June 10, 2008 Over 1.3 million Americans suffer from rheumatoid arthritis (RA), a chronic, inflammatory disease of the joints. RA is a disabling condition, and can lead to long-term joint damage resulting in persistent pain and loss of function in affected areas. A recent study published in the June issue of the Journal of Periodontology, the official publication of the American Academy of Periodontology (AAP), uncovered yet another potential side effect of RA. Researchers in Berlin, Germany discovered that patients with RA have a higher incidence of periodontal disease compared to healthy controls.
For some patients, adverse RA symptoms may affect manual dexterity, which can make one’s daily routine quite difficult. One area that may be affected is oral hygiene which can ultimately lead to periodontal disease. However, these research findings indicate that poor oral hygiene alone did not account for the association between RA and gum disease, suggesting that other factors may play a role as well.
The study examined the oral health of 57 RA patients and 52 healthy controls. To determine oral hygiene status, each participant underwent a comprehensive oral examination including an assessment of plaque accumulation and gingival inflammation, both indicators of oral hygiene. Probing pocket depth and clinical attachment loss, two markers of periodontal disease, were also measured. Researchers used questionnaires to gauge the subjects’ risk factors for periodontal disease.
The study findings indicated that RA patients were nearly eight times more likely to have periodontal disease compared to the control subjects. These findings accounted for demographic and lifestyle characteristics such as age, gender, education and tobacco use. Researchers then examined the extent to which poor oral hygiene was connected to the increased occurrence of gum disease in RA patients. The results showed that while oral hygiene was markedly a factor, it did not fully explain the association between the two diseases, suggesting that there may be other parameters responsible for the increased prevalence of gum disease in RA sufferers.
“With results suggesting that rheumatoid arthritis is associated with periodontal disease, it is easy to assume that an RA sufferer is perhaps unable to properly care for his or her teeth and gums due to the debilitating nature of the disease,” says Dr. Kenneth Kornman, editor of the Journal of the Periodontology. “However, this study implies that there are other potential factors involved. For instance, both RA and gum disease are systemic inflammatory disorders which may explain the connection between the two. Inflammation is already thought to link periodontal disease with other conditions such as cardiovascular disease and diabetes. We look forward to future research that may reveal the biological mechanisms that link these two important diseases.”
In an effort to best maintain oral health, RA patients are encouraged to brush and floss on a regular basis and see a dental professional twice a year. If gum disease develops, consulting a periodontist is an effective way to determine the most appropriate course of treatment.
According to Dr. Susan Karabin, President of the AAP, maintaining the complete health of RA patients should be a collaborative effort. “It is critical that dental professionals and medical professionals work together when treating a patient living with rheumatoid arthritis. This partnership will assure that both the oral and overall health of these patients is paramount.”
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- Pischon et al. Association Among Rheumatoid Arthritis, Oral Hygiene, and Periodontitis. Journal of Periodontology, 2008; 79 (6): 979 DOI: 10.1902/jop.2008.070501
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