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Three disheveled, sad and slightly rotten teeth.

A Bout of Three Cavities

Recently, I had a routine dentist appointment that went a little awry. For the past 22 years, I have had a pretty clean track record with my dentist with having only 2 cavities thus far; however, during this last checkup, my dentist noticed the beginnings of 3 more cavities and some gum issues, with the hygienist even checking to see if my gums were still in tack (they were, thankfully).

While my teeth are still relatively strong and healthy, it perturbed me that these problems were occurring, particularly when I take good care of my teeth. Even before being diagnosed with RA, I was regularly brushing twice a day, flossing once a day, and swishing mouthwash twice a day. It left me wondering: could my RA and my Humira medication be causing these symptoms?

RA treatment side effect or RA symptom?

I called my rheumatologist when I returned home and informed him of what had happened at the dentist. He said that it was possible that both the Humira and Plaquenil were indirect sources of my recent teeth troubles. The rationale behind this was that these medications were causing dry mouth and subsequently leading to a proliferation of bacteria, which thereby created the beginnings of those cavities.

Monitoring tooth decay and other dental issues

However, my rheumatologist also said that the RA itself could be exacerbating these dental problems by leaving my susceptible to bacterial infections of the gums. He told me to keep taking my medication and, if things progressed when I went back to the dentist, we would reconsider whether taking Humira and Plaquenil was the best treatment plan for me.

Dental issues and rheumatoid arthritis

Given this from my rheumatologist, I decided to do some further research. Apparently, I am not alone in experiencing these side effects; in fact, they’re actually quite common. Many people have discussed how after being diagnosed with RA, their perfect track record at the dentist was subsequently sullied.

Sjorgen’s syndrome, another culprit

Their rheumatologists have also informed that it could be a combination of medication and RA, although most pointed to the possibility of having Sjorgen’s syndrome, as well, since dry mouth is the hallmark symptom of Sjorgen’s. In my own experience with comorbidities, I have noticed that I have extremely dry eyes and dry mouth, so when I follow up with my rheumatologist next month, I’ll request an ANA panel screening to see if there could be something else happening.

Products to help with dental issues

Additionally, in my research, I found there are many potential remedies for these problems. The most common ones included buying Biotene mouthwash and toothpaste, drinking more water, and a fluoride prescription. My plan now is to purchase some Biotene products and see if they help any when I go back to the dentist in six months. Hopefully it will!

This experience ultimately reminded me that RA is much more than swollen joints; it affects the entire body and can be an instigator for many other chronic conditions. It also demonstrated the importance of having a rheumatologist who can support you through the extraneous, unexpected, and sometimes weird side-effects of RA.

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

Comments

  • Mafalda
    2 months ago

    I would be very suspicious of a possible Sjögrens. I got a clean bill of health at my Dec. 2018 routine check up and cleaning, but at the following one -this past June- and in spite of keeping a good, regular hygiene, a large cavity was found in the gum line of a last upper molar. There was already a root canal and a crown on it, so it had to be surgically removed, with the consequent bone graft for a coming implant. Not cheap.
    The three specialists I saw in the process weren’t surprised at the quick development and blamed my Sjögrens for all this, as bacteria thrives in a dry environment, so I don’t rule out losing more teeth and ending up with a mouthful of implants.
    I don’t take any medications at the moment for my mild RA -tried Plaquenil for years without effect and Methotrexate that couldn’t tolerate- and co-morbidities, but the Sjögrens is pretty severe, giving me constant dry/watery eyes and a parched mouth, to the point that every morning I must literally pull my cheeks from my teeth as they are stuck to them.
    I tried Biotene spray before bedtime (the morning dryness persisted) and have been using a dolop of prescription Clinpro 5000 1.1% Sodium Fluoride (Tri-Calcium Phosphate) toothpaste after each brushing plus an anticavity fluoride mouthwash. In spite of all these, I wouldn’t be surprised if they find more damage at my checkup in a couple weeks…

  • Mafalda
    2 months ago

    I forgot. I also keep sugarless gum in my mouth -that I chew in a polite way- in order to produce salivation. One does what one has to do.

  • EmmaCB
    2 months ago

    Hi David, I don’t have RA but do have type 1 diabetes and my hygienist tells me my auto-immune condition makes my body over-react to plaque, creating big pockets around my teeth thanks to gum disease. Type 1 diabetes often gives you a drier than usual mouth too. The joy of the auto-immune disease, hmm, and yes it never comes alone…

  • 2mra
    2 months ago

    Hi Emma:

    I looked up the phrase: big pockets around my teeth – and these are the risk factors. That may include mouth dryness.

    Gingivitis

    Poor oral health habits

    Smoking or chewing tobacco

    Older age

    Hormonal changes, such as those related to pregnancy or menopause

    Substance abuse

    Obesity

    Inadequate nutrition, including vitamin C deficiency

    Genetics

    Certain medications that cause dry mouth or gum changes

    Conditions that cause decreased immunity, such as leukemia, HIV/AIDS and cancer treatment

    Certain diseases, such as diabetes, rheumatoid arthritis and Crohn’s disease

    There are many reasons for this condition so if your Hygienist is correct and it is caused by the diabetes then you should be seeing your Endo more often or one that is more efficient.

