Gum Disease Bacteria Triggers Joint Inflammation, Latest Research Suggests

     Your mouth is a busy place, with millions of bacteria constantly on the move. While some bacteria are harmless, other bacteria multiply and produce toxins that can sneak in beneath the gumline, breaking down the bone and connective tissue in and around the teeth leading to periodontal (gum) disease. Left unchecked, gum disease can progress to the point where bone and connective tissue are destroyed, and teeth become loose and may have to be removed.

     This bacterial inflammatory process may play a key role in the onset and progression of rheumatoid arthritis (RA), an autoimmune condition affecting about 1% of the population. Rheumatoid arthritis is a debilitating, joint destroying condition where the body's immune cells attack the joints, causing chronic inflammation, swelling, pain and stiffness. Patients with RA are eight times more likely to have periodontal disease. For years, doctors and dentists have observed that people with RA tended to have more periodontal disease, and people with periodontal disease tended to have more RA. It was assumed that periodontal disease was a result of RA itself (stiff, painful hands made oral hygiene difficult) or the medications to treat RA (drugs that suppressed the immune system inhibited the body’s ability to fight harmful bacteria in the mouth). Furthermore, some people with RA have diminished production of the mouth’s protective saliva, leaving it vulnerable to periodontal disease.

     Recent research suggests the connection is much more complicated.  More and more, scientists are finding that the accumulation of mouth bacteria may trigger the development, or influence the progression, of RA. Here is a summary of some of these studies:

• At least two studies found that tooth loss, a marker for gum disease, may actually predict RA and its severity, with the more teeth lost, the greater their risk for joint inflammation. 
• Several recent studies reported the presence of high levels of antibodies to oral bacteria as well as the presence of virulent perio pathogens in the synovial (joint) fluid of people with RA. The authors concluded that the perio pathogens were directly associated with the development of rheumatoid arthritis.
• Another interesting study found that a specific perio pathogen is the only microbe known to produce an enzyme capable of modifying specific proteins resulting in an autoimmune response to these proteins. This culminates in the joint destruction typically seen in RA patients. 
• Other researchers have examined the possibility that treating periodontal disease in patients with RA could alleviate RA symptoms. They found that study participants who had a professional "deep" non-surgical cleaning at the dental office had significantly less pain and morning stiffness and fewer swollen and painful joints than the group that simply cleaned their teeth at home. Even more impressive, researchers found that the deep cleaning actually decreased levels of an inflammatory protein in the blood that triggers inflammation. 

     There are still many unanswered questions. Not everyone with gum disease develops RA, and not everyone with RA had previous gum disease. However, with such a high prevalence of periodontal disease in patients with RA, a highly plausible biological connection between these two inflammatory disease processes, and evidence of a link between RA and gum disease, we strongly suggest that people who have RA, periodontal disease, or both be diligent in taking care of their oral health.

     If you have RA or periodontal disease we encourage you to do everything possible to improve and maintain your oral health. Schedule regular dental exams and cleanings, eat healthfully, brush and floss and, if you have trouble taking care of your teeth due to stiff, painful hands or jaws, speak us about ways to make dental care easier, including the use of special assistive devices. Prevention and early treatment of periodontal disease is our goal.

     Do you know someone with RA or periodontal disease? We invite you to share this article with them. The team at Jeff M. Morrison & Assoc. DDS has expertise in successfully treating periodontal disease and, as always, we  welcome new patients. Questions?  Would you like to make an appointment?  We invite you to get in touch!  

Sources:

Konig MF, Abusleme L, Reinholdt J et al. Aggregatibacteractinomycetemcomitans–induced hypercitrullination links periodontal infection to autoimmunity in rheumatoid arthritis. Science Translational Medicine . 2016.

Research suggests that taking care of your teeth may be a good way to take care of your joints. Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/comorbidities/gum-disease/ra-and-gum-disease.php

http://www.arthritis.org/living-with-arthritis/comorbidities/gum-disease/dental-care-relieves-ra-pain.php.  Treat Gum Disease to Relieve RA Pain and Stiffness:  A thorough dental cleaning can control symptoms.

http://www.dentaleconomics.com/articles/print/volume-100/issue-11/for-your_practice/periodontal-disease-and-rheumatoid-arthritis.html