Keep Away, Toothfairy! Oral Hygiene Tips for People With RA

Since June 2023, I’ve been scared into really taking care of my teeth. Last year, I had a tooth removed due to severe infection and deterioration. It had nothing to do with hygiene and everything to do with my rheumatoid arthritis (RA). My medications, my secondary Sjogren's syndrome, and chronic inflammation created a beautiful environment for tooth decay.

Tips from my dentist for great oral hygiene

I like my teeth. I like my smile. They are my greatest features. So, when I started losing teeth, I freaked out. I talked to my dentist and he gave me more tips to help maintain my pearly (slightly stained from coffee) whites.

1. Flossing

I'm not going to lie; I wasn't the best about flossing. I maybe did it every 2 or 3 nights. You best bet I am doing it every night now, though!

I asked if I should floss in the morning, and my dentist told me I could, but it wasn’t necessary if I did it the night before.

2. Dipping the floss in mouthwash

Somewhere in the web of social media, I saw a hint about covering floss in toothpaste to really get it between my teeth. I tried it, but constantly pinching and applying the paste was a chronic pain nightmare for me.

The dental hygienist suggested mouthwash, and it changed the game for me. I dip the floss in the mouthwash before I do my top row and again before the bottom row.

3. High fluoride toothpaste

My dentist prescribed a high fluoride (1.1% sodium fluoride) toothpaste for me to use at night. I do not rinse after using it so it stays on my teeth and gums longer.

4. Mouthwash

I never used alcohol mouthwashes to begin with (I don’t like how they taste). My dentist suggested ACT and/or Biotene for my dry mouth (because of the Sjogren’s and steroid use combination). I use ACT because Biotene leaves a weird film and tastes terrible. I don’t particularly like ACT either (it tastes very sweet), but if it’ll help maintain my mouth, I can deal.

5. Order matters

Floss (saturated with mouthwash), rinse with mouthwash (for at least 30 seconds), brush with the prescription toothpaste. Do not rinse and repeat. Do not pass go and go to sleep.

6. An electric toothbrush

I switched to electric toothbrushes ages ago but often wonder if I have the best one. My dentist assured me that it really didn’t matter if my execution was good. I spend a total of 2 to 2 and a half minutes brushing my teeth (morning and night).

Personally, I spend a few seconds on the front of each tooth, the bottom of each, and then on the back. I make sure that the bristles also get up into the gumline. I do not apply much pressure, nor do I move the toothbrush over the tooth. The increased vibration is doing the manual labor of a regular toothbrush. If I feel pain, I am pressing too hard.

7. Gum

I am not a gum chewer. It just was never something I particularly got into. My dentist suggested xylitol gum and to chew it after every meal. This would increase saliva production in my mouth (to move bacteria and food particles out) and decrease bacteria load over time.

He did remind me not to chew at the expense of my jaw; a.k.a. forgo it if I felt any pain. Even though he wasn’t a specialist in chronic inflammation and autoimmune diseases, he was very well-versed in the subject, and I appreciated it!

8. Using a tongue scraper

My dentist didn’t deem this a necessity, but he said it wouldn’t hurt. I use a metal tongue cleaner to gently scrape my tongue after the above rituals. I do this morning and night.

Seeing improvement in my oral health

The inflammation has gone down and the stinging pain has decreased. The bleeding (when I floss) has completely ended. If you have issues with your teeth, I would highly suggest speaking to your dentist for extra tips to protect your mouth. These are what work for me, but this is based on my medical history and current abilities (like being able to floss)!

Have you tried any of these? Have they worked? Share in the comments!

