Unique to You

About arthritis

Arthritis is a progressive disease of the joints caused by the breakdown of cartilage and surrounding tissue. As the condition progresses, inflammation results, causing redness, swelling, stiffness, and pain.

There are more than 100 types of arthritis, but the most common are osteoarthritis (OA) and rheumatoid arthritis (RA).¹ Osteoarthritis is a gradual breakdown of joint cartilage from normal wear and tear. Rheumatoid arthritis is an autoimmune disease that triggers inflammation and attacks cartilage and the lining of your joints.

Nearly one in four adults in the United States have been diagnosed with some type of arthritis.² In addition, 300,000 children and teenagers have been diagnosed with pediatric or juvenile arthritis.³

Arthritis has been associated with other health conditions such as obesity, heart disease, anxiety and depression, diabetes, and chronic respiratory disease.⁴

Arthritis and your oral health

The pain and discomfort that many people with arthritis endure can present challenges to good oral hygiene. These challenges are real for people with any type of arthritis. But, the connection between arthritis and oral health doesn't stop there.

Arthritis and oral disease both cause inflammation, so it shouldn't be a surprise that when both conditions are present, they can cause additional challenges. There is still much to learn about how oral disease and arthritis interact, but there is growing evidence that it is a complex and problematic interrelationship whereby each condition worsens the effects of the other. Much of the available research focuses specifically on rheumatoid arthritis and its interaction with oral health. The learnings may or may not apply to other forms of arthritis.

There is evidence that oral disease – specifically periodontal disease – may contribute to rheumatoid arthritis (RA), speed its progression, and undermine its treatment.⁵ For example:

• A high percentage of people with rheumatoid arthritis have also been diagnosed with moderate to severe periodontal disease. Studies have found that periodontal disease is often severe in people at the early stages of RA. While this doesn't necessarily mean that periodontal disease causes RA, it suggests that periodontal disease may be a risk factor for RA.
• Periodontal bacteria may negatively impact your immune response and worsen arthritis symptoms. Specific types of oral bacteria have been found in the joints of people needing hip or knee replacement due to arthritis.⁶

On the flip side, rheumatoid arthritis and its treatment put you at higher risk for a variety of oral health conditions. For example:

• Periodontal disease: Some studies suggest that periodontal disease may worsen as RA worsens. Other studies suggest that periodontal treatment may contribute to improvements in RA markers.⁵ This is likely due to the reduction of inflammation observed when periodontal bacteria are kept under control.
• Oral infections: A weakened immune system and inflammation may lead to bacterial or fungal infections that can cause swelling around your teeth or jaws, severe pain, fever, and swollen lymph nodes. Thrush, a fungal infection, causes a white coating to develop on your tongue or the inside of your cheeks.
• Mouth sores (ulcers): Unusual lesions, bumps, and cuts can be side effects of medications used to alleviate symptoms of arthritis.
• Dry mouth: This can be an effect of RA itself or the treatment for the disease. It's worth noting that dry mouth (xerostomia) occurs more frequently as people age. Drinking water, chewing gum, or using medications that stimulate saliva flow may help relieve the effects of dry mouth.
• Temporomandibular joint disorders (TMD): RA can cause or worsen inflammation and damage the jaw joints. This can lead to jaw, neck, and sinus pain and persistent headaches. It can also cause problems with chewing, biting, and speech.
• Sjögren's syndrome: Sjögren's syndrome is an often undiagnosed autoimmune disease that accompanies other autoimmune disorders such as RA. It affects about 4 million people in the US, with the vast majority being women. The condition causes the body to fight the normal cells that produce moisture. This results in the oral symptoms of dry mouth, tooth decay, difficulty swallowing, and changes in taste.⁴ It can also cause dry eyes.

Arthritis and related conditions such as those listed above often go undiagnosed. This delays treatment, causes further damage, and impacts your quality of life. People with autoimmune and inflammatory diseases often develop oral symptoms early on, so your dentist may be the first to see signs and refer you to a physician for further investigation. This is yet another reason why regular dental visits are so important.

