I always say your mouth is connected to your body, so if you take care of your mouth then your body will thank you for it. Various diseases have been shown to be linked directly to untreated gum disease (periodontitis) such as hypertension (high blood pressure), atherosclerosis and diabetes type 2 (Non-Insulin Dependent Diabetes Mellitus). Could Rheumatoid Arthritis be one of them?
Studies show that those who have been diagnosed with moderate to severe periodontitis have twice the risk of rheumatoid arthritis than those who were diagnosed with mild or no periodontitis. These studies grew from the observation that those who had RA had more incidences of periodontitis than those people who did not have RA; and those who had periodontitis had a higher incidence of RA as well. A link between these two inflammatory diseases was found, thus leading to further studies.
Doctors initially thought that incidence of periodontitis was due to the symptoms of RA itself – stiff joints leading to decreased mobility and an inability to properly complete oral hygiene at home. Or perhaps that it was due to the RA medications that people were taking since it decreases the immune system’s ability to fight the bacteria that cause periodontitis. And those with Sjögren’s Syndrome as well (another auto-immune disease) have a severely decreased rate of protective salivary production thereby leaving the oral cavity vulnerable to disease. While a study showed that those who had RA vs. a healthy control group were 8 times more likely to have periodontitis, the researchers found that poor oral hygiene alone could not explain the discrepancy.
Studies also show that the mechanism of inflammation in periodontitis is similar to that of RA. In gum disease the bacteria cause inflammation which attacks the periodontal ligaments that attach the tooth to the jawbone, and then it attacks the bone itself leading to eventual bone loss. You can lose your teeth due to bone destruction from untreated periodontitis. Similarly, inflammation in rheumatoid arthritis attacks the synovium, which is the soft tissue that lines the joints, and eventually attacks the bone as well leading to bone loss.
More recently, studies have shown a genetic link between periodontitis and RA. A study in Israel found HLA-DR4 – a genetic type that occurs with high frequency in people who have rheumatoid arthritis – in 80% of patients with rapidly progressive periodontitis, compared to just over a third of a healthy control group. This only increases the belief that there may in fact be a relationship between the two driven by an underlying disease process.
So is rheumatoid arthritis linked to periodontitis? It would seem so based on the literature. So if you have RA or early signs of arthritis, be sure to visit your dentist to ensure that your gums are treated. Remember a healthy smile is always in style!
Dr. Melisande J. Wolff, DMD