# Friday, March 17, 2017
Gum Disease & RA
Most people realize that poor oral health can lead to dental problems such as tooth decay, gum disease, cavities and bone deterioration. Not going to a dentist and receiving adequate dental care usually leads to nasty complications down the road.

In fairly recent years we have also been gaining a clearer understanding on the links between poor dental health and various ailments such as heart disease, risk of stroke, diabetes, dementia, and even some respiratory problems.

In this article, we specifically examine the relationship between gum disease and rheumatoid arthritis, or "RA".

What is Rheumatoid Arthritis?

Rheumatoid arthritis is an autoimmune disorder, whereby your immune system mistakenly attacks tissues in your own body. This results in chronic inflammation of lining in the joints, and in some cases can affect your skin, lungs, heart and eyes.

Rheumatoid arthritis results in painful swelling of the joints, and can be debilitating in more severe cases.

The joints most often affected are the smaller ones such as fingers, toes and wrists.

What is Gum Disease?

Gum disease, also known as periodontal disease, is most likely caused by a build-up of bacteria in the mouth. These bacteria accumulate in plaque, which is the sticky substance you get on your teeth when you haven't brushed in awhile.

Plaque that is not removed results in swollen, inflamed gums that will bleed if brushed hard. This condition is referred to as "gingivitis", and it is a mild form of gum disease. At this point, there has not been any permanent damage done. Regular flossing and brushing, along with cleaning by a dentist or dental hygienist, will alleviate this condition.

If the gingivitis is not taken care of then the next stage of gum disease is periodontitis. Periodontitis involves the inner layer of gums and bone pulling away from the teeth, resulting in gaps where food stuffs can accumulate. The result is more inflammation and further breakdown of the bone and connective tissue that hold teeth in place.

There are other factors besides plaque buildup, however, that can contribute to gum disease. Just some of these factors are hormone changes, diabetes, prescription medications, and diseases/conditions that compromise the immune system such as HIV/AIDS, cancer, etc.

How are Gum Disease and Rheumatoid Arthritis Related?

We have known for quite a long time now that oral health has a direct and significant impact on our overall physical health. Literally thousands of studies have examined the correlation between oral problems and disease in some form or manner.

Studies going back as far as the 1980s have identified a definite correlation between gum disease and rheumatoid arthritis.

Initially medical professionals assumed that periodontal disease was caused by either the arthritis or the drugs being used to treat the RA. This assumption makes sense when you think about what is going on. Rheumatoid arthritis is characterized by chronic inflammation of tissue in joints. Gum disease is also characterized by chronic inflammation of the gums. Why couldn’t RA cause gum disease? In addition, many prescription drugs cause dryness of the mouth, limiting the amount of protective saliva available to the gums.

As more studies were done on RA and gum disease, however, a more complex relationship between the two began to emerge. For example, some studies found that periodontal disease sometimes actually preceded the onset of rheumatoid arthritis.

According to Clifton O. Bingham III (associate professor of medicine and director of the Johns Hopkins Arthritis Center), there are similarities between the tissue in the mouth and joint tissues that are affected by this chronic inflammation. He also found that the levels of pro-inflammatory proteins (e.g. tumor necrosis factor, interleukin-1, etc.) are also similar in gum disease and rheumatoid arthritis.

A study published in the National Center for Biotechnology Information in 2015 found that:
  • Gum (periodontal) disease is common during all stages of rheumatoid arthritis, especially during the early stages.
  • The inflammation associated with the gum disease may play a role in the development of rheumatoid arthritis and augment systemic inflammation that propagates disease.
  • Specific strains of oral bacteria, such as P. gingivalis, along with local inflammations may result in citrullination events that negatively affect our immune systems.
  • Recent studies indicate complex interactions between the oral microbiome (the bacteria present in the mouth) and the body’s immunological mechanisms, thereby demonstrating the need to evaluate this subject from multiple angles.

The Oral Microbiome

While more study is needed to further clarify the relationships between RA and oral health, one thing I’m sure we can all agree upon is the need to do everything we can to prevent gum disease from occurring.

Regular flossing plays an important part for avoiding chronic gum infection. Daily brushing of the teeth is also important. It is interesting to note that there have been studies that have found that excessive toothpaste use is not good for our overall oral health (click here for more).

And this brings us to the oral microbiome, or the bacteria inside of our mouths. The oral biome is very similar (and actually connected) to the gut biome. If you do not have the right type and amount of bacteria in your mouth you may end up with serious problems. For this reason, using a strong mouthwash that kills all bacteria on a regular basis may actually be bad for you. Dr. Weinberg, an associate dean at the Case Western Reserve University School of Dental Medicine, has stated that: "You don't want a sterile mouth; you want a mouth that has primarily good bacteria in it, in order to keep exogenous microorganisms out and prevent them from colonizing the mouth"1

Author’s note: I’ve been using a neem mouthwash that is an Ayurvedic herb for about a year now and have noticed an improvement in my oral health. I also have friends that use a warm solution of salt water that seems to work. If you like natural remedies check out this web page with homemade mouthwash recipes.

Unlike the gut biome, however, probiotics are not effective when restoring the oral biome to optimal health.
And here’s another interesting tidbit: according to Dr. Gerry Curatola (the founder of Rejuvenation Dentistry), improving your gut biome health may actually help to restore your oral biome2!

We leave it up to you, the reader, to do further research into optimizing your oral biome.   


We hope you’ve found this article about gum disease, rheumatoid arthritis and dental care useful.

If you do not have any dentalcare coverage and would like to find out how to get health and dental insurance, please contact us. As experienced Canadian health insurance brokers, we can help. You are also welcome to get as many free, online health and dental insurance quotes as you want, at no obligation.


1    http://www.drbicuspid.com/index.aspx?sec=spt&sub=apr&pag=dis&itemid=309686
2    http://articles.mercola.com/sites/articles/archive/2014/11/30/importance-oral-microbiome.aspx

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