Autoimmune Series: Rheumatoid Arthritis and Oral Health

May 11, 2019

This month on the Hadlock Dental Center blog we’re kicking off a new series. Every other month through 2019 we will be highlighting a different autoimmune disease and the impact it has on oral health, and vice versa. The Autoimmune label encompasses many different diseases that affect multiple systems of the body. The factor they share, 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. You likely know one or more people with any given Autoimmune disease. These diseases are seen more often in women than in men, and it is hypothesized that hormonal changes may play a role. We’ll be starting the series off this month taking a look at the links between Rheumatoid Arthritis (RA) and 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 is  typically characterized by severe pain and stiffness in any of the body’s joints. Common homecare such as brushing and flossing may be difficult if hands are painful and have limited mobility. If RA also affects the temporomandibular joint (TMJ), this can limit the patient’s ability to open, which further complicates keeping their teeth clean. The risk for developing periodontal diseases greatly increases when lacking effective homecare. Poor homecare may not be the exact link, but it is certainly a 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. These findings 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. As we well know, 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). Inflammation has been a hot topic lately due to its role in so many health problems.Another study out of 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. An increase of antibodies to citrullinated peptides is one of the early markers of RA. 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 link to periodontal disease comes from certain 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 triggering the disease process of RA.

Treatment

With all of this information we can assume 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  benefit from scaling and root planing. This treatment will bring it under control and we can help you maintain better oral health with frequent dental visits. It is also important to work with your physician to control your RA. If you have a difficult time with you homecare due to stiff or painful joints, speak with your hygienist. You may benefit from different dental aids, including an electric toothbrush or water flosser.

We strive to work closely with our patients’ physicians to care for overall 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 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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