Don't Avoid the Dentist if you have RA

Going to the dentist is something that many people avoid. In fact, it is estimated that up to 40 million Americans avoid seeing a dentist each year.1 Reasons may include fear of pain, negative past experiences, and embarrassment. That last reason is probably the one that drove me to stay away for almost eight years! During that time, I was diagnosed with rheumatoid arthritis. Given my newfound attention to all things having to do with my body, I finally ventured into my family’s dentist that is literally only two blocks away from my house. Upon examination, the dentist indicated that I had periodontal disease – meaning inflammation around a tooth.2 Risk factors for periodontal disease include having other illness, lack of saliva, and certain medications.

A “deep cleaning” was then conducted which involves scraping off tarter below the gum line and smoothing tooth roots to avoid places where bacteria can live. This process required numbing lidocaine shots and it took three more visits to complete the process throughout my entire mouth. These deep cleanings were required every three months instead of the normal six months until things got under control. Realizing that there must be inflammation involved, I started speculating about a possible connection with RA.

Like RA, periodontal disease is an inflammatory condition that can include gum inflammation and eventually damage to tissue and tooth loss. The National Institute of Dental and Cranofacial Research indicate that it is caused by opportunistic bacterial infections in the mouth.3 A recent review of studies by researchers in Australia found relationships between periodontal disease and inflammatory blood markers like ESR, C-reactive protein, and interleukin 1 that are all implicated in RA.4 Associations between periodontal disease and joint destruction from RA have been found. Some researchers noted connections between the biochemical processes of RA and periodontal disease.5 A study published in Europe showed that a common blood marker for RA, anti-citrullinated antibodies (anti-CCP), is related to periodontal disease.6 Other researchers demonstrated that the bacteria Porphyromonas gingivalis, which is one of the pathogens involved in periodontal disease, is linked to anti-CCP antibodies.7 Another group of researchers indicated that people with RA have a significantly higher rate of periodontal disease than control populations.8 The link is between periodontal disease and RA is very complex.9 While connections are present, scientists cannot at this time say that one causes the other.

However, given the connections, RA patients must be vigilant to care for their teeth. Maintaining regular mouth care, including daily brushing and flossing, is critical to staving off inflammation and bacterial infections. Modified cleaning tools may be necessary for those with hand and arm joint damage from RA. There are a number of assistive dental devices available for those with disabilities. Personally, I use an electric toothbrush to avoid repetitive motion and to give my elbows and shoulders a break. A water jet system can help with flossing. Some RA patients also have Sjögren’s Syndrome that is an autoimmune disease that may result in less saliva production among other symptoms.10 This could contribute to periodontal disease. And finally, don’t avoid going to a dentist. Regular mouth hygiene and professional care can help stave off problems.

My periodontal disease is now under control and my dentist is letting me go back to 6-month cleanings. No more avoiding the dentist for me!

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