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Oral Health & Arthritis

Good oral health reduces inflammation in your mouth as well as risk of associated systemic diseases like rheumatoid arthritis. Find out why & what to do.

Often when we think of rheumatoid arthritis contributing to health issues, we don’t always consider how it can affect one’s oral health. Individuals who have arthritis in their hands, wrists, elbows, shoulders, other extremities might have increased difficulty taking care of their basic oral healthcare.^[1] Brushing and flossing their teeth could prove to be difficult and painful.^[1] Sufferers of this progressive often debilitating autoimmune disease unfortunately, have an increased risk of having gum disease and tooth loss.^[1] Using an electric toothbrush and a water flosser may prove beneficial to help with oral homecare that might otherwise be uncomfortable to do manually.

Which comes first?

Researchers have not yet been able to determine which comes first…kind of like the chicken or the egg conundrum. They don’t know if inflammation in the mouth from gum disease causes the individual to develop Rheumatoid Arthritis, or if in fact the autoimmune disease contributes to an individual developing gum disease.^[2] Oral inflammation can negatively affect the body, just as the inflammation in one’s joints from Rheumatoid Arthritis can negatively impact the mouth.^[2]

How are they connected?

P.gingivalis is a strain of bacteria that is found to be a contributory factor in gum disease. It can trigger an inflammatory response by causing the microbes or harmful bacteria in your mouth to create antibodies.^[2] The antibodies can cause the body to overreact to the body’s infection fighting microscopic warriors. “The antibodies see the proteins that P.gingivalis has released as a threat and stimulates the immune system to overcorrect by producing autoantibodies.^[2] Autoantibodies are antibodies that react negatively with your own body.^[2]Instead of fighting off infection, they attack your immune system.^[2] In the case of Rheumatoid Arthritis and other forms of arthritis, the bacteria from a individual’s mouth has been found in the fluid between their joints. Researchers believe that this harmful bacteria enters the bloodstream from ones gum tissue and then moves throughout the body causing damage.^[2] Researchers believe that having active gum disease can lead to an earlier onset of the disease that progresses quickly and is more painful.^[2]

Prevention & treatment

Preventing or treating gum disease is essential so as to lower the risk of autoimmune disease flare ups and the painful progression of the side effects from the disease and any that may accompany it. Untreated gum disease can potentially negatively affect an individual with Rheumatoid Arthritis and negatively affect the effectiveness of one’s medication that is used to combat Rheumatoid Arthritis. If gum disease is not treated and progresses more extensive dental treatment such as surgery might be needed. To treat gum disease your dental professional may discuss with you nonsurgical therapies such as laser treatments or scaling and root planing (a dental debridement that removes biofilm beneath the gums).^[1] Untreated gum disease can potentially negatively affect an individual with rheumatoid Arthritis and negatively affect the effectiveness of ones medication that is used to combat Rheumatoid Arthritis. If gum disease is not treated and progresses surgery might be needed

Complications & co-morbidities

Individuals who suffer from Rheumatoid Arthritis may also have TMJ (Temporomandibular Joint) discomfort. Their arthritis can affect the TMJ joint that is responsible for opening and closing the mouth.^[1] It can become painful or difficult to open and close their mouth due to the inflammation that can form along the tendons. The dentists can take specific x-rays to determine if there is an issue with the TMJ being inflamed and will be able to discuss any necessary treatment interventions.

Sjogren’s syndrome is an autoimmune condition that can occur on its own or in conjunction with other autoimmune conditions that an individual might also battle, such as Rheumatoid Arthritis.^[1] Sjogren’s affects an individual’s oral health negatively because inflammation from this syndrome damages the glands that secrete salivary fluid. This can cause one to suffer from severe dry mouth due to a lack of saliva lubricating their mouth and throat. Having a lack of saliva makes it difficult to eat because food can get stuck in the throat.^[1]A lack of saliva in the mouth can cause painful dry oral tissue, contributes to cavities, and increases the risk of tooth loss.^[1] Suffers from this syndrome should use alcohol-free mouthwashes that specifically are formulated to help dry mouth suffers^[1] Many have found that using products that help stimulate saliva such as throat lozenges, sugar free candies, and prescription rinses can help increase saliva responses.^[1]

The importance of prevention

When it comes to conditions in the mouth, many don’t realize that they have an issue until it is advanced or painful. Maintaining a healthy mouth and preventing oral disease is imperative so as to achieve overall health and wellness.^[3] Regularly seeing the dental hygienist for preventative or therapeutic treatments and having examinations from the dentist, coupled with good oral hygiene is part of what helps to keep one’s oral health in a controlled state. Assessments will be taken to see if the there is a need for preventative or therapeutic treatment to treat possible gum infection, cavities, TMJ discomfort, or dry mouth symptoms.^[3] The dentist might suggest that a patient who has Rheumatoid Arthritis would benefit from scheduling more frequent visits with the dental hygienist. Navigating life with an autoimmune disease may prove difficult at times, however having your medical physicians team working in conjunction with your dental professional team will allow all your healthcare providers to know how best to address your concerns.

Kari Carter-Cherelus

Kari Carter-Cherelus RDH, DA is an internationally known public speaker, consultant, author, a writer, and a clinician with 25 years in the dental industry. She authored the book The Ultimate Guide for Dental Hygienist Burnout to help dental hygienists in all stages of their career. She uses her platform as Founder of KMC Strategic Solutions to help improve the work culture in teams and organizations as well as to coach individuals.

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