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Arthritis and periodontal disease are generally not thought of as occurring together. We generally think of these inflammatory diseases individually, without much thought as to how they are affected by other diseases or how they may exacerbate disease in the body.

Rheumatoid arthritis is an autoimmune inflammatory disease in which our own cells attack the joints. The disease causes inflammation, pain and stiffness. This can progress to severe bone damage, causing  a disability of the affected joints.

Periodontal disease is a chronic inflammatory disease caused by bacteria that trigger an inflammation of the gums. Further breakdown is caused by our own cells in defense against the periodontal bacteria..

In separate studies, researchers have found a two-way relationship between these two conditions where rheumatoid arthritis patients face higher risks of developing gum disease and periodontal disease patients have increased risk of rheumatoid arthritis.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a disease that leads to inflammation of the joints and surrounding tissues. It can also affect other organs.  The cause of Rheumatoid Arthritis is not known. It is classified as an autoimmune disease, which means the body’s immune system mistakenly attacks healthy tissue. It can occur at any age, but is more common in middle age. Women get rheumatoid arthritis more often than men.

The symptoms can include:

-Morning stiffness, lasting longer than 1 hour, is common. Joints may feel warm, tender, and stiff when not used for an hour or so.

-Joint pain is usually felt on the same joint on both sides of the body.

-Over time, joints may lose their range of motion and may become deformed.

Other symptoms include:

-Chest pain when taking a breath (pleurisy).

-Dry eyes and mouth (Sjogren syndrome).

-Eye burning, itchy eyes, and discharge from eyes.

-Nodules under the skin (usually a sign of more severe disease process).

-Numbness, tingling, or burning in the hands and feet.

-Difficulty sleeping.

Periodontal Disease and Arthritis Link

There is a high incidence of periodontal disease in patients with rheumatoid arthritis. The link between the two can include:

-Periodontal disease and rheumatoid arthritis both occur as a result of  chronic inflammatory responses by the body. This leads to destruction of supporting tissues and bone.

-They have similar characteristics, risk factors, and pathological processes. Smoking is a common risk factor between rheumatoid arthritis and periodontal disease. Smoking causes both conditions to worsen.

-When a patient has both rheumatoid arthritis and periodontal disease, they have more anti-citrullinated protein antibodies (ACPA), which cause even more inflammation in the gums and other parts of the body, making all inflammatory conditions worsen . ACPA increases rheumatoid arthritis disease activity and the level of inflammatory markers.

-research studies have found that patients with both periodontal disease and rheumatoid arhtritis  have  experienced decreased pain, swelling and stiffness after periodontal gum treatments.

-Periodontal disease is responsible for chronic inflammation in the mouth, which can trigger chronic inflammation in other parts of the body, including the joints.

How Does Periodontal Disease Trigger Rheumatoid Arthritis?

Periodontal disease can set off  rheumatoid arthritis in many ways:

-The bacteria causing periodontal disease enters the blood stream and settles in the synovial fluid that lubricates the joints triggering inflammation in the joints.

-research studies have established that periodontal disease may decrease the effectiveness of tumor necrosis factor inhibitor treatment for rheumatoid arthritis. This makes it harder to treat rheumatoid arthritis using this treatment in patients with periodontal disease.

-The inflammation caused by the periodontal disease causing bacteria can raise the level of cytokines, which promote the release of CRP from the liver and result in systematic inflammation in the whole body, causing inflammatory conditions such as rheumatoid arthritis.

-Treatment of periodontal disease decreases rheumatoid arthritis symptoms such as joint pain and inflammation.

Can Rheumatoid Arthritis Contribute to Periodontal Disease?

The following are a few ways that rheumatoid arthritis can add to periodontal disease:

-Generally, symptoms from periodontal disease are more severe in patients with rheumatoid arthritis. For example, they have deeper periodontal pockets between the teeth and gums, making it easier to develop infections.Rheumatoid arthritis sufferers are faced with an increased risk of developing periodontal disease and severe jawbone loss.

