Patients with rheumatoid arthritis (RA) show elevated frequency of dental visits, but also an increased incidence of dental disorders, according to a study published December 15 in BMC Oral Health. The disorders include dental caries, pulpitis, gingivitis, periodontitis, and oral ulceration.
"There is a very close and complex relationship between periodontitis and RA," wrote the authors, led by Ching-Ya Juan of Dalin Tzu Chi Hospital in Chiayi, Taiwan. "Both periodontitis and RA shared similar pathogenesis, including imbalance between pro- and anti-inflammatory cytokines, the role of smoking, microbial dysbiosis especially Porphyromonas gingivalis, and genetic background."
Juan and team assessed utilization of dental care services in 1,337 patients with newly diagnosed rheumatoid arthritis between January 2000 and December 2012. These patients were compared to a subset of 13,370 healthy individuals, matched to age and sex.
Prevalence of dental visits among rheumatoid arthritis patients was higher than in the healthy cohort, at 70.3% compared to 66.7%. Frequency of visits was also higher, at 2.67 visits per year compared to 1.78.
Patients with RA also had higher incidence of dental caries, pulpitis, gingivitis, periodontitis, and oral ulcers, but not temporomandibular joint disorders, compared to healthy controls. The findings were especially notable in female patients, the authors wrote.
Importantly, patients with a primary diagnosis of Sjögren's syndrome were excluded from this study, since Sjögren's is known to be a strong risk factor for developing caries. However, patients in the study may have had secondary Sjögren's syndrome, and hyposalivation could be a shared risk factor for both RA and dental diseases, the authors noted.
"Both the rheumatologist and dental professionals should assess the oral health condition regularly in patients with RA," the team concluded.
