Rheumatoid Arthritis: Oral Considerations

Published on May 18, 2012 by

Rheumatoid Arthritis (RA) is an autoimmune disease affecting multiple organ systems, although the principle characteristic is persistent inflammatory synovitis. The synovitis and subsequent joint pain and destruction can vary widely among patients. RA affects women three times more frequently than men, and the majority of patients are in the fourth or fifth decades at the time of diagnosis.
Although oral signs of RA are uncommon, oral complications to RA treatment do occur. Approximately 50% of individuals with RA will have TMJ involvement. However, less than half this number will develop symptoms such as joint stiffness, TMJ pain, and limited range of motion. A small number of individuals with RA have aggressive and progressive TMJ destruction, leading to fibrosis, ankylosis, and anterior open bite due to condylar destruction. When Sjorgen’s syndrome occurs with RA, xerostomia can increase the risk for caries and periodontal disease. One report exists that suggests that alveolar bone loss may be a complication of RA independent of xerostomia.
 
In most individuals with RA, the condition will not require changes in routine dental care. However, considerations will include the individual’s ability to maintain good oral hygiene, address the associated xerostomia (dry mouth) and its related complications, the individual’s susceptibility to infections, impaired homeostasis, and unpleasant drug actions and interactions. Individuals with RA may require antibiotic prophylaxis owing to joint replacement and/or immune suppression procedures. Intra- and extra-oral conditions such as ulcerations, gingival overgrowth, disease-associated periodontitis and temporomandibular joint (TMJ) pathology also need to be recognized and addressed with the help of a health care professional. If an individual’s manual dexterity is compromised, their ability to clean their teeth can be significantly reduced. Customized toothbrush holders, irrigation and other devices, such as a floss holder, have proven to be beneficial for these RA individuals. If xerostomia is present, caries prevention should include dietary changes, the use of fluoride, and dental sealants that are applied by the dentist if and where appropriate.

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