-While both conditions stem from a chronic inflammatory response and weakened immune system, rheumatoid arthritis damages hand dexterity function, making it hard for patients to take proper care of their teeth using regular dental hygiene techniques. This not only increases the chance of developing new gum problems, but also makes existing gum problems much worse.

-Rheumatoid arthritis increases the risk of developing periodontal problems since alveolar bone loss in arthritic patients is linked to decreasing periodontal health, which has a greater chance of progressing into periodontal disease.

-The bacteria that cause gum disease access the blood circulation. This makes it possible for antibiotics administered to treat arthritis to also kill gum disease bacteria. This way, treating arthritis leads to an improvement in periodontal disease and treating gum disease improves the symptoms of arthritis.

Conclusion

It is important to remember these two conditions do not always occur together. There are plenty of periodontal disease patients who don’t have arthritis and many patients with rheumatoid disease who have healthy gums. While it is not clear which conditions occur first, and there is no conclusive evidence that these two conditions have a connection, the awareness of the association between rheumatoid arthritis and periodontal disease makes it necessary for patients of rheumatoid arthritis to visit a dentist or periodontist for evaluations and treatment regularly. Patients of rheumatoid arthritis should also make a point of regularly practicing proper dental hygiene maintenance, including brushing and flossing.

Did you know that a redheads genetic makeup may lead to a need for increased local anesthetic and have higher dental anxiety? A recent study by the Journal of the American Dental Association (JADA) shows that people with a specific gene tend to experience increased dental anxiety during routine dental treatment. This gene occurs more often in redheads than the general population. A second study showed that redheads need 20% more anesthesia, and it wears off faster than in blondes or dark haired people. Perhaps, the need for increased anesthesia has caused many of these redheads to fear dental treatment?

The Dental Anxiety and Dental Pain Study

The dental anxiety study included 144 people (67 with red hair and 77 with dark hair) who answered various questions about dental fears and dental anxieties. Following survey questions, blood samples were taken to test for the presence of specific gene variations. People with one specific gene, melanocortin 1 receptor (MC1R), were more than twice as likely to report dental fear and dental anxiety than those without the gene. 85 patients had the gene in the study and 65 of them were redheads. This same gene is also thought to be responsible for increased sensitivity to thermal pain and increased resistance to the effects of local anesthesia.

The research teams believes variations of the MC1R gene play a role. This MC1R gene produces melanin, which gives skin, hair and eyes their distinctive color.

While blond, brown and black-haired people produce melanin, those with red hair have a mutation of this receptor. It produces a different coloring called pheomelanin, which results in freckles, fairer skin and red hair. Approximately 5% of whites are believed to have these characteristics.

While the relationship between MC1R and pain sensitivity is not known completely, researchers have discovered MC1R receptors in the brain and some of them are known to influence pain sensitivity. As stated above, non redheads can also carry the gene.

Tips to Deal With Dental Anxiety and Dental Pain

-Communication. Keeping open lines of communication is always important to ensure proper numbing is being obtained to make the patient comfortable. Discussing all aspects of dental anxiety ahead of time will ensure the best possible outcomes for the patient.

-Medication. Many patients do very well taking a pre visit valium to relax themselves and remove excess dental anxiety. It will also allow the anesthesia to work more effectively during the visit because you are so relaxed.

-Distraction. Use of an ipod, to listen to music during your dental visits places your mind in a relaxed state. It helps to drown out unwanted noise.

What Does It All Mean?

Many redheads will present with increased dental anxiety as well as be more resistant to local anesthesia. So, both dentist and patient need to be aware of these situations. A dentist armed with this knowledge will approach these patients differently and ask specific questions about past anesthesia issues, as well as past dental anxiety and experiences. You do not have to have red hair to experience dental anxiety or have difficulty getting numb. There are many ways to address both problems  and overcome them with proper techniques and good communication.

We all have heard the old saying, “We are what we eat”, but did you know it is just as important for your teeth as it is your body? Your choice of drink has a big impact on your waistline as well as your dental health. Most of the focus regarding the consumption of sugary soft drinks, sport drinks, and fruit juices surrounds obesity and diabetes. It is important to realize that these same drinks can contribute to tooth decay and possibly dental pain if untreated.

