Rheumatoid arthritis (RA) causes systemic inflammation that affects the joints, skin, internal organs and vascular system. In addition, recent research indicates that this autoimmune disease can even affect the teeth.

WHAT CAUSES INFLAMMATION?

Severe inflammation is a symptom of RA and periodontal disease (i.e., gum disease). This inflammation occurs when the white blood cells release chemicals to protect the body from foreign invaders (i.e., viruses or bacteria) or to assist in the healing process following an injury. This chemical release leads to an increase in blood flow to the affected area(s). It is this excess blood that causes the inflammation.

WHAT IS RHEUMATOID ARTHRITIS?

When an individual has an autoimmune disease like rheumatoid arthritis, the body mistakenly attacks itself and inflammation occurs even when there are no foreign invaders or injuries present.

THE CONNECTION BETWEEN RHEUMATOID ARTHRITIS AND ORAL HEALTH

Individuals who suffer from RA are at an increased risk of developing gum disease; therefore, disregarding the signs and symptoms of rheumatoid arthritis can lead to the development of serious oral conditions.

Potential conditions may include:

• Gingivitis – this is the first stage of gum disease. Symptoms include swollen, tender gums.
• Slight Periodontitis – this is the second stage of gum disease. Symptoms include swollen, tender gums that bleed while brushing and/or flossing.
• Moderate Periodontitis – once gum disease advances to this stage, the bacteria are freely entering the bloodstream and placing unnecessary stress on the immune system.
• Advanced Periodontitis – this is the final stage of gum disease. At this stage, the teeth are losing their support system, which causes them to loosen or fall out.
• Oral Fungal Infections – such as oral candidiasis (i.e., thrush, yeast infection).
• Sjögren’s Syndrome – this condition causes the salivary glands to become inflamed, which leads to oral dryness. Since saliva is responsible for neutralizing acid and washing away bacteria, when there is not enough of it, periodontal disease and cavities are more likely to develop.

A BACTERIUM ASSOCIATED WITH GUM DISEASE MAY BE LINKED TO RA

A 2016 study conducted by Johns Hopkins indicates that nearly half of their 196 study participants with rheumatoid arthritis tested positive for A. actinomycetemcomitans; whereas, only 11 percent of those participants who did not have RA tested positive for this bacterium. This finding is enlightening in that A. actinomycetemcomitans is a bacterium that is often present in those who have periodontal disease.

THE THEORY

1. actinomycetemcomitans bacteria initiate the formation of citrullinated proteins, which are recognized by the most RA-specific autoantibodies (i.e., the anti-citrullinated peptide antibodies). Once recognized, the body’s immune system begins production of anti-citrullinated protein antibodies. It is this process that links periodontal disease to the development of rheumatoid arthritis.

THE SYMPTOMS OF RHEUMATOID ARTHRITIS CAN MAKE DENTAL CARE CHALLENGING

Unfortunately, due to the systemic inflammation associated with rheumatoid arthritis, individuals who have RA are already at an increased risk of developing periodontal disease. In addition, pain in the shoulders, elbows, temporomandibular joint and hands can make it difficult to brush and floss. However, allowing the body to place limitations on one’s ability to maintain his or her oral health can increase inflammation, aid in cavity development and eventually lead to tooth loss; therefore, finding a way to practice good dental hygiene is essential.

PRACTICING GOOD DENTAL HYGIENE WITH RHEUMATOID ARTHRITIS

If you have rheumatoid arthritis, you are not automatically doomed for early tooth loss. While practicing good oral hygiene may be a bit more challenging, there are ways to make these tasks easier.

Needless to say, brushing and flossing daily is essential. You should brush your teeth twice a day in two-minute intervals using a soft-bristled toothbrush. Floss at least once a day. If brushing and flossing is difficult due to pain in your jaw or your arm, try using an electric toothbrush and a water flosser.

Since you are at an increased risk for periodontal disease, consider scheduling additional annual cleanings. A cleaning every three or four months is ideal (as opposed to every six months). One study indicates that participants who were receiving treatment for RA and periodontal disease at the same time experienced more improvement in their rheumatoid arthritis symptoms than participants who did not have the treatment for gum disease; therefore, preventing the onset of periodontal disease through frequent cleanings may be helpful in avoiding flare-ups.

At Smiles by Shields, we care about your overall wellbeing, which is why we practice holistic dentistry. We offer our patients solutions to their dental problems that are effective and proven to cause no harm. If you are experiencing a dental problem, would like to brighten your smile or want to learn more about holistic dentistry, contact our Jacksonville, Florida office today at 904.731.0777.