Impact of Oral Health on Rheumatoid Arthritis

Abstract

This is a narrative review describing how oral infections and diseases associate with rheumatoid arthritis. From the voluminous oral microbiom, bacteria can get access to circulation through inflamed periodontal tissue, oral mucosa, and carious teeth. This results in upregulation of a number of chemokines and cytokines that often cause chronic, subclinical systemic inflammation with consequent organ pathology. The periodontal pathogen Porphyromonas gingivalis was observed to cause citrullination of proteins that play a role in the development of arthritis by generating of specific autoantibodies such as anti-citrullinated peptide antibody. These migrate and form immune complexes at the synovial membrane of joints. In general, patients with rheumatoid arthritis should have a healthy mouth. Dry mouth is a symptom seen among many patients with rheumatic diseases, also rheumatoid arthritis. Because saliva is one of the principal defense factors of the mouth, hyposalivation renders the patient liable to oral diseases. Consequently, the patients must drink enough daily and use saliva substitutes when necessary, and, above all, maintain good oral hygiene daily. In rheumatoid arthritis, manual dexterity may be impaired, however, causing cleaning the teeth difficult. Hence, patients with rheumatic diseases like rheumatoid arthritis need counseling and individual oral health care instructions by oral health care professionals for implementation at home. An electric toothbrush should be recommended. Regular oral health examinations by dentists are needed more often than among the healthy.