This month we’re kicking off a new blog series here at Innovative Dentistry in SLU! Every other month through 2019 we will be highlighting a different autoimmune disease and the impacts it has on oral health, and vice versa. Autoimmune diseases are diseases that spread throughout the body and affect many different systems. These diseases cause the body to attack its own cells causing painful and sometimes debilitating symptoms. These diseases are seen more often in women than in men, and it is hypothesized that hormonal changes may play a role. There are over 23.5 million people just in the United States who suffer from at least one autoimmune disease. We’ll be starting the series off this month taking a look at the impact of Rheumatoid Arthritis (RA) on oral health.

Rheumatoid Arthritis affecting the hands can limit good oral health.

Digital x rays of both hands showing severe rheumatoid arthritis affecting both wrists and hands. Deformities limiting movement and associated with pain.

Possible Connections

Many individuals with RA also suffer from periodontal disease and there are a couple of different theories as to why. One hypothesis is easy to connect. Symptoms of RA can be severe pain and stiffness in any of the body’s joints. Hands with pain and limited mobility make common homecare, such as brushing and flossing, a much more difficult task. If RA also affects TMJ (Temporomandibular joint dysfunction), the patient’s ability to open can become limited, which further complicates keeping their teeth clean. This leads to a lack of good homecare which is a leading cause of periodontal disease. Poor homecare may not be the exact connection, but it is certainly a risk factor shared between the two diseases.

In 2008, a German study found that patients with RA were 8 times more likely to develop periodontal disease! They noted that poor oral care was not the only explanation for such a significant increase in this risk. They began to dig a little deeper into the cellular level of disease at this point. There have been similarities found in oral tissue with periodontal disease and joints with RA. Inflammation from periodontal disease causes destruction of the bone and tissue surrounding the teeth and is what causes the breakdown of joints, and pain associated with RA. There have been many of the same proinflammatory proteins that were found in both periodontal disease and RA such as Tumor Necrosis Factor (TNF, Interleukin-1, and Interleukin-6. A separate study done in Israel have found that genetics may have a role in an elevated risk for RA.

These studies allow us to gain a better understanding of the entire disease process. An increase of antibodies to citrullinated peptides is an early indicator of RA. Citrullination means a change in cell structure that leads it to be seen as a foreign entity to the body, in scientific terms. This citrullination means the body will release anti-cyclic citrullinated (anti-CCP) antibodies. The antibodies attack the cells thinking they are foreign, even though they are cells of the body. The importance of periodontal disease comes through a link in bacteria. At least one strain of bacteria commonly associated with periodontal disease was found to cause the process of citrullination. A 2009 study concluded that certain oral bacteria could be the cause of RA and/or periodontal diseases may be prompting the disease process of RA.

Treatment

With all this information it is clear that there is some connection with periodontal disease and rheumatoid arthritis. The best way to control the disease is to be sure to treat each one. If you are suffering from uncontrolled periodontal disease, you will likely benefit from scaling and root planing to help take back control of your oral health with frequent dental visits. It is important to also be working with your physician to control your RA. If you suffer from RA and have a difficult time with homecare due to stiff or painful joints, speak with your hygienist as they are here to help. There are some awesome alternate dental tools including an electric toothbrush or water flosser that may be beneficial for you.

We strive to work closely with our patients’ physicians to care for your entire health. It is imperative to maintain good homecare and frequent visits with your hygienist especially if you have RA. We look forward to highlighting more autoimmune diseases over the coming months. Smoking and Diabetes are often mentioned when it comes to periodontal disease, but we feel it is important to highlight these other diseases as well. It is our hope that continued studies will be done to further understand the etiology of these elusive diseases. If you know someone with RA, please share this link with them!

 

References

Arthritis Foundation

https://www.arthritis.org/living-with-arthritis/comorbidities/gum-disease/ra-and-gum-disease.php

Johns Hopkins Arthritis Center

https://www.hopkinsarthritis.org/arthritis-news/5-dental-tips-for-the-ra-patient/

Colgate

https://www.colgate.com/en-us/oral-health/conditions/immune-disorders/ada-06-rheumatoid-arthritis-and-gum-disease-risk

National Library of Medicine, National Institutes of Health

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495574/

 

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