Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by systemic inflammation that primarily affects the joints throughout the body. This condition leads to pain, swelling, and stiffness, often resulting in joint damage over time. While its impact on larger joints like those in the hands and feet is well-known, RA’s influence can extend beyond these common sites. Understanding how RA can affect the oral cavity is an important aspect of managing the disease. This connection between systemic inflammation and oral health highlights the need for a comprehensive approach to patient care.
Understanding Oral Manifestations
Rheumatoid arthritis can directly influence oral health through various mechanisms. Sjögren’s Syndrome, an autoimmune condition often co-occurring with RA, causes severe dry mouth (xerostomia) due to reduced saliva production. This lack of saliva increases the risk of tooth decay, gum disease, and oral infections like thrush, and can make speaking and swallowing difficult.
Individuals with RA also face a heightened risk of periodontal disease (gum disease). The systemic inflammation characteristic of RA can exacerbate gum inflammation, leading to the destruction of tissues supporting the teeth and more aggressive disease progression. Oral infections, such as fungal infections like oral candidiasis (thrush), are also more common, often linked to dry mouth or immune changes. Sores or generalized inflammation of the oral lining can also appear, reflecting the body’s widespread inflammatory response.
Impact on Jaw Joints
The temporomandibular joint (TMJ), which connects the jawbone to the skull, is a synovial joint susceptible to the inflammatory effects of rheumatoid arthritis. When RA affects the TMJ, individuals often experience pain and tenderness in the jaw area. Common symptoms include clicking or popping sounds during jaw movement, limited ability to open the mouth, and difficulty chewing. Some patients may also notice changes in their bite alignment as the joint structure becomes altered.
Chronic inflammation within the TMJ can lead to progressive damage, including erosion of joint surfaces and, in severe cases, fusion of the joint (ankylosis), which can severely restrict jaw mobility. This can significantly impact a person’s ability to eat and speak, affecting their quality of life. Diagnosing TMJ involvement typically involves a clinical examination to assess jaw movement and tenderness, often supplemented with imaging techniques like X-rays, CT scans, or MRI to visualize the extent of joint damage. Early detection and management are important to mitigate complications.
Medication Side Effects
Medications prescribed for rheumatoid arthritis can also contribute to oral health issues, independently of the disease’s direct effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can sometimes lead to dry mouth or an increased risk of oral infections. Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are known to cause painful mouth sores or ulcers that interfere with eating and speaking.
Biologic medications, which target specific parts of the immune system, can increase the risk of oral infections due to their immunosuppressive actions. Some RA treatments may alter taste sensation. Osteonecrosis of the jaw (ONJ), a rare but serious condition involving bone breakdown in the jaw, has been associated with certain bone-modifying agents. Patients should discuss any oral changes with their healthcare providers, as these side effects can affect treatment adherence and overall well-being.
Strategies for Oral Care
Proactive oral care is important for managing rheumatoid arthritis and mitigating its impact on the mouth. Regular dental check-ups are important for early detection and management of oral complications. These visits allow dental professionals to monitor for signs of gum disease, cavities, and other issues that can progress rapidly in individuals with RA. Establishing a daily oral hygiene routine is also important, including brushing teeth twice a day and daily flossing. Using an electric toothbrush or modified-handle toothbrush can be helpful for those with limited hand mobility.
Managing dry mouth involves strategies like frequently sipping water, chewing sugar-free gum or candies, and using saliva substitutes. Running a humidifier, especially at night, can also help keep the air moist.
It is important to communicate openly with both the rheumatologist and the dentist about the RA diagnosis, current medications, and any oral symptoms experienced. This integrated approach ensures coordinated care. Dietary adjustments, such as limiting sugary and acidic foods and drinks, can further protect teeth, especially with dry mouth. Smoking cessation is important, as smoking worsens both RA progression and oral health outcomes.