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RA and periodontal disease

Oral Hygiene and RA: Protect Yourself Against Periodontal Disease

Oral health and hygiene are important for everybody, but especially so for people living with rheumatoid arthritis. People diagnosed with RA can experience oral problems such as dry mouth (xerostomia), methotrexate-induced mouth ulcers, temporomandibular disorders like TMJ, infection, and periodontal disease (gingivitis and periodontitis)1.

How does RA affect oral hygiene?

Certain RA symptoms promote bad oral health

Dry mouth and inflammation are common symptoms of Sjogren’s Syndrome, an autoimmune disease that approximate 10-15% of those diagnosed with RA develop. Dry mouth can contribute to tooth decay, gingivitis, and thrush. Patients may find temporary relief by drinking water, chewing gum, or using saliva substitutes. If these are not sufficient, then patients should ask their doctors about prescription medications to combat symptoms.

Side effects of RA medications

Patients who use methotrexate may experience inflammation of the mucous membrane (called mucositis) which can lead to oral ulcers. Folic acid or folinic acid supplements are frequently used to reduce this type of inflammation2. Recommended dosage and dose scheduling varies somewhat from doctor to doctor. My rheumatologist is fine with me taking an OTC folic acid supplement of 800 mcg daily, except for the day on which I take methotrexate.

Increased risk of periodontal disease in RA

Earlier onset and faster progression

Studies show that people with RA are at increased risk of periodontal disease. Researchers have found that the bacteria, porphyromonas gingivalis, which is responsible for periodontal disease worsens RA by leading to earlier onset, faster progression and greater severity of disease, including increased bone and cartilage destruction3.

When bacteria combine with mucus and other particles in the mouth, a sticky plaque forms on teeth that needs to be removed with daily brushing and flossing. Plaque that hardens becomes tartar which can lead to gingivitis, characterized by red, swollen gums that may bleed easily. Improved dental hygiene and proper treatment is often effective against gingivitis.

How can I avoid periodontal disease?

Symptoms of periodontal disease

Periodontal disease is more than just gingivitis; it involves chronic inflammation that affects tissue surrounding teeth, ligaments providing support, and the bone into which teeth are anchored. Besides bleeding gums, symptoms of periodontal disease include receding gum-line, deep pockets around the tooth, loose teeth, and eventual bone erosion and tooth loss. Studies have shown that bone loss related to periodontal disease is similar to that in other joints of people with RA4.

Tips to protect oral health

In contrast to a century ago, doctors do not suggest that people with RA automatically have their teeth removed to avoid infection. That seems a bit barbaric nowadays. But we should want to keep our teeth as healthy as possible for as long as possible.

Here are some suggestions which may help you protect against oral disease:

  • Brush with a soft bristle toothbrush for two minutes, twice each day. You can use an electric toothbrush which may be more efficient, but might be heavy.
  • If you have difficulty holding a regular toothbrush, try using a child’s toothbrush which comes with a wider handle and has a gentle tongue brush built in which helps to clean the inside of your cheeks while you brush. (This is what I use. It’s easy to hold, effective, and a bit whimsical.)
  • Replace your toothbrush every 3 months, even if it doesn’t seem too worn. Also, replace your toothbrush after you’ve been sick to avoid reinfecting yourself.
  • Floss daily to remove plaque and food particles located where brushing cannot reach, such as below the gum line.
  • Rinse each day with an anti-microbial mouthwash to reduce bacteria and help prevent gingivitis.
  • Visit your dentist or dental hygienist every 6 months for professional cleaning and routine checkup. If you notice signs of gum disease, such as bleeding or swollen gums, see your dentist as soon as possible and follow the recommended treatment plan.
  • If you use methotrexate, talk to your rheumatologist about taking folic acid.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Bingham CO, Moni M. Periodontal Disease and Rheumatoid Arthritis: The Evidence Accumulates for Complex Pathobiologic Interactions. Curr Opin Rheumatol. 2013;25(3):345-353. Accessed at
  2. Deeming GM, Collingwood J, Pemberton MN. Methotrexate and oral ulceration. Br Dent J. 2005 Jan 22;198(2):83-5. doi:10.1038/sj.bdj.4811972 Accessed at
  3. Detert J, Pischon N, Burmester GR, Buttgereit F. The association between rheumatoid arthritis and periodontal disease. Arthritis Research & Therapy. 2010, 12:218 doi:10.1186/ar3106 . Accessed at
  4. Maresz KJ, Hellvard A, Sroka A, et al. Porphyromonas gingivalis Facilitates the Development and Progression of Destructive Arthritis through Its Unique Bacterial Peptidylarginine Deiminase (PAD). PLoS Pathog. 2013; 9(9): e1003627. doi:10.1371/journal.ppat.1003627. Accessed at


  • Kimberly
    2 years ago

    I had to get upper denture last year! I was 48 and have always had healthy perfect teeth. Until RA

  • Catherine Wester
    2 years ago

    These are all great suggestions but it doesn’t work for all of us. I have been losing my teeth now for the past year and a half no matter how much I brush or floss they keep crumbling. I was curious how many others dealt with this I posted the question on one of the Facebook groups I belong to of people with RA it’s the one about Laughing Living Loving and Learning. It was one sentence Anyone else loosing their teeth to RA, I have had 146 comments of people who yes are losing teeth to this illness whether it’s RA or the medication we don’t know but its a serious issue that should be researched and acknowledged.

  • ncanterbury
    2 years ago

    I’ve lost a few teeth. The dentist told me it’s because I grind my teeth at night. Even more of a problem with myself is the color. I’ve had the dentist whiten my teeth. I’ve bought three different at home product. My teeth may look a little whiter but to keep them that color I need to do this 2/3 times a day. I’ve given up my favorite hot tea in the morning. I try to stay away from drinks/foods that could discolor my teeth. I don’t know what medication that could be causing this! Help!

  • Richard Faust moderator
    2 years ago

    Thanks for writing ncanterbury. Sorry you are having these difficulties with your teeth. This, like any potential new symptom, should be brought to the attention of your doctor. While there is the evidence connecting RA and periodontal disease, I’m not seeing anything specifically related to discoloration (this, of course, does not mean it isn’t out there). Hopefully, some others may be able to chime in with additional information or experience. Best, Richard ( Team)

  • Lisa Emrich author
    2 years ago

    HI Catherine,
    That’s a great point. I wonder what happens that weakens the teeth themselves to cause them to crumble. I’m sorry that you’ve been going through this. Thank you for sharing.
    Best, Lisa

  • Polly
    5 years ago

    Thanks for an informative article. I use an electric toothbrush with a broad, easy to hold base but my OT suggested putting a bit of pipe insulation around the handle if using an ordinary brush. That works well for hair brushes too.

  • Poll