Good Dental Care Is Important for Those with Rheumatoid Arthritis

People who have rheumatoid arthritis (RA) are at high risk for gum inflammation (gingivitis) and gum disease (periodontitis).¹Mercado FB, Marshall RI, Klestov AC, Bartold PM. Relationship between rheumatoid arthritis and periodontitis. J Periodontol. 2001 Jun;72(6):779-87. doi: 10.1902/jop.2001.72.6.779. PMID: 11453241^,2Bartold PM, Marshall RI, Haynes DR. Periodontitis and rheumatoid arthritis: a review. J Periodontol. 2005 Nov;76(11 Suppl):2066-74. doi: 10.1902/jop.2005.76.11-S.2066. PMID: 16277578 These conditions can lead to gum damage and tooth loss and are linked to worsening RA symptoms.³Rodríguez-Lozano B, González-Febles J, Garnier-Rodríguez JL, Dadlani S, Bustabad-Reyes S, Sanz M, Sánchez-Alonso F, Sánchez-Piedra C, González-Dávila E, Díaz-González F. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study. Arthritis Res Ther. 2019 Jan 18;21(1):27. doi: 10.1186/s13075-019-1808-z. PMID: 30658685 Bad oral hygiene has also been linked to a higher risk of getting RA.⁴Gomez-Bañuelos E, Johansson L, Konig MF, Lundquist A, Paz M, Buhlin K, Johansson A, Rantapää-Dahlqvist S, Andrade F. Exposure to Aggregatibacter actinomycetemcomitans before Symptom Onset and the Risk of Evolving to Rheumatoid Arthritis. J Clin Med. 2020 Jun 18;9(6):1906. doi: 10.3390/jcm9061906. PMID: 32570853^,5Gómez-Bañuelos E, Mukherjee A, Darrah E, Andrade F. Rheumatoid Arthritis-Associated Mechanisms of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. J Clin Med. 2019;8(9):1309. Published 2019 Aug 26. doi:10.3390/jcm8091309. PMID: 31454946^,6Konig MF, Abusleme L, Reinholdt J, Palmer RJ, Teles RP, Sampson K, Rosen A, Nigrovic PA, Sokolove J, Giles JT, Moutsopoulos NM, Andrade F. Aggregatibacter actinomycetemcomitans-induced hypercitrullination links periodontal infection to autoimmunity in rheumatoid arthritis. Sci Transl Med. 2016 Dec 14;8(369):369ra176. doi: 10.1126/scitranslmed.aaj1921. PMID: 27974664

Research suggests that taking care of your teeth and gums can improve oral health and may help ease rheumatoid arthritis symptoms, such as joint tenderness and swelling.⁷Sun J, Zheng Y, Bian X, Ge H, Wang J, Zhang Z. Non-surgical periodontal treatment improves rheumatoid arthritis disease activity: a meta-analysis. Clin Oral Investig. 2021 Jan 29. doi: 10.1007/s00784-021-03807-w. Epub ahead of print. PMID: 33515120^,9Ortiz P, Bissada NF, Palomo L, et al. Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors. J Periodontol. 2009;80(4):535-540. doi:10.1902/jop.2009.080447 PMID: 19335072

See Rheumatoid Arthritis (RA) Symptoms

10 tips for healthy teeth and gums with RA

Stay on top of your oral health and prevent gum disease with the 10 tips described below. While these tips can be used by everyone, many are specific to people who have RA, such as advice on brushing when you have hand joint pain.

1. Look for puffy, bleeding gums

If you notice your gums bleed or are puffy and red, make an appointment with your dentist. Bleeding, puffy gums are not normal and may be a sign of gingivitis, which is reversible with treatment.

If the gum inflammation from gingivitis is not treated, it may lead to gum disease, a more serious condition associated with permanent gum damage and tooth loss.

2. Get a wide handled toothbrush

If you have difficulty gripping and brushing with a toothbrush, look for one with a large handle that’s designed for people with hand arthritis. If you want to avoid the extra cost, wrap your toothbrush handle in duct tape or a washcloth secured with rubber bands.

3. Go electric

Try an electric toothbrush. Electric toothbrushes typically have thicker handles that are easier to grip. They also require less motion while brushing, taking pressure off the hand, wrist, and elbow joints.

4. Ditch traditional flossing

Daily flossing is important to oral health, but it typically requires using both hands. If flossing with both hands is difficult, try using floss holders or floss picks, which require just one hand to use. Another option is to use a water flosser.

5. Don’t squeeze the toothpaste tube

Squeezing a tube of toothpaste can be tricky if your hand joints are swollen and painful. Instead, use toothpaste that comes in a pump. Alternatively, place the toothpaste tube on a counter and press it with your palm to get the toothpaste out.

6. Avoid foods that promote plaque and tooth decay

Whether you have RA or not, eating candy, starchy foods like chips and bread, and drinking sugary drinks increase the likelihood of gum inflammation and disease.

7. Avoid tobacco products

Cigarettes, vaping cartridges,¹⁰Atuegwu NC, Perez MF, Oncken C, Thacker S, Mead EL, Mortensen EM. Association between Regular Electronic Nicotine Product Use and Self-reported Periodontal Disease Status: Population Assessment of Tobacco and Health Survey. Int J Environ Res Public Health. 2019;16(7):1263. Published 2019 Apr 9. doi:10.3390/ijerph16071263. PMID: 30970567 and other tobacco products are full of chemicals that attack gums and teeth and increase the risk for gum disease.

8. Find an experienced dentist

Look for a dentist who is experienced in treating people with rheumatoid arthritis or other inflammatory conditions and knows about signs to watch out for. Make sure they know about your specific health concerns and medications.

9. Go to the dentist every 6 months (minimum)

See your dentist for cleanings and check-ups at least every 6 months. If you have signs of problems, your dentist may suggest more frequent visits. For example, if you have a lot of plaque build-up, you may be advised to schedule extra teeth cleanings in between dental check-ups.

10. Don’t forget the basics

Brush and floss your teeth at least twice a day or—ideally—after every meal.

We’re still learning about the connection between rheumatoid arthritis and gum health. While researchers know that both are influenced by factors such as genetics and the digestive tract’s microbiome,¹¹Hajishengallis G, Chavakis T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities [published online ahead of print, 2021 Jan 28]. Nat Rev Immunol. 2021;1-15. doi:10.1038/s41577-020-00488-6^,12Iljazovic A, Amend L, Galvez EJC, de Oliveira R, Strowig T. Modulation of inflammatory responses by gastrointestinal Prevotella spp. - From associations to functional studies. Int J Med Microbiol. 2021 Feb;311(2):151472. doi: 10.1016/j.ijmm.2021.151472. Epub 2021 Jan 8. PMID: 33461110 many facts are still unknown.

If you have RA, it may take extra care and diligence to maintain healthy gums and teeth. If you follow the tips above and notice you still have bleeding gums, check with your physician. They can rule out other problems, such as a vitamin deficiency and diabetes.

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