Rheumatoid Arthritis and Gum Disease: What You Need to Know
Why do rheumatoid arthritis and gum disease often go hand in hand? Learn about the significance of the connection and what you can do to protect your overall health.
By Cathy Garrard
Medically Reviewed by Alexa Meara, MD
Good oral hygiene is especially important for those living with rheumatoid arthritis.
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When you’re living with rheumatoid arthritis (RA), brushing, flossing, and seeing your dentist regularly are especially important. Studies show a strong connection between RA and gum disease, an inflammatory condition that can lead to tooth loss and other health complications, such as heart disease.
At this point, experts aren’t sure which health issue is the chicken and which is the egg. A German study published in June 2008 in the Journal of Periodontology showed that people with RA had eight times the odds of developing gum disease as compared with people without RA. A study out of the University of Louisville in Kentucky published in September 2013 in the journal PLoS Pathogens found that the bacterium that causes periodontal disease, Porphyromonas gingivalis, increases the severity of rheumatoid arthritis, leads to an earlier onset of the disease, and causes symptoms to progress more quickly. And a Swedish study published in March 2016 in the journal Arthritis & Rheumatology suggests that P. gingivalis may be a possible trigger for autoimmune disease in a subset of RA patients. “The connection is confusing,” says Terrance Griffin, DMD, chair of the department of periodontology at the Tufts University School of Dental Medicine in Boston. “There are so many factors that can come into play, like oral hygiene. RA can cause you to lose some dexterity, which may mean you can’t clean your teeth as well. But that may only partially account for this relationship.”
Gum Disease and Rheumatoid Arthritis: The Inflammation Link
Doctors may not know for sure how gum disease and RA are linked, but both diseases have inflammation in common, which may explain the connection. Inflammation is a protective immune system response to foreign bodies like viruses and bacteria. But with autoimmune diseases like rheumatoid arthritis, the immune system mistakenly triggers inflammation even though there are no viruses or bacteria to fight off, says Scott Zashin, MD, clinical associate professor of medicine at the University of Texas Southwestern Medical School and attending physician at Texas Health Presbyterian Hospital in Dallas. Dr. Zashin says it’s possible that the immune system is stimulated by mouth inflammation and infection, “setting off a cascade of events where inflammation develops at the site of joints or arthritis.” He says controlling the inflammation through better dental care could play a role in reducing the incidence and severity of RA.
Treating One Condition May Improve the Other
Researchers at Case Western University found that when people with a severe form of rheumatoid arthritis successfully treated their gum disease, their pain and other arthritis symptoms got better. Patients who were treated with drugs for both gum disease and rheumatoid arthritis fared better than those who received RA medication alone. “People who have both gum disease and RA should have an informed care team comprised of both a physician and a periodontist,” says Dr. Griffin. “Brushing and flossing can be challenging for those with RA, and you should work with your doctors to find out what works best for you. And if you don’t have a periodontist, get an evaluation from your dentist every year to monitor the status of your gums, since you are more likely to get it.”
Dental Care for People With Rheumatoid Arthritis
Gum disease ranges from gingivitis, a mild form that causes swollen, tender gums, to more serious forms like periodontitis, in which inflammation affects the tissue and bone supporting the teeth. Some people with RA also develop Sjögren’s syndrome or sicca syndrome, an autoimmune disease of the glands, which causes dry mouth and increased tooth decay. If you have gingivitis, it can be reversed with twice-yearly dental cleanings and good at-home care.
Here are some other tips from the American Dental Association to make dental care easier to manage:
• Reinvent your toothbrush. To better handle your brush, add a tennis ball or bicycle grip to the end.
• Experiment with new types of floss. Try floss holders, floss picks, or threaders.
• “Pump up” your paste. Toothpaste in a pump might be easier for you to use than a tube you have to squeeze.
• Don’t light up. Smoking is a big risk factor in developing gum disease, and it can interfere with the success of some treatments.
Additional reporting by Regina Boyle Wheeler
Last Updated:10/18/2
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