Dr. McGlennen: Like periodontitis, rheumatoid arthritis (RA) is a chronic inflammatory condition. But unlike periodontitis, where the genesis of the inflammation is the complex infections in the gingival sulcus, the cause of RA is unknown. Recent studies, however, provide insights that, in part, oral bacteria play a role in evoking an abnormal immune response that then leads to joint disease. In a recent meta-analysis of 21 separate studies, there was a significantly increased risk of periodontitis in people with RA compared to healthy controls (relative risk: 1.13; 95% CI: 1.04, 1.23; p = 0.006; N = 153,277).1 The most prevalent pathogens found were Porphyromonas Gingivalis (Pg) and Fusobacterium nucleatum (Fn). Importantly, the infection and the antibodies against these bacteria are typically found before the onset of symptoms.2 The good news is that therapeutic reduction of bacterial load, as determined by molecular tests such as MyPerioPath®, may reduce symptoms and improve the prognosis of the arthritis.3
Many dental and medical practitioners are incorporating an overall health approach into their practices. We have invited one of those clinicians, Jill Wade DDS, to share how she communicates to a patient the link between periodontal pathogens and joint health.
Jill Wade, DDS: “Patient, as you may know arthritis is an inflammation that sets up in your joints. So why are we, your dental team, concerned about that? Well, periodontal disease is an infection around your gums and is ALSO a chronic inflammatory disease. ANY time that you can reduce inflammation in your body is a good thing. We now know that certain bacteria found in the mouth causing gum disease, such as Pg & Fn, can also complicate arthritis. Therefore, there is a huge benefit to optimize your oral health and reduce some of the bacterial burden. It will potentially help your overall health, reducing pain and inflammation in all your joints. Ultimately creating a better quality of life, which makes you smile more and that is what we are all about here, beautiful, happy and healthy smiles.”
- Fuggle NR, Smith TO, Kaul A, Sofat N. Hand to Mouth: A Systematic Review and Meta-Analysis of the Association between Rheumatoid Arthritis and Periodontitis. Front Immunol 2016; 7:80.
- Johansson L, Sherina N, Kharlamova N, et al. Concentration of antibodiesagainst Porphyromonas gingivalis is increased before the onset of symptoms of rheumatoid arthritis. Arthritis Res Ther 2016; 18:201.
- Khare N, Vanza B, Sagar D, Saurav K, Chauhan R, Mishra S. Nonsurgical Periodontal Therapy decreases the Severity of Rheumatoid Arthritis: A Case-control Study. J Contemp Dent Pract 2016; 17:484-8.