Why do rheumatoid arthritis and gum disease often go hand in hand? Learn about the significant connection between the two.

Brushing, flossing, and seeing your dentist regularly are especially important for people with rheumatoid arthritis.

Research studies show a strong connection between RA and gum disease, an inflammatory condition that can lead to tooth loss.

A German study published in the Journal of Periodontology showed that people with RA had more gum disease than people without RA — in fact, the RA patients had eight times the odds of developing gum disease.

And a report presented at the 2011 European League Against Rheumatism meeting found that of 95 patients with rheumatoid arthritis studied, 18 percent had severe periodontal disease and 32 percent had moderate periodontal disease.

By comparison, about 10 to 15 percent of adults without RA have moderate to severe periodontal disease.

Gum Disease and Rheumatoid Arthritis: The Inflammation Link

Rheumatoid arthritis is due to an overactive immune system, says Scott Zashin, MD, clinical associate professor of medicine at the University of Texas Southwestern Medical School and attending physician at Presbyterian Hospital in Dallas.

Doctors don’t know for sure how gum disease and RA are linked, but the diseases have inflammation in common, which may explain the connection.

Inflammation is a protective immune system response to substances like viruses and bacteria. In autoimmune diseases like rheumatoid arthritis, the immune system mistakenly triggers inflammation, although there are no viruses or bacteria to fight off. In RA, the inflammation causes joints to become swollen, painful, and stiff.

Dr. Zashin says it’s possible that the immune system is stimulated by mouth inflammation and infection, “setting off a cascade of events where inflammation develops at the site of joints or arthritis.” He says controlling the inflammation through better dental care could play a role in reducing the incidence and severity of RA.

In fact, another study also published in the Journal of Periodontology showed that when people with a severe form of rheumatoid arthritis cleared up their gum disease, their pain and other arthritic symptoms got better. Researchers from the Case Western Reserve University School of Dental Medicine and University Hospitals of Cleveland studied 40 people with moderate to severe gum disease and severe RA. To control RA, patients either received standard RA treatment or standard treatment plus anti-tumor necrosis factor-alpha (anti-TNF-alpha) medications. Patients were then randomly selected to receive non-surgical periodontal treatments for their gum disease. Both the standard RA treatment and anti-TNF-alpha treatment patients whose gum disease was treated reported significant improvements in their RA symptoms compared to those who did not receive treatments.

Dental Care for People With Rheumatoid Arthritis

Gum disease ranges from gingivitis, a mild form that causes swollen, tender gums, to more serious forms like periodontitis, in which inflammation affects the tissue and bone supporting the teeth. Some people with RA also develop Sjogren's syndrome, an autoimmune disease of the glands, which causes dry mouth and increased tooth decay.

If you have gingivitis, it can be reversed with twice-yearly dental cleanings and good at-home care. People with more severe gum disease need treatment from a periodontist, or gum specialist.

Zashin says rheumatologists should include good dental practices in their recommendations to patients. However, people with RA sometimes have a hard time maintaining good oral hygiene because the disease can affect the joints in their hands, making brushing and flossing difficult. “Electric toothbrushes can be a great help to patients who have trouble brushing,” Zashin says.

Here are some other tips from the American Dental Association to make dental care easier to manage:

• Reinvent your toothbrush. To better grip your brush, add a tennis ball or bicycle handle to the end.
• Experiment with new types of floss. Try floss holders, floss picks, or threaders.
• “Pump up” your paste. Toothpaste in a pump might be easier for you to use than a tube you have to squeeze.
• Make the most of mouthwash. Buy one with fluoride to protect your teeth from cavities.
• Don’t light up. Smoking is a big risk factor in developing gum disease, and it can interfere with the success of some treatments.
• Speak to your dentist. Tell your dentist about your rheumatoid arthritis. Sometimes shorter appointments scheduled later in the day when joints are less stiff can make you more comfortable. Ask for a neck or leg pillow for better support in the dentist’s chair.

Gum disease has been linked to other conditions like heart disease, stroke, and diabetes as well as RA. Taking care of your mouth may very well improve your overall health.