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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.



Many believe that periodontal disease is a disease that is solely based on genetics. My grandparents had dentures, my parents had dentures, so will I. The truth is, that genetics plays a role, but is not a sentence for dentures. There are risks and limitations in the progression of periodontal disease… Can each patient limit the risks of developing full blown progressive periodontal disease?….The answer is a resounding…YES! It takes a good oral hygiene regimen, knowledge of the current state of your condition, and frequent professional cleaning to keep our mouths in a healthy, disease-free state.

Risk Factors Of Periodontal Disease

Patient Caused Risk Factors

-Poor Oral Hygiene – This is an obvious one that each individual can control. Brushing, flossing, rinsing, and seeking regular dental care are essential steps to remain periodontal disease free and avoid progression beyond gingivitis.

-Age - Research has shown that older people have the highest rates of periodontal disease. The research shows that over 70% of Americans 65 and older have periodontitis.

-Smoking Or Tobacco UseTobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

-Poor nutrition- Eating an unhealthy diet will not supply you with the essential vitamins and minerals necessary for tissue healing and repair.

-Anatomy - The local anatomic risk factors for periodontal disease include:,

1. Furcation anatomy. These are the spaces between roots of molars.  In many instances, the entrance of  such furcations are restricted enough to limit access for proper hygiene maintenance. Risk factors for periodontal disease are classified according to their involvement in tooth furcations. A Grade I CEP presents with minimal projection of enamel toward the entrance of the furaction. A Grade II CEP approximates the entrance of the furcation, and the tip of a Grade Ill CEP is well within the furcation.

2. Common anatomic deformities. These interfere with a patient’s ability to effectively remove plaque biofilm which are one of the risk factors for periodontal disease. An example are Cervical enamel projections (CEP). CEPs are tooth developmental deformities of the CEJ found on molars.

4. Palato-gingival grooves (PGG). POGs are tooth developmental deformities of maxillary central and lateral incisors. They begin in lingual pits and extend vertically onto root surfaces. PGGs could, on rare occasions, extend to the root apex. PGGs are commonly associated risk factors for periodontal disease with increased gingival inflammation, plaque accumulation, and probing depth.

5. Open contacts, loss of interdental papilla, and food impaction. Open contacts between teeth may allow for easy food impaction. Food impaction is defined as the forceful wedging of food between teeth. Loss of the pointed papilla between teeth leaves another area for food impaction.

-Medications - Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can have an affect on your oral health, causing dry mouth, inflammation and gum tissue overgrowth. It is important to tell your dentist the medications you might be on so they can tailor a treatment schedule for your needs.

-Other Disease - These include cardiovascular disease, diabetes, and rheumatoid arthritis.  These diseases can interfere with the inflammatory process, causing healing problems, and may worsen the condition of the gums.

-Poor Nutrition – A diet without all the essential nutrients for our bodies to function can compromise our immune systems, decrease healing ability, and make tissue weaker and easier to breakdown. This will make it harder to fight off infection. Since, periodontal disease essentially begins as an infection, this lack of nutrition can make the periodontal disease develop and progress faster than it normally would. Studies have also linked obesity with an increased risk of periodontal disease.

Dentist Caused Risk Factors

-Overhanging dental restorations – A poorly completed dental restoration typically has dental material overhanging the tooth. This creates an issue keeping the area clean and also creates an area for food and bacteria to build up. These overhangs can be irritating to the tissues and retain plaque and food more easily.

-Violation of the “biologic width” –  is the height between the deepest point of the gum pocket and the bone. This distance is important to consider when fabricating any dental restorations, because they must respect the natural architecture of the gingival attachment if harmful consequences are to be avoided. These consequences include bone and tissue recession.

-Open contacts and food impaction - If a dentist places a new dental restoration and does not create the proper tight contact between adjacent teeth, that area becomes a food and plaque trap. It will necessitate improved dental hygiene in that area to keep it clean. More often than not, food and debris will accumulate creating a localized area of periodontal disease.

-Occlusal trauma – If a new restoration is not properly set in alignment with the other teeth, a patient can create damage to the tooth as well as the surrounding tissue just from the act of chewing. The bite should always be checked and adjusted after dental work to prevent trauma to an individual tooth.

Periodontal Disease Conclusion

Luckily, with the exception of the anatomy we are born with, all of these periodontal disease risk factors can be overcome. The first step is to practice good oral hygiene by brushing, flossing, and using an antibacterial mouthrinse. The second step is to choose a well qualified dentist and keep a regular schedule to help give you the best fighting chance at preventing,  treating and stabilizing periodontal disease.

Halloween is a fun time but also one of apprehension on the part of most parents. We always worry about our kids, but at certain times of the year, the worries become more pronounced. For parents, the worry at Halloween time, is the amount of candy their kids consume. This is due to a variety of reasons, behavior, weight gain, but especially their dental health. We all know by now eating lots of sugar and candy can lead to an increased risk of tooth decay. So what are some fun alternatives to that sugary, gooey candy that causes so many problems?

Top 10 Candy Alternatives

1. Sugar free xylitol gum. This is a great alternative to candy as it promotes dental health.  The chewing action of the gum actually promotes salivary flow which lessens the amount of time the sugars stay in the mouth thereby lowering the risk factors for tooth decay. This is also recommended as a tool after your kids indulge in candy to keep their mouths clean between brushing.

2. Halloween Stickers. Kids love stickers especially Halloween ones. The spookier and scarier the better and kids love them. You can even hand these out at the door to the neighborhood kids.