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turtle13 Member
I get my teeth cleaned every 12 weeks. That’s every three months. It’s worth it. And I still do most of the care listed above. I’ll try the floss dipped in mouthwash. Also I floss, then use electric toothbrush, then use manual toothbrush until my teeth squeak from being cleaned and I STILL have to scrape away tarter from the gum line! It’s so sticky! So no matter what, I see the hygienist every 3 months. 
1. turtle13 Member
 <inline-mention username="christine.laaksonen" user-id="3148879"/> I forgot to mention the water pic and the blue cavity preventer wash. Dentist didn’t really say much about using both brushes. Developed my routine during Covid. Just couldn’t take a chance that I’d need dental work. I’m so susceptible to infection. 
2. christine.laaksonen Community Admin
 <inline-mention username="turtle13" user-id="3171865"/> wow, good for you! It makes sense that this is something that came out of being stuck at home during Covid. Definitely worth the extra work to not have to need extra dental work, especially during the middle of a pandemic. Thanks again for sharing! -- Warmly, Christine (Team Member)
Mickelley13 Member
I actually use an electric water pick and it is amazing 
1. mcadwell Member
 <inline-mention username="Mickelley13" user-id="3209864"/> So do I. I warm up tap water in the microwave so it isn't too cold, add a splash of mouthwash (I use a tea tree oil mouthwash to help remove bacteria) and electro-floss.
2. Erin Rush Community Admin
 <inline-mention username="mcadwell" user-id="3207174"/>, I never thought about warming up the water for the water pik! That's a great idea! Thank you for sharing. Best, Erin, <a href='http://RheumatoidArthritis.net' target='_blank'>RheumatoidArthritis.net</a> Team Member.
David Advent Moderator & Contributor
Thanks so much for sharing your experience and tips for the dentist. I've never heard of dipping the floss in mouthwash; I might give that a try so I can take care of my teeth and alleviate some of the anxiety about going to the dentist. Stay well, David (RheumatoidArthritis.net Contributor/Moderator)
Splodge Member
Luckily my hygienist has taught me how to look after my teeth and I can recommend the slightly bendy toothpicks which in the UK are under the brand TeePee. There are various thicknesses and you'll be advised which to use. Just as good as floss, as far as I can ascertain.
1. latoya.juniel Community Admin
 <inline-mention username="Splodge" user-id="8785667"/> Thanks so much for your recommendation! It's great that you have been taught by your hygienist how to care for dental health. Knowledge is truly power and it makes a difference when you leave their off and have to upkeep with your dental routine. -Latoya (Team Member)
ARmama Member
Thank you for all the great suggestions on best practices to maintain our oral care. I used to floss daily but when it became so painful I stopped. My hands and wrists have improved somewhat so I need to get back to caring for myself when I'm able. The waterpic is a great option when I'm not doing so well. Risk of infection with haphazard oral care is not worth it! Threes reminders are just what I needed. 
1. christine.laaksonen Community Admin
 <inline-mention username="ARmama" user-id="3202606"/> I'm so glad this was helpful! And, I really like your idea of turning to the waterpic if the flossing is too difficult due to hand and wrist pain. Wishing you a gentle day. -- Warmly, Christine (Team Member)
2. latoya.juniel Community Admin
 This is so great to hear, <inline-mention username="ARmama" user-id="3202606"/>! It's always great to hear when the information shared here is making a difference! Glad you found this helpful to you! Be well, Latoya (Team Member)
CommunityMember3aecd3 Member
Thank you so much for sharing! This information is so valuable to me. I lost several teeth after years of decent (not outstanding, but decent) care. My dentist said he had "never seen anything like it." Thank you so much. I will implement some of your suggestions!
1. latoya.juniel Community Admin
 <inline-mention username="CommunityMember3aecd3" user-id="3657146"/> You're not alone! There are so many that have done their very best and unfortunately still experienced losing several teeth. Chronic illness has it's way of having a greater impact on these kinds of things so it understandable how something like that could still happen even if you are doing a decent job. The great thing is that you can still incorporate ways to manage your overall dental health and I'm glad to hear you're going to start implementing some of the helpful tips mentioned here! We'd love to hear an update on any progress you see with your new regimen! Keep in touch, Latoya (Team Member)
2. 55rainey Member
 <inline-mention username="latoya.juniel" user-id="3929151"/> I have always taken care of my teeth but have lost many the past few years due to RA/RD <inline-mention username="ARmama" user-id="3202606"/>
55rainey Member
I've had to have eight teeth pulled in the past year and a half. First my teeth deteriorated and I had a lot of crowns and root canals done for a lot of money and then all of the crowns are failing because my jaw swells up my gum swell up and then when they go down the teeth loosen up and finally it was to the point where a couple of the crowns just got pulled off with fingers. They just kept all coming out post and all. Up until I was 35 years old, I had perfect dentist appointments and one small filling. My teeth have just fallen apart fighting RA
1. 55rainey Member
 <inline-mention username="latoya.juniel" user-id="3929151"/> My concern with implants is risk of infection. they are talking multiple bridges. Also the expense is off the charts even with a co-pay insurance. My teeth are failing due to a medical condition. Any chance Medicare B and G would cover implants and/or bridges?? 
2. christine.laaksonen Community Admin
 <inline-mention username="55rainey" user-id="3170842"/> that is a great question. I don't have any experience with Medicare so I'm not sure what they do and don't cover when it comes to implants/bridges needed due to a medical condition. Hopefully if any of our community members here know, they can chime in. Otherwise it's possible your dentist (or whoever does the implants) would know, or I would reach out to your insurance directly. Sorry I couldn't give you more helpful information. How are you doing currently? Sending you gentle hugs. -- Warmly, Christine (Team Member)
mcadwell Member
 I'd lost my health insurance in between jobs and had some temp positions so didn't go to the dentist for a number of years. When I finally got a stable job again with dental insurance I went back to the dentist. He was surprised at how good my teeth were (he'd assumed he'd find several cavities). I told him I'd been using a neem-tree oil toothpaste with no flouride and a tea tree oil mouthwash for a long time. He said to keep it up because it was doing it's job. Whew!
KimSeattle Member
BLEEDING GUMS is a DAILY Occurrence! With so many OTHER RA/Sjogrens Symptoms--I have been IGNORING it. To my PERIL, I now understand. THANK YOU for this heads-up! I certainly do NOT want to lose my Teeth due to RA/Sjogrens..... 
1. Richard Faust Community Admin
 Hi <inline-mention username="KimSeattle" user-id="8803196"/>. I'm glad the information has been helpful. I can also tell you that my wife, Kelly Mack (a contributor here), a few years ago started a treatment called Perioprotect to help deal with her bleeding gums (gingivitis). It involved getting special mouth molds/trays made that a gel is used in (every other day in Kelly's case). I'm not going to lie, it was pricey to get the molds made, but it has definitely made a difference for her teeth. Of course, it may not be for everybody and I don't know enough specifics about individual criteria, but thought I'd share the information. Best, Richard (RheumatoidArthritis.net Team)
CommunityMember3140 Member
What I find effective is a toothpaste made with olive oil and baking soda. Even more effective is ozonated olive oil (fully ozonated). Many people claim that it cures all oral problems like gingivitis and you may not any dental treatment. In fact some dentists shops sell them but only a few perhaps for fear of losing business.
CommunityMember3140 Member
Based on my research on RA issues, it is more likely that dental problems cause RA rather than RA causing dental problems. Several RA practitioners have associated mercury poisoning from dental fillings to RA.
msjoey311 Member
I see my dentist every 3 months for a check up. It’s definitely what I need it has been very helpful. I highly recommend it for all with RA.

Keep Away, Toothfairy! My Tips for Healthy Teeth and RA