disease, a risk factor for both lupus and RA patients.
Attend regular dental check-ups: Inform your dentist that you are taking Plaquenil. Regular visits will allow them to monitor for any potential issues, such as gum changes or new sores.
Stay hydrated: Staying hydrated can help with any potential dry mouth, which some experience and is a symptom of conditions like Sjögren's syndrome, a related autoimmune disorder.
Monitor for unusual symptoms: Be vigilant for any unusual oral symptoms, including discoloration, persistent sores, or bleeding gums, and report them to your doctor promptly.

Conclusion

In conclusion, the answer to "Can Plaquenil cause teeth problems?" is no, it doesn't cause tooth decay directly, but it can contribute to other oral health challenges. The primary dental risks often stem from the underlying autoimmune disease itself, such as a heightened risk of gum disease due to chronic inflammation. However, patients should be mindful of rare direct side effects, including oral hyperpigmentation and mouth sores. By maintaining excellent oral hygiene and working closely with both their rheumatologist and dentist, patients on Plaquenil can effectively manage their oral health and mitigate potential risks. For further medical information, consider exploring resources from authoritative sources like the U.S. National Institutes of Health.

Frequently Asked Questions

No, Plaquenil does not directly cause teeth to fall out. The risk of tooth loss is more closely associated with periodontal (gum) disease, which is more prevalent in patients with autoimmune conditions like lupus and rheumatoid arthritis that Plaquenil is used to treat.

Oral hyperpigmentation, a rare side effect of Plaquenil, is often reversible. The discoloration may fade or disappear after the medication is discontinued, though the process can take time.

You should not stop taking Plaquenil without consulting your prescribing doctor. Many dental issues arise from the underlying autoimmune condition, and stopping the medication could cause your systemic symptoms to worsen. Always discuss concerns with your healthcare provider.

Mouth ulcers or sores can be a sign of a serious, though rare, side effect like a severe skin reaction or a blood disorder associated with Plaquenil. They can also be a symptom of the underlying autoimmune disease itself. You should contact your doctor immediately to investigate the cause.

There is no evidence to suggest that Plaquenil directly increases the risk of cavities. Regular dental hygiene and check-ups are the best way to prevent cavities, regardless of medication.

Yes, taking Plaquenil does not pose a significant risk for dental implant procedures, and there is no need to discontinue the medication before implant surgery.

It can be difficult to tell on your own. Communicating openly with both your rheumatologist and your dentist is crucial. Your dentist can perform a thorough examination, and your doctor can help determine if your symptoms align with known side effects or are part of your autoimmune condition.