Exploring the Oral Health Impact of Rheumatoid Arthritis
We kick off a new blog series here at Ballard Dental Arts! For the rest of 2019, we will highlight different autoimmune diseases bimonthly and discuss their impacts on oral health and vice versa. Autoimmune diseases affect many systems of the body, causing the body to attack its own cells, which leads to painful and sometimes debilitating symptoms.
Over 23.5 million people in the United States alone suffer from at least one autoimmune disease, with a higher prevalence in women than in men. Researchers hypothesize that hormonal changes may play a role. This month, we start the series by examining the impact of Rheumatoid Arthritis (RA) on oral health.
Is There a Connection Between Rheumatoid Arthritis and Periodontal Disease?
Researchers propose several hypotheses about the relationship between RA and periodontal disease. One hypothesis links RA to severe pain and stiffness in the body’s joints.
Limited mobility in joints, including those in the hands, makes homecare tasks like brushing and flossing more difficult. If RA affects the temporomandibular joint (TMJ), it can restrict the patient’s ability to open their mouth, complicating the maintenance of a healthy oral environment. Insufficient homecare significantly increases the risk of developing periodontal disease. While poor homecare may not be the sole link, it certainly acts as a shared risk factor between the two diseases.
In 2008, a German study found that patients with RA were eight times more likely to develop periodontal disease. The study indicated that poor oral hygiene alone could not explain such a significant increase, prompting further investigation into the cellular mechanisms involved.
Similarities in Oral Tissue and Joint Inflammation
The oral tissue affected by periodontal disease and the joints impacted by RA share similarities. Inflammation from periodontal disease leads to the destruction of bone and tissue surrounding the teeth. Similarly, inflammation in joints causes breakdown and pain associated with RA. Researchers have identified many of the same pro-inflammatory proteins in both conditions, including Tumor Necrosis Factor (TNF), Interleukin-1, and Interleukin-6. A separate study from Israel also suggested that genetics may elevate the risk for RA.
The growing body of knowledge surrounding these connections enhances our understanding of the disease processes. One early marker of RA is an increase in antibodies to citrullinated peptides. Citrullination refers to a change in cell structure that causes the body to perceive these cells as foreign, prompting the release of anti-cyclic citrullinated (anti-CCP) antibodies.
These antibodies attack cells identified as foreign, even though they are actually the body’s own cells. The link to periodontal disease lies in specific bacteria; researchers found that at least one strain of bacteria commonly associated with periodontal disease triggers the citrullination process.
Managing Both Conditions: Periodontal Disease and Rheumatoid Arthritis
With this information, one can assume a clear link between periodontal disease and rheumatoid arthritis. Effectively treating each disease is crucial for controlling their progression. If you suffer from uncontrolled periodontal disease, you will likely benefit from scaling and root planing to regain control and maintain better oral health through regular dental visits. It is also essential to collaborate with your physician to manage your RA effectively.
If you have RA and struggle with homecare due to stiff or painful joints, consult your hygienist. You might benefit from using different dental tools, such as an electric toothbrush or water flosser.
At Ballard Dental Arts, we strive to work closely with our patients’ physicians to address your overall health. If you have RA, maintaining good homecare and scheduling frequent visits with your hygienist is imperative. Look for our upcoming blogs highlighting other autoimmune diseases in the months ahead.
These conditions often take a backseat to smoking and diabetes concerning periodontal disease. We hope that continued studies will further elucidate 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/
National Library of Medicine, National Institutes of Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495574/