This month, we’re kicking off a new blog series at Laurel Dental! Every other month through 2019, we will highlight a different autoimmune disease and explore how it impacts oral health—and how oral health affects it in return. Autoimmune diseases affect many body systems, but they all share one trait: the body attacks its own cells, causing painful and sometimes debilitating symptoms.
This month, we’re kicking off a new blog series at Laurel Dental! Every other month through 2019, we will highlight a different autoimmune disease and explore how it impacts oral health—and how oral health affects it in return. Autoimmune diseases affect many body systems, but they all share one trait: the body attacks its own cells, causing painful and sometimes debilitating symptoms.
Who Is Affected by Autoimmune Diseases?
More than 23.5 million people in the United States suffer from at least one autoimmune disease. These diseases occur more often in women than men, possibly due to hormonal changes. This month, we’re starting by examining how Rheumatoid Arthritis (RA) affects oral health.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis happens when your immune system attacks the synovium—the lining of membranes around your joints. This inflammation thickens the synovium and can destroy cartilage and bone inside the joint. Tendons and ligaments weaken and stretch, causing the joint to lose its shape and alignment over time. RA can begin at any age but usually starts in middle age. Women under 55 who are overweight or obese have a higher risk of developing RA.
Possible Links Between RA and Periodontal Disease
Experts suggest several reasons why many RA patients also suffer from periodontal disease. RA causes severe pain and stiffness in joints, making brushing and flossing difficult, especially if it affects the TMJ and limits mouth opening. Poor home care increases the risk of periodontal disease.
A 2008 German study found that RA patients were eight times more likely to develop periodontal disease. Poor oral hygiene alone did not explain this large increase, so researchers looked deeper. They found similar inflammation and proteins, like Tumor Necrosis Factor (TNF), Interleukin-1, and Interleukin-6, in both RA and periodontal disease.
Other studies from Israel highlight that genetics may raise the risk of RA. Smoking also increases this risk and worsens disease severity, especially in genetically predisposed people.
The Role of Citrullination and Oral Bacteria
One early marker of RA is an increase in antibodies to citrullinated peptides. Citrullination changes cell structures, making the body see them as foreign. The immune system then produces anti-cyclic citrullinated (anti-CCP) antibodies, which attack these cells. Some bacteria linked to periodontal disease trigger citrullination. A 2009 study suggested this oral bacteria could cause RA or trigger its disease process.
Diagnosing Rheumatoid Arthritis
First, get a diagnosis from your doctor to create a suitable treatment plan. Early diagnosis can be challenging because no single blood test or physical sign confirms RA. During a physical exam, doctors check joints for swelling, redness, and warmth, along with reflexes and muscle strength.
Doctors often order blood tests to measure erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), which indicate inflammation. Tests also look for rheumatoid factor and anti-CCP antibodies. X-rays, MRIs, and ultrasounds track joint damage and disease severity.
Treatment Options for RA
Currently, no cure exists for RA. However, starting treatment early with disease-modifying antirheumatic drugs (DMARDs) increases the chance of symptom remission.
Managing Both RA and Periodontal Disease
It’s clear that rheumatoid arthritis and periodontal disease are linked. Managing both conditions improves overall health. If you have uncontrolled periodontal disease, scaling and root planing can help control it, along with frequent dental visits.
Work closely with your physician to control RA. If stiff or painful joints make home care difficult, ask your hygienist about tools like electric toothbrushes or water flossers.
Our Commitment to Your Health
At Laurel Dental, we collaborate with your doctors to care for your whole health. If you have RA, maintain good home care and see your hygienist regularly. We look forward to sharing more about autoimmune diseases in upcoming posts.
These diseases often get less attention than smoking or diabetes when discussing periodontal disease. We hope ongoing research will clarify their causes. If you know someone with RA, please share this information with them!
References:
Arthritis Foundation – https://www.arthritis.org/living-with-arthritis/comorbidities/gum-disease/ra-and-gum-disease.php
Johns Hopkins Arthritis Center – https://www.hopkinsarthritis.org/arthritis-news/5-dental-tips-for-the-ra-patient/
Colgate – https://www.colgate.com/en-us/oral-health/conditions/immune-disorders/ada-06-rheumatoid-arthritis-and-gum-disease-risk
National Library of Medicine, National Institutes of Health – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495574/