The average American consumes over 50 gallons of soda and other sweetened drinks each year. Statistics show that almost 20 percent of all children under the age of 19 have untreated cavities. The sweetened soft drinks and the like are wreaking havoc on our dental health. They work by constantly washing your mouth with sugar and acid allowing for the perfect acidic environment and constant supply of sugar for the bacteria in your mouth. These bacteria then produce more acids that lead to tooth decay by dissolving the enamel that protects our teeth. Sugar also dries your mouth out and makes you thirstier, causing you to drink much larger sized beverages to satisfy your thirst.

Worst Drinks for Your Dental Health

Soft Drinks

The most obvious of the bad drinks for you. This is probably not new information to anyone. Soft drinks are bad for you for two reasons. One is the sugar, but the other is the acidity. Carbonated drinks like Coke and Pepsi use phosphoric acid in their ingredients (Mountain Dew and Sprite use citric acid). The acid breaks down the enamel in our teeth. The enamel is the outer protective layer of our teeth and it also gives us an attractive, shiny smile.

Sports Drinks 

These drinks include Gatorade, flavored water, as well as others. These drinks are not acidic like soda but these come with a double does of sugar. Most of these drinks are great for their intended purpose…recovery from activity. These drinks are

Sports Drinks Marielaina Perrone DDS

Change Drinking Habits for Better Dental Health

generally not used for their intended purpose of severe re hydration, they are consumed as a regular beverage. Over time, when too often consumed, they can easily stain your teeth and cause tooth decay.

Fruit and Energy Drinks

Fruit drinks, and beverages like red bull, also pose a threat to your pearly whites. These drinks are also damaging to your teeth and need to be used in moderation as well. Fruit drinks like Hawaiian Punch and Sunny Delight are nearly as acidic as Coca-Cola. Combine the acid levels with the sugars already in the ingredients and you have a recipe for catastrophe.

How to Minimize the Damage from These Beverages

-Brushing. Tooth brushing after every meal is the best way to decrease the chance of developing tooth cavities.

-Rinsing. Swish your mouth out with water after drinking these beverages can help decrease the amount of acid contacting the teeth.

-Chew Gum. Chewing sugar-free gum or xylitol gum will also help minimize the damage caused by these drinks by increasing saliva production.

-Drink at Mealtime. Drink sugary and acidic beverages with meals, and never before bedtime unless you plan to brush your teeth before heading to bed.

-Use a straw. This also helps decrease contact of these sugars and acids with the teeth.

-Other drinks that contribute to tooth decay (sugary, acidic, or both): dairy milk, soy milk, energy drinks, protein shakes, wine, beer, tea, coffee, smoothies, all fruit juices, some bottled waters.

Conclusion

Yes, we are what we eat! Be smart about what you choose for yourself and for your family. Many health issues can be circumvented by choosing healthier options and using your educated judgement to make the best choices. Use sweet drinks in moderation, and take care of your dental hygiene in between drinks. As always visit your dentist regularly for dental examinations and professional cleanings for better dental health.

Root Canal Therapy (also called root canal treatment or endodontic treatment)  is a dental procedure in which the diseased or damaged nerve (pulp) of a tooth is removed and the inside areas (the nerve or pulp chamber and root canals) are cleaned, filled and sealed permanently to avoid infection. Without treatment, the surrounding tissues of the tooth (including the gums and bone) will become infected and a dental abscess can form.

A tooth’s nerve and blood vessel provide nutrients and hydration to a tooth as well as sense of temperature. It provides the sensation of hot or cold. The presence or absence of a nerve will affect the routine functioning of a tooth. Over time the tooth with the root canal dehydrates which makes the tooth brittle and more susceptible to fracture. Most often, a crown is placed after root canal treatment is completed to protect the tooth and restore full function.

Root canal therapy is considered by many to be the most feared dental procedure. Does that surprise you?  Surveys completed by the American Association of Endodontists reveals that most people with a fear of the dentist are based on others’ experience and not their own.

