Q. Periodontal Disease - Are Rheumatoid Arthritis Patients More Prone to It?

Researchers have studied the co-existence of periodontal disease and rheumatoid arthritis. What is periodontal disease? What are the risk factors for developing periodontal disease? Are there warnings signs for periodontal disease? How is rheumatoid arthritis tied to periodontal disease?

What Is Periodontal Disease?

Periodontal disease essentially is an infection of tissues that support the teeth. Between the tooth and gums, there is a v-shaped crevice called a sulcus. Periodontal disease attacks just below the gum line in the sulcus and can cause the attachment of the tooth and supporting tissues to break down. As tissues become more damaged, the sulcus develops into a pocket. With severe periodontal disease, the pocket can be quite deep.

Gingivitis and periodontitis are two stages of periodontal disease. Gingivitis is considered the less severe form of periodontal disease -- it only affects the gums and is reversible. Periodontitis is considered more destructive and more severe than gingivitis. Untreated gingivitis can lead to periodontitis.

What Are the Risk Factors for Periodontal Disease?

According to the American Dental Association, there are certain factors that increase the risk of developing periodontal disease. Having a systemic disease is one of those risk factors. Rheumatoid arthritis is a systemic disease -- meaning, it can affect the organs of the body.

Risk factors for periodontal disease include:

• smoking or chewing tobacco
• having a systemic disease
• taking certain types of medication, including steroids
• having a bridge with an improper fit
• crooked teeth
• fillings that have become loose or defective
• using oral contraceptives
• pregnancy

What Are the Warning Signs for Periodontal Disease?

It is possible to have no warning that you are developing periodontal disease. That is why regular dental check-ups are important. If you only go to the dentist when you have a toothache, you may be missing the signs of early periodontal disease that your dentist would be able to observe.

Warning signs of periodontal disease include:

• gums that bleed easily (for example, when brushing teeth)
• red, tender, or swollen gums
• gums that have receded or pulled away from teeth
• a persistent problem with bad breath or taste that seems off
• loose teeth
• change in your bite
• change in the fit of partial dentures

How Is Rheumatoid Arthritis Tied to Periodontal Disease?

In June 2001, the Journal of Periodontology reported on an Australian study involving 130 people. Of those study participants, 65 had rheumatoid arthritis. Those with rheumatoid arthritis were twice as likely to have periodontal disease with moderate to severe jawbone loss than those without rheumatoid arthritis. The rheumatoid group had 11.6 missing teeth on average compared to 6.7 missing teeth in the non-rheumatoid group.

Some scientists suggest that the immune system and chronic inflammation play a role in both rheumatoid arthritis and periodontal disease. Other scientists questioned whether the impact rheumatoid arthritis has on mobility, range of motion, and manual dexterity make it difficult to brush and floss properly and therefore contribute to poor oral hygiene. The study showed however that there was no difference in plaque deposits on the teeth of rheumatoid or non-rheumatoid study participants.

Another study conducted at The University of Sao Paulo, the largest institution of higher education and research in Brazil, investigated periodontal disease in 39 rheumatoid arthritis patients and 22 healthy individuals. They found that rheumatoid arthritis patients had fewer teeth, a higher prevalence of sites with dental plaque, more teeth with advanced attachment loss. There was no difference in bleeding from gingivitis in the two groups of the Brazilian study.

Studies that have compared periodontal disease in healthy persons to juvenile arthritis patients (rheumatoid arthritis in patients 16 years old and younger) found that juvenile arthritis patients had more periodontal attachment loss even though they had similar levels of plaque and bleeding. This shows that the association between periodontal disease and rheumatoid arthritis exists in young patients as well.

Interestingly, yet another study revealed that patients with worse bone loss related to periodontal disease also had more disease activity from rheumatoid arthritis in terms of swollen joints, health assessment questionnaire scores, CRP levels, and sedimentation rates. CRP and sedimentation rates are indicators of inflammation. The correlation between rheumatoid arthritis and periodontal disease may have to do with an abnormal, underlying problem with unregulated inflammation.

_{Sources:
Relationship between rheumatoid arthritis and periodontitis. Mercado FB et al. Journal of Periodontology. June 2001.
http://www.joponline.org/doi/abs/10.1902/jop.2001.72.6.779
Periodontal (Gum) Diseases. American Dental Association. Accessed 4/27/2008.
http://www.ada.org/public/topics/periodontal_diseases.asp
Periodontal conditions in patients with juvenile idiopathic arthritis. Miranda LA et al. Journal of Clinical Periodontology. November 2003.
http://www.blackwell-synergy.com/doi/abs/10.1034/j.1600-051X.2003.00406.x
Periodontal condition in patients with rheumatoid arthritis. Ishi E et al. Brazilian Oral Research. January - March 2008.
http://www.scielo.br/scielo.php?script=sci_abstract&pid=S1806-83242008000100013&lng=en&nrm=iso&tlng=en}