Periodontal disease and rheumatoid arthritis

Jannette Whisenhunt, RDH, examines the oral-systemic link between periodontal disease and rheumatoid arthritis.

Apr 1st, 2018
Whisenhunt Grey
No direct link, but similarities between diseases merit consideration

Jannette Whisenhunt, RDH, BS, MEd, PhD

When we have patients that have that suffer from stiff, painful, swollen joints with rheumatoid arthritis (RA), there may be something that we can do to help these patients to suffer less. RA is an autoimmune disease that triggers the inflammatory response in the joints affected. It is a complicated disease and the research that is out there is not saying that one causes the other. But there is a significant connection with the inflammatory process of both diseases. It makes sense that if we can help a patient to control the inflammatory process of one that it should help decrease or make it easier to control the RA inflammation symptoms.

Controlling the periodontal disease with more frequent nonsurgical periodontal therapy, and extensive HCI will decrease the “inflammatory products, endotoxins and bacteria in the bloodstream” (Billings). A literature review study by dental hygiene students at University of Southern Indiana reported (Access, 2017) that several items that are of interest of how these two diseases “link”:

• RA autoimmune response produces citrullinated proteins

• These natural proteins in someone with RA are overactive, resulting in an excess of these proteins that triggers an antibody reaction.

• This response causes increased inflammation in joints.

• This relates to periodontal disease because the inflammatory mediators in perio also produces hyper-citrullinated proteins.

• RA can destroy bones, and joints, and we know perio can destroy the periodontium(Chou, Billings)

In another study, they found that Porphyronmonas gingivalis (P. gingivalis) can cause similar conditions that increase the number of citrullinated proteins ( Bingham). In another study they looked at Aggregatibacter actinomycetemcomitans (Aa) bacteria and that it reproduced the same citrulliated antigens that are found in RA (Persson). These were pretty impressive links between the two diseases.

“While previous studies have linked periodontitis to RA disease activity, this study (Eustice) further suggests treating gum disease might work by reducing blood TNF-alpha levels. In both diseases, soft and hard tissue destruction is linked to TNF-alpha, so researchers are hoping that TNF blockers will help periodontitis the same way they alleviate joint inflammation and damage in RA” (Eustice).

This study found that treating the periodontal disease with nonsurgical periodontal therapy on these patients did decrease their RA symptoms.

These TNF blockers are immunosuppressant drugs that are commonly used in the treatment of RA symptoms. This study also looked at how this drug treatment that helps RA may in turn help reduce the destruction from periodontal disease. This study found that treating the periodontal disease with nonsurgical periodontal therapy on these patients did decrease their RA symptoms.

We may not be able to directly connect one to the other, but there are enough similarities for us to be paying closer attention. We need to always be educating our patients to the best of our ability and individualize it for the patients’ own health history and oral findings. Our education can make a difference in these patients RA symptoms. Happy scaling!

Jannette Whisenhunt,RDH, BS, MEd, PhD, is the Department Chair of Dental Education at Forsyth Technical Community College in Winston-Salem, N.C. Dr. Whisenhunt has taught since 1987 in the dental hygiene and dental assisting curricula. She has a love for students and served as the state student advisor for nine years and has won the student Advisor of the Year award from ADHA in the past. Her teaching interests are in oral cancer, ethics, infection control, emergencies and orofacial anatomy. Dr. Whisenhunt also has a small continuing education business where she provides CE courses for dental practices and local associations. She can be reached at jwhisenhunt@forsythtech.edu.

References:

1. Billings S, Libbert S; Hawthorne P. “Periodontal Disease: Impact on Rheumatoid Arthritis.” Access, Dec. 2017. www.adha.org.

2. Persson G. “Rheumatoid Arthritis and the periodontal-inflammatory and infectious connections. Review of Literature. J. Oral Microbiol. 2012; 1-16.

3. Bingham III C, Moni M. “Periodontal disease and Rheumatoid Arthritis: the evidence accumulates for complex pathologic interaction. Curr Opin Rheumatol. 2013; 25 (3): 345-53.

4. Chou Y, Lai K, Chen D, et al. “Rheumatoid Arthritis risk associated with periodontitis exposure: a nationwide, population-based cohort study. 2017

5. Eustice C. “Eliminating Inflammation Associated with Gum Disease has Side Benefits. Oct. 27, 2016.

6. https://www.verywell.com/rheumatoid-arthritis-and-gum- disease. Article covering study: Periodontal Therapy Reduces the Severity of Active Rheumatoid Arthritis in Patients Treated With or Without Tumor Necrosis Factor Inhibitors. 2009, Vol. 80, No. 4. Ortiz P., et al.

7. http://www.joponline.org/doi/abs/10.1902/jop.2009.080447

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