How does Arthritis effect oral health
What is Rheumatoid Arthritis
Arthritis is an illness that is not just a disease of the old. Some forms of arthritis affect children still in diapers, while thousands of people are stricken in the prime of their lives. However, the common link is joint and musculoskeletal pain. Arthritis is an inflammatory condition that can cause pain and swelling in the joints. Arthritis can also cause other problems in the rest of the body as well, such as the eyes, chest or skin. There are several kinds of arthritis with the two most common being rheumatoid and osteoarthritis.
Rheumatoid arthritis is an autoimmune disease. Autoimmune diseases are illnesses that occur when the body tissues are mistakenly attacked by its own immune system. Therefore, rheumatoid arthritis causes chronic inflammation of the joints, the tissue around the joints, as well as in other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. The disease can begin at any age but it most often starts after age 40 and before 60. In some families, multiple members can be affected, suggesting a genetic basis for the disorder.
Osteoarthritis is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body. It most commonly occurs in the weight bearing joints of the hips, knees, and spine. It can also affect the fingers, thumb, neck, and large toe Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity, making it prone to damage and decreasing its ability to act as a shock absorber making the bones rub against each other.
Although no one knows what causes arthritis researchers have studied its effect on the rest of the body, specifically in the oral cavity. The articles used in this essay focused on the prevalence of unhealthy oral conditions in the mouth in those with arthritis. The articles used helped to determine whether there was a relationship between rheumatoid arthritis and periodontal disease.
Arthritis related to periodontal disease
Periodontal disease relates to the destructive inflammatory disorder of the hard and soft tissues surrounding the teeth. Recent studies have shown that periodontal disease may be related to a number of systemic diseases such as heart disease and diabetes. Since rheumatoid arthritis is a chronic inflammatory disease it demonstrates similar patterns of soft and hard tissue destruction like that of chronic periodontitis.
The first article “Is there a relationship between rheumatoid arthritis and periodontal disease?” published in 2000 by Munksgaard suggested that of those patients involved in the study who were identified as having rheumatoid arthritis, 62.5% had advanced forms of periodontal disease. The aim of the study was to test the hypothesis that individuals with periodontal disease would have an increased chance of rheumatoid arthritis than those without periodontal disease.
The Human Ethics Committee of the University of Queensland was involved in the study be giving approval to allow the participation of 1412 and the obtainment and evaluation of their dental records. In order to be identified as having rheumatoid arthritis the subjects needed to have a prescription of a medication for the condition.
The results proved the hypothesis to be correct and the prevalence of rheumatoid arthritis was 3.95% greater in those with periodontitis. Furthermore, among the 36 subjects who reported to have arthritis 33 (92%) had radiographic evidence of moderate to severe bone loss. In addition 62.5% of the arthritis patients suffered from advanced forms of periodontal destruction indicating that both conditions maintain a causal effect relationship with either one being the cause or the effect.
The objective in another article “Association of Periodontal Disease and Tooth Loss with Rheumatoid Arthritis in the US Population” in the Journal of Rheumatology was similar to the one above except it included the association of tooth loss with rheumatoid arthritis.
The article noted that periodontitis and RA share numerous characteristics which include certain pathogenic processes. Therefore, its objective was to compare periodontal disease and tooth loss prevalence in subjects with and without RA in the US population.
Although no dentists were mentioned in the study, materials and methods for the study were obtained from other sources such as the Third National Health and Nutrition Examination Survey, and classification of RA was obtained from the American College of Rheumatology, as well the Stata Corp was involved in the statistical analyses and survey collection.
The study proved that participants with RA had a higher prevalence of periodontitis (16% vs 10%) and edentulism (56% vs 34%). Furthermore RA participants had more missing teeth (20 vs 16).
Data from both studies indicate an overwhelming relationship between periodontal disease in systemic health. Both studies highlight the relationship between two of the most common, chronic, and inflammatory conditions affecting humans.
A Norwegian survey from 1977 on RA patients found that the illness had a negative effect on oral home care along with the number of remaining teeth. The study concluded that serious and long lasting rheumatoid arthritis had a negligent effect on the number of remaining teeth in middle-aged Norwegians (“Remaining teeth, oral dryness, and dental habits in middle-aged Norwegian rheumatoid arthritis patients”). Another survey done in Finland echoed the same results: RA patients had few remaining teeth compared with the general population.
However, with that said another study called “Remaining teeth, oral dryness, and dental habits in middle-aged Norwegian rheumatoid arthritis patients” suggests otherwise. The aim of the study was to assess the effect of RA on dental health. Data was obtained from 125 patients aged 44 -56 years.
The main finding of the study was that RA does not seem to be a risk factor for tooth loss. The dental faculty from the University of Oslo involved in the study inferred that the above could be due to a high regularity of dental attendance, which was continued after the onset of RA, coupled with an increase in oral health education and promotion.
Another study supported by the Department of Periodontology Institute for Postgraduate Dental Education in Sweden and published in the article “General Oral Status in adults with rheumatoid arthritis” focused on the disorders related to the tempro-mandibular joint, being that arthritis is an inflammatory disease
The study included 204 subjects, 194 with RA and 153 without, the study was able to conclude that disorders of TMJ were more frequent among RA patients than among non-RA patients. It was of no surprise that about 30% of RA subjects had symptoms (pain of the TMJ, difficulty chewing, difficulty opening, tenderness, crepitus) indicative of pathological changes within the TMJ.
The team leading the study concluded that since TMJ diagnosis is generally not included in the medical examination of RA patients, prevention of damage to the TMJ might be neglected. Therefore, stomatognathic examinations and follow ups should be included in the overall care of these patients.
Conclusion:
Articles such as the ones mentioned and researched in this essay prove that many advances have been made in understanding rheumatoid arthritis and therefore improving the quality of life for those living with the condition. Although arthritis is a common chronic disease that affects millions, significant breakthroughs in medicine, technology, and education have made it possible for affected individuals to get through their day with added ease and comfort.
These studies in particular, shed light on mobility and dexterity problems of people with RA, therefore, affecting their oral health status. They also proved that an unhealthy mouth may be linked to other systemic conditions. With the advancements in dentistry many with rheumatoid arthritis will be bale to maintain their natural teeth longer and achieve better oral health.
This material is the work of a dental hygiene student at Oxford College
Originally prepared by Haneen, DH student at OXFORD college.
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