AB0201 “IT SURPRISED ME A LOT THAT THERE IS A LINK”: A QUALITATIVE STUDY OF THE ACCEPTABILITY OF PREVENTIVE PERIODONTAL TREATMENT FOR INDIVIDUALS AT-RISK OF RHEUMATOID ARTHRITIS

Abstract

BackgroundCurrent evidence suggests that periodontitis could be a causal risk factor for rheumatoid arthritis (RA) onset and progression, and periodontal treatment may improve disease activity in patients with established RA [1, 2]. Earlier periodontal intervention in individuals at-risk of RA could provide a unique opportunity to delay progression or prevent RA entirely.ObjectivesTo explore the acceptability of preventive periodontal treatment among individuals at-risk of RA and healthcare professionals from dental and medical backgrounds.MethodsThis was a qualitative study using a phenomenological approach. Anti-CCP positive at-risk individuals with musculoskeletal symptoms but no synovitis were recruited from the Leeds CCP cohort, and healthcare professionals were recruited through dental and rheumatology professional networks. Individual semi-structured interviews were conducted via video or telephone. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically.ResultsNineteen at-risk participants (ten women; age range 35-70) and 11 healthcare professionals (rheumatology clinicians, dentists, general practitioners, commissioners) participated. Three themes (six subthemes) were identified as important to understand factors that may influence participants’ acceptance of preventative periodontal treatment to reduce the risk of RA: i) understanding risk (knowledge of shared risk factors; information and communication); ii) oral health perceptions and experiences (personal challenges for dental intervention and oral health maintenance; external barriers); iii) oral health treatment and maintenance (making oral health changes to prevent RA; acceptability of participation in periodontal research to prevent RA). The majority of at-risk participants lacked awareness of the association between oral health and the risk of developing RA, and perceived a lack of knowledge of this link among dentists. Healthcare professionals highlighted disjoin between dentistry and medicine due to commissioning and financial barriers, and inadequate training. Preference for information provision relating to oral health as a risk factor varied extensively among all participants. At-risk participants discussed oral health issues, but oral health was less of a priority when compared to comorbidities that had a bigger impact on daily life, e.g. irritable bowel syndrome. Both groups of participants perceived that dental anxiety, the cost of dental treatment, and difficulty in accessing NHS dentists were barriers to seeking dental care. Participation in a clinical trial involving preventive periodontal treatment was perceived to be acceptable for most at-risk participants. Comparatively, taking medication to prevent RA was perceived to be less acceptable. Facilitators to trial participation included reducing risk, access to a dentist, and not having to pay for treatment. At-risk participants with dental anxiety indicated that seeing the same dentist at every visit was important.ConclusionThe impact of poor oral health may not be well understood by individuals at-risk of RA. Information relating to this risk factor should be tailored to the individual and is a key first step before clinical trial involvement. Whilst periodontal disease is common in individuals at-risk of RA, both at-risk participants and healthcare professionals identified that seeking dental treatment can be hindered by dental anxiety, treatment costs and a shortage of dentists. Future trials involving preventive periodontal treatment should take into account what has been identified as important by this group of individuals at-risk of RA.