Inform your dentist: Be open and honest with your dentist about any medical or dental conditions or concerns you have. In many cases, your dentist may be the first health care provider to suspect oral issues may be due to an underlying cause or vice-versa.

• Inform your dentist or hygienist that you have been diagnosed with RA, or have a family history of RA, when they conduct a health history and current health status. If you have begun any treatment, be sure to mention this as well.
• Mention all medications you are taking, including supplements or natural remedies.
• Let your dentist know if you've noticed any issues such as dry mouth, swollen or bleeding gums, mouth sores, or white or red rashes in your mouth.
• If you have pain in your jaw joints, tell your dentist before treatment begins. There are specific types of X-ray images that can help your dentist get a better picture of these joints to see if there is inflammation or other problems.
• Be sure to provide your dentist and physician with each other's contact information. This is important if they need to discuss your disease, oral health status, or medications.

Make oral health a priority:

• Be proactive about your oral health throughout your life. Don't wait until conditions arise before taking action.
• If arthritis is affecting your ability to grasp a toothbrush or dental floss, ask your dental professional whether the use of a mechanical toothbrush and floss holder could improve the effectiveness of your oral hygiene.
• To prevent and treat tooth decay, gingivitis, and periodontal disease, visit your dentist regularly for exams and professional teeth cleanings on the schedule your dentist recommends. As your RA progresses, your dentist may suggest more frequent visits.
• You and your dentist should let your physician know about any treatment your dentist recommends. Ask if any of the medications you are taking have side effects, such as dry mouth.
• Make sure you are brushing at least twice a day with a soft-bristled brush and fluoride toothpaste. If you have symptoms of dry mouth, specially formulated toothpaste or gel are available to help reduce these symptoms. If your gums bleed, don't stop brushing your teeth. Bleeding gums may be a sign of inflammation or plaque build-up below your gum line, which requires more attention, not less.
• Flossing at least once a day helps remove plaque from between teeth where brushes do not reach.
• Don't smoke. Tobacco use is a shared risk for rheumatoid arthritis and periodontal disease.⁵

Coping with arthritis pain: The pain and stiffness of arthritis can cause difficulty with your oral care at home and at the dentist. Don't let your arthritis interfere with your regular oral hygiene routine or keep you from going to the dentist. Some tips to consider include:

At home

• Arthritis pain and stiffness can make brushing and flossing more difficult. Electric toothbrushes have larger handles which can aid in gripping and require less precise motor skills to use. Enlarging a standard toothbrush's handle with a bike handlebar grip or tennis ball can also help.
• Floss holders are easier to grasp than string floss.
• Toothpaste that comes in a pump may be easier to use than toothpaste in a tube.
• Hot and cold compresses can help reduce inflammation and pain.
• Using an occlusal guard or a repositioning appliance as recommended can help reduce symptoms of TMD.

At the dentist

• Arthritis pain, especially in your back or hips, can make it uncomfortable to lie in a dental chair. Ask your dentist or hygienist if they can allow you to adjust your position as needed or stand for a short period. Supporting your neck (e.g. with a rolled towel) during dental procedures can be very helpful.
• Be sure to tell your dentist or hygienist if it is uncomfortable for you to keep your mouth open for long periods of time. They can adjust their treatment strategy to make you most comfortable. This can include the use of a bite prop, which can assist in holding your mouth open while the dentist and hygienist work.⁷

Medications:

• Aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) are often used for arthritis pain management. Prolonged use or not strictly following instructions can increase the risk of bleeding during invasive dental procedures such as scaling and root planing, extractions, or oral surgery.⁷
• Immunosuppressant drugs, like methotrexate, may be used to treat RA. These drugs can cause mouth sores which can be uncomfortable.⁸ It may be helpful to use mouthwash with a numbing medication if the ulcers are very painful. Your dentist may also recommend a folic acid supplement to help reduce the ulcers.⁹