Poor oral health can affect a patient’s overall well-being: the risk of diabetes, dementia, heart disease and respiratory infections can be increased by an inadequate oral hygiene routine.[i] Another prominent systemic health condition is rheumatoid arthritis (RA), which has a strong association with gingival diseases.
RA is an autoimmune disease characterised by an accumulation of inflammatory cells that destroy cartilage and bone tissue.[ii] Its symptoms include joint pain, joint damage, impaired function and increased mortality, with a global prevalence of 0.5% to 2%.[iii] Whilst exasperated by environmental factors such a smoking and obesity, RA has a connection with periodontitis and tooth loss and so practitioners must educate patients on the need for a consistent oral hygiene routine.iii
Inflammatory explanatory
30% of the adult population are affected by periodontal disease,iii with poor brushing and flossing habits facilitating plaque build-up, eventually leading to the development of gingival diseases.[iv] RA and periodontitis are inflammatory diseases that share many similarities – both can be triggered by smoking, for instance. Genetic risk factors also overlap, with shared epitopes within the β-chain of the human leukocyte antigen and tyrosine phosphatase being involved in both RA and periodontitis.iii
For patients with RA, the immune system attacks the synovium – the cells that line the joints – by mistake, making the joints swollen, stiff and painful.[v] However, research suggests that RA does not begin in the joints, but is a result from autoantibodies produced in other areas of the body, such as the mouth or lungs.[vi] Identifying the role of the oral cavity in contributing to RA is essential to educate at-risk patients on.
Oral microbes excel at creating autoantibodies. One such microbe is Porphyromonas gingivalis, which is linked to both periodontitis and arthritis.vi P. gingivalis escapes through damaged tissue and enters the bloodstream to travel around the body. The microbe contains a unique enzyme that changes proteins to the extent that the body perceives them as a threat and attacks. Known as citrullination, the process increases the production of antibodies that attack the synovium.vi By maintaining an effective oral hygiene routine, the prevalence of harmful microbes such as p. gingivalis can be reduced, and therefore also the risk of RA.
A reciprocating relationship
Poor oral hygiene and the resulting risk of periodontitis may increase the likelihood of RA, but patients with RA also have a risk of developing periodontitis. Arthritic patients are twice as likely to have a gingival disease compared to those without RA, and the severity is far worse too.vi
While gingival diseases can increase the risk of RA, RA can impact the oral cavity. Common oral manifestations of RA include temporomandibular joint disease (TMD) and Sjögren’s syndrome.[vii] As impaired movement is a common symptom of RA, toothbrushing and interdental cleaning may become a challenge if joints in the jaw, arms or hands are affected. This can exacerbate oral health problems so it is essential to reduce the risk of RA where possible.
An effective solution
As a practitioner, simply providing information on oral care may not change the daily cleaning practices of a patient. Acceptance and adoption of a practitioner’s oral hygiene recommendations may be more likely if patients are informed of the link between oral health and overall health, in particular the connection between gingival diseases and systemic diseases like arthritis.[viii] With a greater awareness of why they should take look after their oral health, patients can take more time and care in their daily hygiene routine.
Using an effective toothpaste consistently can prevent plaque build-up and reduce the risk of gingival diseases. Arm & Hammer offer an excellent range of 100% Natural Baking Soda toothpastes, with one aimed for Whitening Protection and another perfect for Gum Protection. Baking soda has a low-abrasive nature, and Arm & Hammer toothpastes boast superior stain removal compared to non-baking soda toothpastes. The unique formula contains 1450ppm of fluoride for the efficient neutralising of acids and the remineralising of the enamel. The carton, tube and cap are all fully recyclable to encourage eco-friendly dentistry. For patients in need of a first-class natural toothpaste, recommend Arm & Hammer.
Research continues to highlight the connection between systemic health complications and oral health, such as RA and periodontal diseases. It is therefore vital that patients are educated on how a good oral hygiene routine can reduce the risk of diseases like RA developing.
For more information about the carefully formulated Arm & Hammer™ toothpaste range, please visit https://www.armandhammer.co.uk/ or email: ukenquiries@churchdwight.com
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Author: Sharon Kidd, GDC – 4566Diploma in Dental Hygiene 1993Hygienist
Sharon qualified as a dental nurse in The Royal London Dental Hospital in 1988. She trained as a dental hygienist in the Royal Army Dental Corps in 1993.
Sharon has experience working as a hygienist in a variety of different settings including dental hospital, domiciliary home visits, military, private and general practice. She works with specialists and general dental practitioners to support patients with different needs including those who are nervous to visit the dentist.
Sharon is also a professional educator for Waterpik, water flosser .
She enjoys family time at home with her husband two teenage daughters and family pets.
[i] www.colgate.com. (n.d.). How Poor Dental Care Can Affect Your Overall Health. [online] Available at: https://www.colgate.com/en-us/oral-health/gum-disease/how-poor-dental-care-can-affect-your-overall-health#
[ii] Shim, H., Koo, J. and Ahn, J. (2022). Association between Rheumatoid Arthritis and Poor Self-Perceived Oral Health in Korean Adults. Healthcare, 10(3), p.427. doi:https://doi.org/10.3390/healthcare10030427
[iii] Chang, Y., Chung, M.K., Park, J.-H. and Song, T.-J. (2023). Association of Oral Health with Risk of Rheumatoid Arthritis: A Nationwide Cohort Study. Journal of Personalized Medicine, [online] 13(2), p.340. doi:https://doi.org/10.3390/jpm13020340
[iv] NIH (2018). Periodontal (Gum) Disease. [online] www.nidcr.nih.gov. Available at: https://www.nidcr.nih.gov/health-info/gum-disease
[v] NHS (2023). Rheumatoid Arthritis. [online] NHS. Available at: https://www.nhs.uk/conditions/rheumatoid-arthritis/
[vi] www.arthritis.org. (n.d.). Gum Disease and Arthritis | Arthritis Foundation. [online] Available at: https://www.arthritis.org/health-wellness/about-arthritis/understanding-arthritis/mouth-bacteria
[vii] Bingham, C. O., & Moni, M. (2013). Periodontal disease and rheumatoid arthritis. Current Opinion in Rheumatology, 25(3), 345–353. https://doi.org/10.1097/bor.0b013e32835fb8ec
[viii] Protudjer, J.L.P., Billedeau, C., Hurst, K., Schroth, R., Stavropoulou, C., Kelekis-Cholakis, A. and Hitchon, C.A. (2021). Oral Health in Rheumatoid Arthritis: Listening to Patients. JDR Clinical & Translational Research, p.238008442110126. doi:https://doi.org/10.1177/23800844211012678