  • 2mra
    2 months ago

    Good topic David:

    I had a similar experience 4 months ago. My Dentist was ready to fix one tooth, then he was surprised to discover another decay on the tooth beside it. I told him many times that when I floss in that area, that the floss kept getting caught on something but he didn’t listen. So I had a two-for-one fixer-upper.

    He also menioned several times that my mouth soreness was caused by my so-called unmanaged Diabetes. I left in a huff and the next time brought back my medical test results and my Endo’s congrats on my maintaining good blood glucose control.

    He then sent me to a Specialist and it turns out that I have another autoimmune disease and No, it’s not Sjorgens. So I’m waiting for an apology at my next Dental appointment.

    As usual, wonderful info. Thanks!

  • 1ea2lph
    2 months ago

    I’m reading here a lot of you are heavily medicated but have you ever thought it was day to day things in your diet that causes your immune system to react causing it to attack itself?

    I got diagnosed early, at 23 it was absolutely debilitating and any time I stopped my methotrexate I could barely use my hands. Through a thorough bit of research I discovered that gluten, sugar and dairy were the main culprits, when I stopped eating them the pain dramatically eased. If you look up the correlation between yeast in the gut “candida” you’ll understand why certain foods kick start these antibodies. Other than my elimination diet mentioned the amount you only other thing I take is 2 cups of pau d arco tea morning and night. I’ve been medication free for two and a half years now, been back in the gym for over 12 months lifting heavy weight.

    Unfortunately RA specialist as usual are focused on fighting symptoms instead of the Use which gets you absolutely nowhere!!!

  • Jackie Reed
    2 months ago

    I have had numerous dental problems and my dentist and rheumatologist think the prednisone is my major culprit. I had great teeth before my autoimmune disease kicked in and now I am down to two partials one lower and one upper. I can’t express enough about your dental health. I use Biotene products and drink lots of water.

  • Richard Faust moderator
    2 months ago

    Hi Jackie. Sorry you have had these dental issues. Unfortunately, there is some evidence that corticosteroids can contribute to these problems. This research article looks at the impact of long-term corticosteroid therapy on oral health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858744/. Hope the steps you are taking help. Best, Richard (RheumatoidArthritis.net Team)

  • trishak913
    2 months ago

    Hi, David! I don’t know if this will help you, but after my second child was born, I started to experience bleeding gums for the first time in my life. I’ve always been kind of a fanatic about caring for my teeth so this left me extremely perplexed. I don’t know how, but something told me to take an extra 2Kmg vitamin C daily after breakfast along with a healthy diet of vegetables & fruits containing an abundance of vitamin C. I believe that our RA/RD bodies require more of certain vitamins. Also, I’ve read how mouthwash kills the good bacteria in our mouths which can negatively affect our cardiovascular systems. And heart disease is still the #1 killer of those with RA/RD!

  • KimberlyWilson
    2 months ago

    Heart disease? Really? Wow, I.never knew this… I have reading these email forums for a few years now…I am always surprised by something I did.not know every time I read them..I try to “ignore” researching more about my RA… but thank for this information

  • KimberlyWilson
    2 months ago

    Wow! YES!!! Rheumatoid arthritis affects many many more parts of our bodies than JUST our joints.
    A BIG lesson I learned was to IMMEDIATELY STOP taking Enbrel and Levothroxin when I have ANY kind of infection. I had 2 implants installed in my lower mandible 8 years ago (I was diagnosed with RA 6 years ago) knowing my teeth have been an issue since the birth of my son whom happens to have down syndrome. (He was really sick and sucked the health right out of me) after his birth my top teeth crumbled…so I have upper dentures. Knowing my bottom teeth were no longer in great shape and were becoming an issue in my future I had the 2 implants on the back left and right of my lower jaw so when the time came my lower dentures would just snap on.

    Christmas eve 2018 I chipped a tooth 4 away from 1 implant. I was in the most tremendous pain I have ever felt. The tooth was pulled…then another 4 total…pic line, surgery to remove left lower implant, and debis/scrap infection from my bone, my jaw continued to be painful and haw a tennis ball hard knot…..I acquired Osteomyelitis- a bone Infection in my lower jaw.

    Long story short..I just had a 14 hour long surgery Mandiblectomy with flap. 11/20/2019

    They removed half of my lower jaw bone and tissue. They took bone from my left fibula to replace it. Then a skin graft from my thigh to cover my lower leg.
    This is the scariest and most painful experience ever.

