Arthritis can directly and indirectly affect teeth and overall oral health through several complex pathways. The connection involves the body’s systemic inflammatory response, the physical structure of the jaw joint, and the side effects of medications used for treatment. Inflammatory types of arthritis, such as Rheumatoid Arthritis (RA), are chronic conditions characterized by widespread inflammation. This systemic inflammation links the disease to conditions seemingly unrelated to joints, including those in the mouth.
Systemic Inflammation and Periodontal Disease
The primary biological link between arthritis and oral health is chronic, systemic inflammation. Inflammatory arthritis, such as Rheumatoid Arthritis, and periodontal disease (gum disease) share common pathological features involving the destruction of soft tissue and bone. Both conditions are characterized by persistently high levels of pro-inflammatory signaling proteins, known as cytokines.
Cytokines like Tumor Necrosis Factor-alpha (TNF-α) and Interleukin-6 (IL-6) contribute to tissue destruction in both the joints and the structures supporting the teeth. Periodontitis increases the overall inflammatory burden in the body, potentially worsening the symptoms and progression of systemic arthritis. This suggests a bidirectional relationship where inflammation in the joints can promote inflammation in the gums, and vice versa.
Periodontitis is an inflammatory disease triggered by oral bacteria that leads to the progressive breakdown of the periodontal ligament and surrounding bone. Patients with RA are more likely to have periodontitis, and this chronic gum infection contributes to the systemic inflammation affecting the joints. Targeting these shared inflammatory pathways with specific therapies, such as TNF-α inhibitors used for RA, has shown promise in improving the inflammatory condition of the periodontium.
Mechanical Effects on the Jaw
Arthritis can directly impact the jaw’s function by affecting the Temporomandibular Joint (TMJ), which connects the jawbone to the skull. Both Rheumatoid Arthritis and Osteoarthritis can cause inflammation, pain, and structural damage in this joint. This involvement limits the range of motion and causes stiffness, making it difficult to open the mouth fully for eating or adequate dental hygiene.
Inflammation in the TMJ can lead to the erosion of bone and cartilage, causing changes in the bite alignment over time. Structural changes often include the flattening of the condyle—the rounded end of the jawbone—and the formation of osteophytes, or bone spurs, within the joint. Symptoms often involve a grinding or creaking sound, known as crepitation, during jaw movement, and this pain can sometimes be mistaken for a toothache.
Structural damage within the TMJ, such as bone erosion, can be present even in patients who report no specific jaw pain. The silent progression of arthritis in the jaw can lead to long-term functional impairment and bite issues. Furthermore, physical limitations from jaw involvement can make routine dental visits and extended procedures uncomfortable.
Oral Health Side Effects of Arthritis Treatments
Many medications used to manage arthritis symptoms and slow disease progression can have secondary effects that impact oral health. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) can cause gastrointestinal issues, which may lead to stomach acid erosion of tooth enamel in severe cases. Corticosteroids, while reducing inflammation, can increase the risk of oral infections, such as oral thrush, due to their immunosuppressive nature.
Disease-Modifying Antirheumatic Drugs (DMARDs) and Biologics, which target the immune system, also contribute to oral health problems. Some DMARDs, like methotrexate, may cause painful mouth sores or ulcerations. A widespread issue with many arthritis medications is the side effect of dry mouth, or xerostomia.
Saliva is necessary for washing away food particles and neutralizing acids, which protects teeth from decay. A reduction in saliva flow due to medication significantly increases the risk of cavities and gum disease. Patients on long-term treatments may also experience altered taste perception, indirectly influencing appetite and nutrition.
Maintaining Oral Hygiene and Dental Care
Managing oral health while living with arthritis requires proactive strategies, especially for overcoming limited hand and wrist mobility. Simple tasks like gripping a toothbrush or manipulating dental floss can become challenging due to joint stiffness and pain. Adaptive tools can make a substantial difference in maintaining consistent daily care.
Electric toothbrushes are highly recommended because their larger handles are easier to grip, and the powered movements compensate for reduced manual dexterity. For flossing, specialized tools eliminate the need to wrap floss around painful fingers. Manual toothbrush handles can also be modified with foam tubing or bicycle grips to create a wider, more comfortable surface to hold.
Consistent communication among the patient, rheumatologist, and dentist is necessary for comprehensive care. The dental team should be informed about the specific type of arthritis, current medications, and any jaw pain or mobility issues during dental procedures. Regular dental check-ups and professional cleanings are important to catch potential problems early, as arthritis and its treatments increase the risk of decay and gum disease.