By Dr. Ricardo S. Bocanegra, DDS
Why do rheumatoid arthritis and gum disease often go hand in hand? Learn about the significance of the connection and what you can do to protect your overall health.
People living with rheumatoid arthritis are more likely to develop gum disease compared to people who do not have RA. Inflammation related to gum disease or peridontitis may play a role in rheumatoid arthritis disease activity.
Controlling gum disease inflammation may help
improve rheumatoid arthritis symptoms.
When you’re living with rheumatoid arthritis (RA), brushing, flossing, and seeing your dentist regularly are especially important. Studies show a strong connection between RA and gum disease, an inflammatory condition that can lead to tooth loss and other health complications, such as heart disease.
At this point, experts aren’t sure which health issue is the chicken and which is the egg. A German study published in June 2008 in the Journal of Periodontology showed that people with RA had eight times the odds of developing gum disease as compared with people without RA. A study out of the University of Louisville in Kentucky published in September 2013 found that the bacterium that causes periodontal disease, Porphyromonas gingivalis, increases the severity of rheumatoid arthritis, leads to an earlier onset of the disease, and causes symptoms to progress more quickly. And a Swedish study published in March 2016 in the journal Arthritis & Rheumatology suggests that P. gingivalis may be a possible trigger for autoimmune disease in a subset of RA patients. “The connection is confusing,” says Terrance Griffin, DMD, chair of the department of periodontology at the Tufts University School of Dental Medicine in Boston. “There are so many factors that can come into play, like oral hygiene. RA can cause you to lose some dexterity, which may mean you can’t clean your teeth as well. But that may only partially account for this relationship.”
Gum Disease and Rheumatoid Arthritis:
The Inflammation Link
Doctors may not know for sure how gum disease and RA are linked, but both diseases have inflammation in common, which may explain the connection. Inflammation is a protective immune system response to foreign bodies like viruses and bacteria. But with autoimmune diseases like rheumatoid arthritis, the immune system mistakenly triggers inflammation even though there are no viruses or bacteria to fight off. It’s possible that the immune system is stimulated by mouth inflammation and infection; therefore, setting off a cascade of events where inflammation develops at the site of joints or arthritis. Dr. Bocanegra strongly believes that controlling the inflammation through better dental care could play a role in reducing the incidence and severity of RA.
Treating One Condition May Improve the Other
People with a severe form of rheumatoid arthritis that have successfully treated their gum disease, have seen their pain and other arthritis symptoms get better. In addition, patients who have been treated with drugs for both gum disease and rheumatoid arthritis fared better than those who received RA medication alone. Dr. Bocanegra recommends that people who have both gum disease and RA should have an informed care team comprised of a physician, a dentist and a periodontist. Brushing and flossing can be challenging for those with RA, and you should work with your doctors to find out what works best for you. And if you don’t have a periodontist, get an evaluation from your dentist every year to monitor the status of your gums, since you are more likely to get it.
Dental Care for People With Rheumatoid Arthritis
Gum disease ranges from gingivitis, a mild form that causes swollen, tender gums, to more serious forms like periodontitis, in which inflammation affects the tissue and bone supporting the teeth. Some people with RA also develop Sjögren’s syndrome or sicca syndrome, an autoimmune disease of the glands, which causes dry mouth and increased tooth decay. If you have gingivitis, it can be reversed with twice-yearly dental cleanings and good at-home care.
Brushing and flossing can be challenging for those with RA, and you should work with your doctors to find out what works best for you. And if you don’t have a dentist, call Dr. Bocanegra at 239-482-8806 for an evaluation to monitor the status of your gums, since you are more likely to develop gum disease.
Porto Fino Dental
6805 Porto Fino Cir., Fort Myers, Fl 33912