The Link Between Rheumatoid Arthritis and Dental Health
Anyone with rheumatoid arthritis (RA) knows it can do a number on your joints, especially your hands, wrists, and knees. But teeth? That’s a new one. Actually though, suggests this inflammatory disease and oral health are closely connected, and understanding the correlation could lead to new avenues of treatment and prevention in the future. We asked the experts what the latest research shows, and how you can take action to protect your oral health if you’re already dealing with RA.
RA Raises Periodontal Disease Risk
Research into oral health and RA has been ongoing for decades. “For some reason, rheumatoid arthritis and dental health—specifically something we call periodontal disease—are linked,” says Maximilian Konig, M.D., a rheumatologist at Johns Hopkins Medicine in Baltimore, MD. In fact, a study from Johns Hopkins Arthritis Center found that out of 100 RA patients, 70% of them had at least moderate gum disease. That rate is significantly higher than the general population, where only 35% of people have gum disease.
Bacteria May Be to Blame
Researchers have suspected a connection between rheumatoid arthritis and gum disease for nearly a century, but only recently has the picture become clearer. The current thinking is that certain bacteria in your mouth that are known to cause periodontal disease may also act as a trigger for RA, says Dr. Konig. Essentially, your oral health might play a role in either initiating joint pain symptoms or exacerbating them. “Nothing is 100 percent certain, we are still learning,” he says, but it is likely that it’s a two-way street between oral health and arthritis.
Inflammation Is the Common Denominator
As it turns out, the same bacteria may be responsible for inflammation in both dental disease and RA. In 2016, researchers at Johns Hopkins identified a type of bacteria called Aggregatibacter actinomycetemcomitans (try saying that three times fast!) as the source for chronic gum inflammation that leads to periodontal disease. Basically, the bacteria triggers the production of modified proteins that the immune system attacks as foreign. Scientists believe the inflammatory response to the bacteria may spread throughout the body, triggering RA symptoms.
It’s Likely—But Still a Theory
While the correlation between gum disease and RA is becoming increasingly accepted in the medical community, it’s still just a theory. “We know that oral flora can have an impact on rheumatoid arthritis, but not every patient has an A to B connection,” says Jonathan Samuels, M.D., a rheumatologist at New York University Langone Health. In other words, if you have RA, you might never develop gum disease, and vice versa. Also, because RA symptoms can take years to appear, it’s possible someone could have had periodontal disease a decade before an RA diagnosis, and not realize the connection.
Your Gut Could Play a Role
Scientists know that gut bacteria can affect the immune system and some research shows a potential connection between the so-called gut microbiome and chronic inflammation that accompanies RA. Could this be the same bacteria that is involved in periodontal disease? Researchers are working to find out. “Ideally, you would be able to say, ‘We think this bacterium and this bacterium are the perpetrators,’” says Dr. Konig. “We can’t do that yet.”
How Bacteria Affects Autoimmune Diseases
If certain types of oral bacteria do cause RA, it wouldn’t be the first time an autoimmune disease has been linked to a bacterial trigger. Previous studies have revealed that if you have a family history or genetic marker for conditions like lupus, for instance, you may be more susceptible to bacteria that kick off the inflammatory process. Furthermore, trials of antibiotics have shown some promise in treating autoimmune diseases.
New Treatments Are on the Horizon
Ideally, once specific bacteria are identified as triggers for gum disease and rheumatoid arthritis, doctors may be able identify people at risk for RA based on their teeth and treat them before symptoms even occur. “Interfering with oral health might actually improve overall health in terms of RA,” Dr. Konig explains. “If you were to start aggressive periodontal treatment to get rid of the bacteria, maybe you could prevent them from developing the other disease.” Keeping gums healthy plus preventing the progression of joint pain: Now that’s getting your money’s worth!
Regular Dentists Visits Are Key
Dentists are an important resource for RA folks. If the research on oral bacteria proves correct, a healthy mouth could minimize progression of your arthritis symptoms. “Everyone with RA should have a dentist that is also able to evaluate their overall oral health and the presence of periodontal disease,” Dr. Konig says. And if you have periodontal disease, it’s worth getting a periodontist to guide you through treatment: deep cleaning, medication, and surgery if necessary.
Stay One Step Ahead
Everyone should get their teeth cleaned at least once per year but if rheumatoid arthritis runs in your family, you might want to go more often. “It’s not unreasonable for people to ask their dentist of periodontist about the overall state of their oral health and use that information to guide their decisions about RA,” Dr. Konig says. An increase in gum inflammation could be an early warning sign of an RA flare and eliminating bad oral bacteria may keep RA symptoms at bay. Bottom line: Take care of your teeth—it just might help your aching joints.
Johns Hopkins 2015 Study: Johns Hopkins Arthritis Center. (2015). “Dental Health and Rheumatoid Arthritis: A Research Update.” hopkinsarthritis.org/arthritis-news/ra-news/dental-health-and-rheumatoid-arthritis-a-research-update/
Johns Hopkins 2016 Study: Science Translational Medicine. (2016). “Gum Disease Linked to Rheumatoid Arthritis.” hopkinsrheumatology.org/2017/01/gum-disease-linked-to-rheumatoid-arthritis/
RA and Dental Health Basics: Johns Hopkins Rheumatology LEAP. (2017). “LEAP: Winter 2017.” hopkinsrheumatology.org/2017/02/leap-winter-2017/
Gut Bacteria and Immune System: Gut Microbes. (2012). “The Role of Gut Microbiota in Immune Homeostasis and Autoimmunity.” ncbi.nlm.nih.gov/pmc/articles/PMC3337124/
RA and Microbiome: eLife. (2013). “Expansion of Intestinal Prevotella copri Correlates with Enhanced Susceptibility to Arthritis.” ncbi.nlm.nih.gov/pmc/articles/PMC3816614/
Bacteria and Autoimmune Conditions: Science. (2018). “Translocation of a Gut Pathobiont Drives Autoimmunity in Mice and Humans.” science.sciencemag.org/content/359/6380/1156
Antibiotics and Autoimmune Conditions: Infection and Autoimmunity. (2015). “Chapter 16 – Can Antibiotics Cure Autoimmune Diseases?” sciencedirect.com/science/article/pii/B9780444632692000088
Periodontal Disease: American Dental Association. (2005.) “Treating periodontal diseases.” ada.org/~/media/ADA/Publications/Files/patient_46.ashx