Autoimmune Series: Rheumatoid Arthritis Effects on Oral Health

May 11, 2019

We are excited to kick off a new blog series this month! 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 boundless diseases that affect many systems of the body. There are multiple different types of autoimmune diseases, though they all share one common factor; 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. Women tend to carry the disease more often than men. Some hypotheses believe this may be due to hormonal changes. 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 is a strong link between RA and periodontal disease; there are multiple hypotheses for this. 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 make common homecare, such as brushing and flossing much more difficult. If RA also affects the TMJ, this can limit the patient’s ability to open, which further complicates keeping their teeth clean. The risk of developing periodontal disease can certainly be increased by poor homecare habits. Though poor oral hygiene may not be the exact link, 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. The study also noted that poor oral hygiene alone could not explain such a significant increase in risk. This, of course, leads us to look deeper into the cellular level of disease.

Commonalities have been found in oral tissue with periodontal disease and joints with RA. Inflammation caused by periodontal disease destroys 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). Another study based out of Israel also found that genetics may play a role in an elevated risk for RA.

With the abundance of information out there, we now have a better understanding of the entire disease process. Studies have found 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. At least one strain of bacteria has been found that is commonly associated with periodontal disease, this causes the process of citrullination. In 2009 a study 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

With overwhelming evidence, one can assume that periodontal disease and rheumatoid arthritis are obviously linked.  The best way to stop progression is to treat each disease individually. If you are suffering from uncontrolled periodontal disease you will likely benefit from Gum Therapy or “scaling and root planing “  to bring it under control. To continue better oral health maintain your routine wellness visits. It is also important to work with your physician to control your RA. If you are a patient who suffers from RA symptoms, speak with your hygienist. You may benefit from different dental tools, including an electric toothbrush or water flosser.

Here at Dental Care of Vashon we correspond directly with our patients’ physicians about their overall health needs. If you have RA, it is imperative to maintain good home care and frequent wellness visits with your hygienist. The risk discussion for periodontal disease is most often focused on those who use tobacco or have diabetes. Autoimmune disease’s do pose a risk factor as well, we look forward to highlighting these over the coming months. 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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