The inaccurate information they receive about root canal therapy prevents patients from making a properly informed decision regarding their teeth.  Many patients will ask that a tooth be extracted rather than experience a root canal procedure.

Painless DentistryRoot canal treatment is needed when the nerve or pulp tissue becomes inflamed or infected. The inflammation or infection can occur from a number of ways: Decay that extends into the pulp chamber, repeated dental procedures on the tooth, or a fracture or chip in the tooth that allows bacteria to spread into the pulp chamber. Also, a traumatic injury to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to a dental abscess.

Root canal therapy is almost always recommended because a tooth is causing pain from a condition that is irreversible. Pulpitis (inflammation of the pulp), an infected pulp, broken teeth, or a slowly dying nerve are all common reasons for root canal therapy.

Root canal therapy is used to alleviate pain. Most people who have root canal therapy admit they did not experience any pain during the appointment and felt better afterward.

Signs that a root canal may be necessary include pain, prolonged sensitivity to temperature (hot or cold), tenPainless Dentistryderness to touch and chewing, darkening or discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes, bone and surrounding gingival tissues. Sometimes, no symptoms are exhibited.

Root Canal Therapy generally requires one or more visits to the dentist and can be performed by either a dentist or a specialist called an endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention, and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. The choice is generally up to the dentist on who will perform the root canal. The reasons the dentist may send you to the endodontist include: degree of difficulty of the tooth involved and need for a microscope, re treatment of a Painless Dentistryprevious root canal, and the patients preference. You and your dentist will discuss who is best suited to complete this treatment for you.

The first step is to take an X-ray (if one has not been already taken during the diagnosis) to see the shape of the root canals and determine if there are any indications of infection in the surrounding bone tissues. Your dentist or endodontist will then use a local anesthetic to numb the area surrounding the tooth. Anesthesia is not always necessary but generally preferred by patient.

Once numb, the pulpal tissue along with bacteria, the decayed nerve tissue and related debris are cleaned out from the inside of the tooth and roots. Tiny instruments called dental files are used to measure the length of the root canal and to shape and clean the inside of each root. Sterile water, peroxide, or sodium hypochlorite are used periodically to flush away the debris and kill bacteria..

Once the tooth is thoroughly cleaned, each root canal is filled to the end with a rubbery compound called gutta percha and sealed . The process essentially is like a cork to prevent bacteria and fluid from re-entering the tooth, and keep it sterile. Some dentists like to wait a week before sealing the tooth. This will give the Painless Dentistryinflammation a chance to settle down. Some prefer to seal the tooth the same day it is cleaned out. If the root canal is not completed on the same day, a temporary filling is placed to keep out contaminants like saliva and food until the next appointment.

The final step may involve a more extensive restoration of the tooth. Generally a tooth that needs a root canal often is one that has a large filling or extensive decay. Even when decay was not a factor, the root canaled tooth is weaker than a ”live” tooth. Therefore, a crown, crown and post, or other restoration often needs to be placed on the tooth to protect it, prevent it from breaking, and restore it back to full function again. After restoration, you will not notice any difference in its function or form. You and your dentist will discuss this need further and decide together the best course of action for you.

Root canal therapy is highly successful and has more than a 95% success rate. Many teeth repaired with a root canal can last a lifetime.

Most root canals are performed to relieve the pain of toothaches caused by pulpal inflammation or infection. With modern techniques and anesthetics, most patients report that they do not feel any pain once the procedure is underway. Root canal procedures have the reputation of being painful. Usually most patients report that the procedure itself is no more painful than having a routine filling placed.

For a few days following treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over the counter or prescription medications or an antibiotic if an infection was present. Follow directions given to you very carefully.

Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your dentist.

As noted above, the pain from root canals in modern dentistry is from the infection that presents to the dentist and the actual procedure should be pain and worry free. Best defense against developing a toothache is to see your dentist regularly, maintain proper oral hygiene, and call your dentist if you have any pains or discomfort.

Radiograph of RCT

Xray of completed root canal