3. Vampire Teeth, spider rings. Go for the glow in the dark ones. Always a hit even with older kids.

4. Temporary Halloween Tattoos. If you go this route make sure you buy some that are for all ages and not just the cute bats and pumpkins. The older kids will want scary tattoos that look more mature.

5. Pretzels, potato chips & popcorn. There are many fun sized bags of these snacks available, a great choice and kids love them.

6. Pencils with Halloween erasers.

7. Silly String. Kids and adults love silly string.

8. Bubbles.

9. Halloween glow necklaces and bracelets. Fun and great for safety as you walk through the neighborhood!

10. Halloween Balloons.

Tips for Good Oral Health at Halloween and everyday!

-Brush twice a day with a fluoride toothpaste

-Floss at least once a day. Some kids have trouble flossing the old fashioned way so there are kid friendly alternatives like flossers.

-Visit your dentist regularly for dental examinations and professional cleanings.

Hope Everyone has a Safe and Happy Halloween!!

 

It is estimated that well over 1 billion people in the world smoke. Many of these smokers have their health directly affected by their choice of habit. Research has shown time and again that smoking is a significant hazard to a person’s general well being but it has been less publicized the effect smoking has on a person’s dental health.

Logically, the mouth is the primary recipient of the tars, nicotine, and smoke from either smoking or chewing tobacco. The tissues of the oral cavity would be the first to come into contact with these harmful and toxic materials. Even though the smoke is in the mouth for only a short period of time it is more than enough time for it to cause damage.

The following are some of the effects smoking has on a person’s dental health:

1) Increased risk of developing oral cancer. Oral cancer affects almost 40,000 Americans each year. Oral Cancer kills one person per hour (totals about 8,000 deaths per year). Only a little more than 50% of those 40,000 diagnosed, will be alive in 5 years. This is a sobering statistic that has stayed steady for quite a few years. Around the globe, the problem is even greater. There are a reported 640,000 new cases of oral cancer each year.

2) Increased risk of periodontal disease. Periodontal disease is a leading cause of tooth loss. The most recent research studies have shown that tobacco use may be one of the most significant risk factors in the development and advancement of periodontal disease.  A study published in journal of periodontology highlights that smokers are 4X more likely to suffer from advanced periodontal disease. Also, the chemicals in tobacco can make oral surgery or periodontal treatments less predictable. It seems that smoking interferes with the normal function of gum tissue cells. This interference makes smokers more susceptible to infections, such as periodontal disease. Every Time you inhale, the blood vessels in the mouth constrict and impair blood flow to the gums. This decreased blood flow affects wound healing. Smokers are more likely than nonsmokers to have the following issues:

-Increased build up of plaque and tartar.

-Deep pockets between your teeth and gums

-Loss of the bone and tissue that support your teeth

smoking facts

Facts about Smoking

If the bacteria is not removed during a professional cleaning, and it remains below your gum line, the bacteria can destroy your gum tissue and cause your gums to become inflamed, swollen, and pull away from your teeth.  When this happens, periodontal pockets form and fill with disease-causing bacteria. Periodontal disease is a progressive disease and if this situation is left untreated it will only get worse. The pockets between your teeth and gums can get larger allowing more bacteria to get in to destroy and breakdown gingival tissue and supporting bone. The gums may shrink away from the teeth making them look longer. Without any further treatment to slow or stop the progression your teeth may become loose, painful, and will probably fall out.

3) Discoloration of teeth. Nicotine and tar present in cigarette smoke, form deposits on tooth surface and cause discoloration of teeth. These discolorations can range from yellow to black. Most smokers are aware of this discoloration but it is almost impossible to remove via regular home care techniques.

4) Halitosis or smoker’s breath. Every smoker at some time or another has probably been told that their breath smells bad. Most smokers become used to the bad smell and hardly notice it but the bad breath is quite obvious to non smokers. This is not something that will go away without cessation of smoking.

5) Increased risk of tooth decay.  The deposits from tar and nicotine caused by smoking add to the plaque build up in the mouth creating a environment for tooth-decay causing bacteria to flourish. Smoking will also affect dental work and will reduce success rates of procedures such as periodontal surgery and dental implants. Dental implants are quite costly and smoking can mean the difference between a successful outcome and an unsuccessful one.

6) Xerostomia or Dry Mouth. Cigarette smoking causes the condition known as dry mouth. This decrease in saliva is generally caused by the inflammation of the salivary gland ducts. This can in turn lead to a variety of problems including bad breath and cavities.

Some lesser effects from smoking include change in taste sensation, sinusitis, and delayed wound healing.

Quitting Tobacco Use

If you wish to quit smoking, your dentist can help calm your nicotine cravings with certain medications. These can include nicotine gum, nicotine patches, or puffers (an artificial cigarette with nicotine only). Most of these are over the counter medications but others need a prescription. For example, Zyban and Chantix are prescription drugs used to help patients quit smoking, and must be

quit smoking - chantix

chantix – quit smoking

monitored by your physician.

Smoking cessation classes and support groups are often used together with drug therapy. Ask your dentist for information they may have on similar smoking cessation programs.

Herbal remedies, along with hypnosis and acupuncture, are other treatments that may help patients quit smoking.

The bottom line is that the habit of smoking poses a very significant threat to your overall health and that includes your dental health. Education is the key to making current smokers aware of the pitfalls of smoking as well as the rest of the population who may take up the habit now or in the future. As always regular dental visits are recommended.