Do Patients With Rheumatoid Arthritis Have More Dental Problems Than The Average Person?

Surveys of large groups of people show that individuals with RA have twice the rate of periodontal disease as people of the same age, sex, and socioeconomic status who do not have RA. Periodontal disease affects the tissues that surround and support the teeth. These tissues include the gums (gingiva), the bones that form the tooth sockets, and the periodontal ligament (a thin layer of connective tissue that holds the tooth in its socket, and acts as a cushion between tooth and bone).

In studies, researchers have discovered that patients with RA tend to have more severe periodontal disease than those without RA. Of the patients with both RA and periodontal disease, 62.5% of them suffered from advanced disease and more than half had severe bone loss in the jaw. In addition, the patients with RA averaged 11.6 missing teeth compared with 6.7 missing teeth in the control group in one Australian study.

Both RA and periodontal disease are inflammatory diseases that lead to bone destruction. When researchers examined patients who had both RA and periodontal disease, they found that the rates of other inflammatory diseases, such as cardiovascular disease and diabetes mellitus, were higher in this group than in age-matched people without RA. They also noted a relationship between the severity of the periodontal disease and the risk of having RA: Patients with more advanced periodontal disease were at higher risk of having RA.

One theory suggests that the inflammation and infection associated with periodontal disease help to trigger RA. This relationship suggests that periodontal disease may be the result of the same inflammatory process that affects the joints of patients with RA. Other researchers have suggested that the effects of RA, such as swollen and painful fingers, loss of motion, fatigue, and decreased saliva production, result in poor oral hygiene that causes periodontal disease. Dentists cannot be sure which problem came first, but they do emphasize that good oral hygiene can decrease plaque and gingivitis. They encourage patients with RA to brush with an electric toothbrush, floss daily, and visit their dentist regularly for plaque removal and repair of dental caries (cavities) if present.