    If you ever have any kind of infection speak to your Rheumatologist about stopping your biologic and any other medication that could hinder your healing. I stopped all mine 1 month after I realized the severity of my situation. RA is a horrible disease that lead to MANY other issues. Take it from me- please be super vigilante

  • Louise1024
    2 months ago

    You are on the right track David. Saliva helps in aiding digestion, and it increases anti microbial actions. Salivary proteins will protect the tooth surface and allow calcium ions to initiate remineralization. A substance called pellicle will form on the tooth which will prevent bacteria from adhering to the tooth, and protecting the teeth from ph variations.
    I have seen this problem occur many times in my career as a registered dental hygienist. The biggest culprit was dry mouth, and often the use of hard candy to alleviate it. I would recommend a dry mouth toothpaste. Biotine is excellent, and their dry mouth spray. This spray is helpful to use during the night, and to keep with you at work, etc. a fluoride RX is also good.

  • David Advent moderator author
    2 months ago

    Thank you for your insightful comment, @louise1024! I’m glad to hear my suspicions are leading me in the right direction; that is, RA can affect our teeth. I bought some Biotine the other day, so I’m hoping that will help.

    Thank you for being a member of this community. Wishing you the best,

    David (RheumatoidArthritis.net Team Member)

  • Richard Faust moderator
    2 months ago

    Hi Louise1024. Thanks for sharing. Always great to get information from an expert. Really interesting that you mention the hard candies – shows how sometimes general “remedies” it seems natural to turn to can actually make things worse. I’m curious what your thoughts are on use of sugarless candies and gums to stimulate saliva production.? Best, Richard (RheumatoidArthritis.net Team)

  • Louise1024
    2 months ago

    Hi Richard, good question, there are a number of dry mouth lozenges and gum available. They are designed to stimulate salivary flow. Sugar free candy will also do that. Look for gum and candy with xylitol which can reduce the risk of tooth decay.

  • Lawrence 'rick' Phillips moderator
    2 months ago

    Oh my dentist and I have this discussion with every appointment. He claims tooth stuff caused my RA, I claim having RA caused my tooth issues. Turns out, I still know I am right. 🙂

    I mean if you do not ask him.

  • David Advent moderator author
    2 months ago

    Haha, I’ve had the same experience. Dentist always claims its something else and never RA. Still don’t believe him.

    -David (RheumatoidArthritis.net Team Member)

  • Louise1024
    2 months ago

    I agree with you rick. I have never had a problem with gingivitis, or periodontal disease. I was taken by surprise to read that gum disease can be a key initiator of RA related autoimmunity. That really got me mad. Practicing as a dental hygienist for 45 years, with healthy gingiva. No way was that a factor for me. My gingiva is still healthy, but I had been clenching at night from several years of pain. Now I need gingival grafting surgery.

  • Richard Faust moderator
    2 months ago

    Hi Louise1024. Understand your frustration and Rick’s. Not saying that periodontal issues cannot be a potential trigger for RA, but there is nothing pointing to the causal arrow not potentially going in both directions. I also think about the fact that we have two contributors here who were diagnosed at two (including my wife) and another at nine – I don’t think periodontal issues were their trigger. All evidence is that there are a lot of potential triggers – and that autoimmune issues (and some of the medications) can impact the teeth. Thanks so much for adding to the conversation. Best, Richard (RheumatoidArthritis.net Team)

  • Cynthia Ventura moderator
    2 months ago

    Thanks for the reminder David that RA impacts more than just joints. RA is a systemic disease, meaning it impacts our entire body including teeth, eyes, hearing, and organs including skin, etc. For me that means my eyesight, speech and lungs. In addition to my rheumatologist I also have had to include an Ophthalmologist, ENT, and a pulmonologist to my healthcare team who together work with my rheumy to keep me as healthy as possible.

    The effects of medication is also a big part of the equation that needs to be looked at as well. As you point out, having a rheumatologist who is capable of effectively overseeing and responding to these issues is vitally important. Thanks for such a personal and informative article and best wishes with your dental issues.

    CynthiaV, Site Moderator, RheumatoidArthritis.net Team Member

  • David Advent moderator author
    2 months ago

    Thank you for your comment, Cynthia! It’s hard to pin RA down when its effects are so widespread but having a team of medical professionals invested in your well-being helps alleviate some of those effects.

    Wishing you the best,

    David (RheumatoidArthritis.net Team Member)

  • Anni
    2 months ago

    I read with interest your comments regarding dental health and RA. For a number of years I suffered with terrific joint pain. I also had terrific issues with my gums: bleeding, sores, receding gums, burning mouth. I took care of my teeth and visited my dentist regularly. I felt terrible about myself. Five or six years ago, I was DX with RA. Prescribed Plaquenil,Sulfasilazine, Arava, Humira and now Embrel.
    My mouth cleared up in 2-3 months!
    My front teeth don’t look very good and I wonder if Plaquenil is messing with them. I have had dry mouth and eyes for over 30 yrs. Antidepressants and Antihypertensive drugs to blame?
    I do use Biotene products. Lips are dry and lipstick won’t stay on.

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