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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.




Gingivitis is simply inflammation of the gum tissue in the mouth. It is a reversible, non-destructive form of periodontal disease. While there are many causes of gingivitis, the

Gingivitis Marielaina Perrone DDS

Gingivitis Can be Prevented!

number one cause is poor dental hygiene.

Gingivitis can develop as

-a side effect to medication

-surges in hormones

-mouth breathing

-dry mouth

-poor nutrition

-disease state

-tobacco use

-poor oral hygiene.

When dental hygiene is not sufficient, bacteria in dental plaque release acids that stimulate the inflammatory response by the body. This in turn cause the gums to appear puffy, red, and bleed easily upon brushing. It takes some work to restore the gums back to a healthy state. Frequent professional cleaning along with regular tooth brushing and flossing can help to remove plaque and keep it from building up on the teeth and gums.

Signs Of Gingivitis

-swollen, shiny, and tender gums

-blood on toothbrush while brushing

– pink toothpaste when spitting out

-pus around teeth

-bad breath

-gum redness

-visible tartar deposits

-bad taste in mouth

-gums bleed easily

-gum ulcers

Other Causes Of Gingivitis

Medications. Many prescription and over-the-counter medications come with the side effect causing dry mouth or xerostomia, and sometimes gum overgrowth. Saliva is important to help keep your teeth clean by controlling the growth of bacteria as well as maintaining a neutral environment to prevent tooth decay. That means that the less saliva you have, the greater your risk for gingivitis (and tooth decay!). Many common medications including antidepressants, blood pressure meds,  asthma inhalers, and cold medications can reduce the amount of saliva in your mouth. Seizure medications, and some blood pressure medications can cause the gum tissue to grow. This extra tissue, makes it more difficult to keep clean. It is important you always read the side effects for any medications you are taking to ensure you take the proper steps like drinking more water and brushing more often following meals.

-Infection/ Disease: Various types of viral infections or fungal infections can cause periodontal disease. Oral Thrush is an example. Thrush occurs when a type of fungus that occurs normally in the mouth gets out of control and forms lesions that can infect the tongue and gums. Also, an infection caused by the herpes virus can cause

Gingivitis Marielaina Perrone DDS

periodontal disease. It is important to get these infections under control as soon as possible as they are quite treatable in most cases. There are also other diseases that can effect the oral tissue, such as oral cancer, and diabetes.

-Nutrition: If you follow a fad diet or a diet that is severely lacking in calcium and vitamins B and C, you may be at increased risk for periodontal disease.

Mouth Breathing: leaving the mouth open to breathe while awake or sleeping, dries the mouth substantially. Oral dryness  allows gingivitis to occur more readily.making healing more difficult

Tobacco use: Smoking directly effects the gums by decreasing blood circulation and thereby increasing inflammation. Smokeless tobacco cause irritation in direct response to the product eroding the tissue.

Hormone surges: Hormonal imbalance during puberty, menstruation, pregnancy, and menopause can cause gingivitis. The drastic hormone changes allow gum tissues to become inflamed quite readily.

Possible Complications From Gingivitis

In most cases, if gingivitis is properly treated and the patient follows good dental hygiene there will be no complications. However, if left untreated, gingivitis can worsen and develop into a more advanced version of periodontal disease called periodontitis. This form of periodontal disease is quite destructive and will cause loss of bone and eventually loss of teeth.

Possible complications from gingivitis can include:

-Abscess in the gum tissues.

-Abscess in the jaw bones.

-Infection in the jaw bone or gum tissues.

-increased susceptibility to heart disease.

-Loss of esthetic gum contours. The points of gum tissue between the teeth disappear, leaving behind a “black triangle”. Red, jelly-roll margins at the gum line of the tooth. Pink stippling disappears.

-Periodontitis.

-Recurrent gingivitis.

-Trench mouth, or ANUG.  Ulcerations of the gums caused by bacterial infection.

Gingivitis can cause damage in other areas of the body if allowed to remain untreated. The bacteria from the gums can enter the bloodstream and cause infections elsewhere. Periodontal disease has been linked to heart disease, stroke and erectile dysfunction. It may also cause the delivery of premature infants as well as low birth weight infants to gingivitis-infected mothers. Those with diabetes may have problems controlling blood sugar levels if they also suffer from gingivitis.

Prevention of Gingivitis

Gingivitis may be prevented or cured by following some simple preventative measures:

-Brush teeth, gum line, and tongue daily. Teeth should be brushed at least twice a day. Both morning and night and after meals when possible.Gingivitis Marielaina Perrone DDS

-Use a soft bristled toothbrush, which is less likely to damage teeth or gums. Replace toothbrush every three months or sooner if needed.

-Use a fluoride toothpaste.

– Do not snack in the middle of the night. Chew gum after daytime snacks.

-Floss at least once a day.

-Rinse with an effective mouthwash, such as listerine.

-Visit the dentist at least once every six months for cleaning and examination to keep gingivitis away.

-Avoid sugary foods, tobacco and drinking excessive amounts of alcohol.

Conclusion

Gingivitis is very treatable. The first step, is understanding what is making it occur. Following a regular dental hygiene regimen will keep gingivitis at bay and not allow it to progress to periodontal disease. A few minutes a day is all it takes to maintain a healthy teeth and gums. Remember to visit your dentist regularly for dental examinations and professional cleanings to avoid the onset of gingivitis.