Autoimmune Series: Oral Health Effects of Rheumatoid Arthritis

May 10, 2019

Starting this month we’re kicking off a new blog series! Every other month through the remainder of 2019 we will be focusing on a different autoimmune disease and the impacts it has on your oral health.  Autoimmune diseases are wide ranging diseases that affect many systems of the body. Their commonality though, is that the body begins attacking its own cells wreaking havoc and causing painful and sometimes debilitating symptoms. Over 23.5 million people in the United States alone suffer from at least one autoimmune disease. These diseases are more commonly found in women than in men. It is hypothesized that hormonal changes may play a role. 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 Links

There are a couple of different hypotheses currently out there as to why so many individuals with RA also suffer from periodontal disease. One such hypothesis is an easy link to make. RA can cause severe pain and stiffness in any of the body’s joints. Painful hands with limited mobility makes common homecare, such as brushing and flossing very difficult. If RA also affects the TMJ, this can limit the patient’s ability to open, which further complicates keeping their teeth clean. These symptoms in combination with a lack of good homecare can certainly increase one’s risk for developing periodontal disease. Poor homecare may not be the exact link, but it is certainly a common risk factor shared between the two diseases.

A German study in 2008 found that patients with RA were 8 times more likely to develop periodontal disease and also noted that poor oral hygiene alone did not explain such a significant increase in risk. This of course leads us to look deeper into the cellular level of disease.  Similarities have been found in oral tissue with periodontal disease and joints with RA. The inflammation of periodontal disease causes destruction of the bone and tissue surrounding the teeth. Inflammation is also what causes the breakdown of joints, and pain associated with RA. Many of the same proinflammatory proteins were found in both diseases (Tumor Necrosis Factor (TNF), Interleukin-1, and Interleukin-6). A different study from Israel also found that genetics may play a role in elevated risk for RA.

All of this information and more has led to a better understanding of the entire disease process. One of the early markers of RA is the increase of antibodies to citrullinated peptides. Citrullination is the scientific term, for a change in cell structure that leads it to be seen as a foreign entity to the body. This citrullination leads the body to release anti-cyclic citrullinated (anti-CCP) antibodies. These antibodies then attack the cells thought to be foreign, even though they are in fact cells of the body. The importance to periodontal disease comes through a link in bacteria. It was found that at least one strain of bacteria commonly associated with periodontal disease causes the process of citrullination. A study in 2009 concluded that due to these facts, certain oral bacteria could be the cause of RA and/or that periodontal disease may be inducing the disease process of RA.

Treatment

One can assume then that with all of this information, periodontal disease and rheumatoid arthritis are clearly linked. One of the best ways to control them is to be sure to treat each disease. If you are suffering from uncontrolled periodontal disease you will likely benefit from scaling and root planing to bring it under control and maintain better oral health with frequent dental visits. It is also important to work with your physician to control your RA. If you suffer from RA and have a difficult time with you homecare due to stiff or painful joints, speak with your hygienist. You may benefit from different dental tools, including an electric toothbrush or water flosser.

We strive to work closely with our patients’ physicians to care for your entire health. If you have RA, it is imperative to maintain good homecare and frequent visits with your hygienist. We look forward to highlighting other autoimmune diseases over the coming months. They are not spoken about often, taking a backseat to Smoking and Diabetes when it comes to periodontal disease. 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 feel free to 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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