Several years ago after an 8 year hiatus, I finally made a visit to my dentist. The hygienist and dentist noted that my gums were red and tender – I had periodontal disease. They used a probe to measure the depth of the pockets between the gums and teeth. There were quite a few pockets that were deeper than desired and it was recommended that I get a “deep cleaning” and then move to a cleaning every 3 months. The deep cleaning required lidocaine shots to numb the nerves since the cleaning tools would probe deep. Realizing that there must be inflammation involved, I started speculating about a possible connection with RA.
Like RA, periodontal disease is an inflammatory condition that can include gum inflammation and eventually damage to tissue and tooth loss. The National Institute of Dental and Cranofacial Research indicate that it is thought to be caused by opportunistic bacterial infections in the mouth. A recent review of studies by researchers in Australia found relationships between periodontal disease and inflammatory blood markers like ESR, C-reactive protein, and interleukin 1 which are all implicated in RA. Associations between periodontal disease and joint destruction from RA have been found (see this study). Some researchers noted connections between the biochemical processes of RA and periodontal disease. A study published in the Annuals of the Rheumatic Diseases in Europe showed that a common blood marker for RA, anti-citrullinated antibodies (anti-CCP), is related to periodontal disease. Other researchers demonstrated that the bacteria Porphyromonas gingivalis, which is one of the pathogens involved in periodontal disease, is linked to anti-CCP antibodies. Another group of researchers indicated that people with RA have a significantly higher rate of periodontal disease than control populations. While there are statistical correlations between RA and periodontal disease, it is not proven that periodontal infections are a cause of RA. The link between the two continues to be explored by dental and rheumatology researchers.
Based on these findings, it is important for RA patients take good care of their mouth in order to avoid diseased gums and teeth. If RA-caused joint damage in the fingers and wrist make it difficult to brush and floss, it may be necessary to use some adaptive tools like an electric toothbrush, a floss holder, and water jet systems. I use an elective toothbrush and let the motor do the hard work. I’ve now gotten the periodontal disease under control and my dentist is letting me go back to 6 month cleanings.
Creative Commons photo credit: http://www.flickr.com/photos/ephotion/39301156/