Mounting evidence is linking moderate to severe perodontitis to several health conditions, including cardiovascular disease. According to the new research presented this week at the American College of Rheumatology Annual Scientific Meeting in Philadelphia, moderate to severe perodontitis may also be linked to the development of rheumatoid arthritis.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by rheumatoid arthritis (RA), inflammation can develop in other organs as well. An estimated 1.3 million Americans have rheumatoid arthritis (RA), and the disease typically affects women twice as often as men. 

The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection characterized by inflammation that affects the gums and bone supporting the teeth. Periodontal disease begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

Periodontal Disease and Rheumatoid Arthritis Study

The joint connection between rheumatoid arthritis (RA) and periodontal disease is due to similar pathologies; damage caused by the immune system and chronic inflammation are central to both diseases.

Researchers recently set out to determine the risk for developing rheumatoid arthritis (RA) based on periodontitis as well as asses the levels of protein-attacking antibodies and rheumatoid factor in these patients.

The researchers studied 6,616 people who were a part of a separate epidemiological study who had been examined four times between 1987 and 1998. Each individual was assessed for periodontal disease between 1996 and 1998.

Each participant was characterized as having no, mild, moderate or severe periodontitis and either prevalent rheumatoid arthritis (RA) (having been hospitalized with a diagnosis of rheumatoid arthritis (RA) within the nine years before their periodontal exam) or new rheumatoid arthritis (RA) (having been hospitalized with a diagnosis of rheumatoid arthritis (RA) within eight years after their periodontal exam). In addition, researchers performed anti-cyclic citrullinated peptide antibody tests on blood samples collected during their study visits.

The risk of developing rheumatoid arthritis (RA) was over twice as high in persons with moderate to severe periodontitis, compared to those with no-mild periodontitis. The risk of developing rheumatoid arthritis (RA) was even higher among non-smokers with moderate to severe periodontitis compared to non-smokers with no to mild periodontitis.

People with peridontitis were also more likely to develop higher levels of the anti cyclic citrullated antibody, which has been associated with more severe, damaging rheumatoid arthritis (RA). Those individuals with positive anti-cyclic citrullinated antibodies were more likely to have moderate to severe periodontitis and to be smokers than those who did not have both of those putative rheumatoid arthritis (RA) risks.

The researchers conclude that moderate to severe periodontitis may be a risk for developing rheumatoid arthritis (RA), in non-smokers, and that it may increase the risk of anti-CCP antibody positivity in smokers.

"Moderate to severe periodontitis, a chronic infectious disease of the gums leading to loosening of the teeth, may also increase the risk of developing rheumatoid arthritis," explains Jerry A. Molitor, MD, PhD; associate professor, department of medicine, division of rheumatology and autoimmune disease, University of Minnesota Minneapolis, Minn., and lead investigator in the study.

"Furthermore, among those who smoke, moderate to severe periodontitis may increase the risk of developing a specific type of antibodies associated with more severe, damaging rheumatoid arthritis. These studies point out the importance of further studies into how periodontitis may predispose to rheumatoid arthritis (RA), and the possible value of dental care in prevention of rheumatoid arthritis (RA)."

Rheumatoid Arthritis and Oral Health

The relationship between rheumatoid arthritis (RA) and periodontal disease is not just one way. A study published in the Journal of Periodontology found that people with rheumatoid arthritis (RA) were twice as likely to have periodontal disease with moderate to severe jawbone loss. In fact, they averaged 11.6 missing teeth versus 6.7 in the control group. Therefore it is very important that if you have been diagnosed with rheumatoid arthritis (RA) or have rheumatoid arthritis (RA) in your family that you pay special attention to your teeth and gums.

A study published in the Journal of Periodontology found that people with rheumatoid arthritis were twice as likely to have periodontal disease with moderate to severe jawbone loss. In fact, they averaged 11.6 missing teeth versus 6.7 in the control group.

Miantaining Healthy Gums and Good Health

The evidence indicates that if you practice good oral hygiene, which means brushing and flossing after every meal, you may lower your risk of developing or have a better control of other medical issues such as heart disease and other inflammatory diseases.

To maintain good health always brush and floss after each meal and look for signs of periodontal disease, such as red, swollen gums that bleed easily. The earlier you detect periodontal disease and treat it, the better off you are.

Preserving your Teeth and Gum Health

Most people have some sort of periodontal disease. If undetected or left untreated - and these diseases are usually painless at first - the support for the teeth in the jaw bone is destroyed. At later stages this causes the teeth to become loose or painful. In addition, gum disease can cause bad breath and change the appearance of your smile. By being proactive and addressing periodontal (gum disease) your smile may last a lifetime. If caught in the earlist stages all you may need is instructions on how to care for your teeth, or a better teeth cleaning which your primary dentist may not be giving you.

The most important thing in preventing periodontal disease is to manage it and the first step in doing so is to have an experienced and qualified periodontist in your corner.

Dr. Sam Khorsamdi, DDS

The most important thing in preventing periodontal disease is to manage it and the first step in doing so is to have an experienced and qualified periodontist in your cor]ner. If you are in the Los Angeles are and want to be evaluated for periodontal disease and discuss the viable treatment idetime.  for periodontal disease, such as scaling and root planing (or Soft Tissue Management), or periodontal surgery, I would highly recommend visiting Dr. Sam Khorsandi. is conveniently located in Encino, California.