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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.

Medications are any chemical substance used in the treatment, cure, or prevention of disease. It can also be used as a supplement to enhance a person’s physical or mental well being.

Over the course of our lives we will all, most likely, take some form of medication. The medications can just be a simple over the counter pain reliever or something prescribed by your physician for a more serious medical condition. Did you know many of these medications also affect your oral health?

Prescribed and over-the-counter drugs, vitamins, minerals, and herbal supplements can all cause oral health issues. Some of these issues include, dry mouth, inflammation, overgrowth of the gums, changes in taste and bone loss.

Oral Health Side Effects of Medications

Some of the most common oral health side effects include:

1) Xerostomia or Dry Mouth. Medications that can cause dry mouth by decreasing salivary flow include: antihistamines, decongestants,  high blood pressure medications, medicine for Parkinson’s disease, pain medication, and antidepressants. There are hundreds of medications that list dry mouth as a side effect. Xerostomia is quite common,and needs to be monitored for your oral health to be maintained. Without proper salivary flow, you will be more likely to develop more tooth cavities and periodontal infections.

Tips to Combat Dry Mouth

-Drink lots of water throughout the day to keep your mouth wet and moist. This will also help to rinse your mouth throughout the day to minimize tooth decay and bacteria buildup.

-Stop using or cut down on caffeinated drinks, sugary beverages, alcohol, and tobacco. All of these contribute to dry mouth.

-Chew gum to promote salivary production. Recommend a sugarless gum or one with xylitol.

-Avoid salty and spicy foods. This can not only dry you out further but cause some discomfort as you are unable to wash the spices away as quickly without the proper amount of saliva.

-Use a humidifier at bedtime. Many people feel this helps to keep their mouths moist through the night.  Works well for mouth breathers.

-Use an artificial saliva rinse, and dry mouth specific products. These will allow you to keep your mouth moist and avoid the problems mentioned above. Biotene is a good example of such products.

2) Abnormal bleeding. Medications known as blood thinners can cause prolonged bleeding of tissues in your mouth. These include aspirin and anticoagulants (such as Heparin). These medications work by lowering the ability of the blood to form clots. They are helpful in preventing heart attacks and strokes but they can cause excessive bleeding especially during any type of oral surgery, or even after a deep cleaning. It is therefore very important to tell your doctor or dentist if you are taking this type of medications.

3) Change in taste. Many drugs can give you a metallic or bitter taste. While others can totally change the way you perceive taste of different foods. Some good examples of these medicines are as follows:

-Heart medications. Such as beta blockers or calcium channel blockers.

-Flagyl (metronidazole). This is an antibiotic.

-Nicotine skin patches. These patches are used for people who want to quit smoking.

The only option for these patients usually is to deal with the side effects of the medication or ask your physician if there is some other medication that can work in its place.

4) Inflammation, gum overgrowth, mouth sores, or changes in color of the soft tissues in your mouth. These can include blood pressure medications, immunosuppressive drugs, oral contraceptives, and some chemotherapy drugs. If you are having issues with these drugs let your dentist know. You may need to increase your oral hygiene regimen to maintain a healthy mouth.

5) Tooth Cavities. Various medications contain sugar. Many children’s medications have a high amount of sugar in them to improve taste. Too much sugar as we know can lead to tooth cavities. Sugar can also be found in cough drops, antacid tablets, anti fungal lozenges, and many vitamins.

Tips to help lower risk of tooth decay from medications:

-Take the medications at mealtimes, not at bedtime.

-Drink water after taking medications.

-Make you or your children brush or chew sugarless (or xylitol) gum after taking the medication.

-Visit your dentist regularly for dental care.

6) Bone loss. Medications such as corticosteroids (like prednisone) and anti-epilepsy drugs can lead to bone loss. Medications used in the treatment of osteoporosis (bisphosphanates) can lead to a rare condition called osteonecrosis of the jawbone. This results in destruction of the bone. Symptoms can include painful, inflamed gums, loos teeth, jaw numbness, fluid in the gums or jaw, and bone that becomes exposed.

If you are taking medications for osteoporosis be sure to tell your dentist. The dentist may be able to prescribe you an antibiotic or non steroidal anti inflammatory drug (NSAID) to slow your bone loss.

7) Thrush, or an oral yeast infection. Thrush is caused by a fungus (Candida) and shows up in the mouth as white and red lesions on the tongue and/or surrounding tissues. Taking antibiotics, steroids, or going through chemotherapy can cause thrush. The general course of attack in dentistry is to recommend anti fungal mouthwashes or lozenges. If that does not work, then a stronger anti fungal medication will be needed.

Bottom Line on Medications and Your Oral Health

All of the medications listed above generally serve a greater purpose for the maintenance of your overall health. Therefore these side effects from medications must be dealt with, as we cannot just stop taking these medications. This is why it is so important to be open and honest to all your physicians and dentists letting them know everything you are taking. Your treatment may need to be altered or monitored closely by your dentist. You may not realize the impact your specific medications may have on your oral condition, but your caretakers do.