The Link Between Dental Health and Rheumatoid Arthritis

For a few decades, researchers have theorized that bacteria in the gut and periodontal disease may be involved in triggering RA. A 2016 Johns Hopkins study may have identified one of the factors in the disease process. The study showed that bacteria responsible for chronic inflammatory gum infections seems to trigger the creation of citrullinated proteins. These proteins are theorized to kick off a chain of events that lead to the development of RA.

The Johns Hopkins study found that almost half of 196 study participants with RA tested positive for a bacterium called A. actinomycetemcomitans, which is also often present in people with periodontal disease. In people without RA, only 11 percent had the bacteria. However, more research is needed in order to confirm the role this bacteria plays in the development of RA.

“I had gingival graft surgery due to gum recession, believed to be a direct result of my autoimmune diseases.” — Leslie Rott

People with RA also have a higher incidence of periodontal disease, which may be linked to systemic inflammation caused by RA. One small study suggested that treatment for gum disease may help. Participants receiving nonsurgical treatment for gum disease reported more improvement in RA symptoms than those just treated for RA alone.

“For me, swelling gums is the first indication of an impending flare.” — Ruth DeVitt

The symptoms of RA can also contribute to dental problems. RA in the jaw joints may make it difficult to open your mouth fully. Likewise, pain in the hands, elbows, and shoulders can make brushing your teeth a challenge. When your body places limitations on your ability to take care of your oral health, it can have consequences, such as an increase in cavities and gum inflammation.

Treating your RA with medication can improve joint function, making it physically easier to take care of your teeth. Medicine that reduces inflammation in the body may benefit your mouth as well. On the other hand, side effects of medications can also be a problem for oral health. For instance, if you are taking an immunosuppressant, it can be difficult for the immune system to fight oral bacteria, leading to an increase in gum inflammation.

“My dentist gave me a prescription-strength toothpaste and tablets that stick on your gums to encourage saliva.” — Joanna Chladek

Some people with RA experience dry mouth as a side effect of meds or due to Sjögren’s syndrome, a condition characterized by dry eyes and mouth that can occur with RA. Saliva fights bacteria in the mouth and neutralizes acid. Without enough of it, you may get more cavities and periodontal disease. Your dentist will be able to share tips to help you manage dry mouth.

When experiencing tooth loss, some opt for dental implants, a procedure in which a screw is implanted in the jawbone to serve as a platform for a replacement tooth. The success of dental implants depends on several factors. Autoimmune diseases can lead to a higher rate of complications and rejection. If you are considering a dental implant, talk to your dentist about the pros and cons based on recent research before committing to the considerable expense of this procedure.

RA doesn’t automatically doom you to early tooth loss. You can help by taking very good care of your mouth. Floss and brush your teeth daily. If you have trouble reaching all your teeth due to pain in your arm or jaw, consider an electric toothbrush. Regular professional cleaning of your teeth is an important aspect of preventative care and you may consider getting teeth cleanings 3-4 times a year, if financially possible. Talk to your dentist about other tips.

“Keeping my jaw open wide while at the dentist makes my jaw flare, so my dentist puts a small block back between my upper and lower molars.” — Katie Voakes Putnam

Eating softer foods or cutting your food into small pieces can make it easier to chew. If you’re flaring, try chewing with your front teeth; it puts less pressure on your jaws than chewing with your molars. You may also want to talk to your dentist about getting a bite plane to prevent pain from grinding your teeth at night.

Your gums can swell as a response to plaque accumulating on your teeth, but this phenomenon called gingival enlargement or gingival overgrowth can also result as a side effect of certain medications, including immunosuppressants. When it is medication-related, the gums will usually be pink, but not tender and not bleed easily. The degree to which the gums swell vary and treatment may include surgery to reduce severe cases. Gingival overgrowth usually subsides with discontinuation of the medication.