If you have rheumatoid arthritis, you know that chronic inflammation is no laughing matter. But did you know that it can affect your smile?

I went to the dentist recently because I was experiencing extreme pain in and around my two back molars. I was sure that one of my crowns must have cracked, it was so painful. I was ready for him to tell me I had developed a bad cavity under the crown and that I was in need of a root canal. Two X-rays and a comprehensive exam later, however, the dentist gave me some surprising news: there was nothing he could do. There was no tooth decay and no gum disease; nor was there any problem with my crowns. My pain was being caused by chronic inflammation, most likely caused by my RA.

Getting to the Root of It: the RA and Dental Health Connection

According to medical research conducted by John Hopkins and others, there is a much higher prevalence of gum disease and tooth loss among people with RA than other healthy individuals. High levels of inflammation are present in both RA and periodontal disease, and while medical experts aren’t sure which occurs first, one disease negatively impacts the other. And just as inflammation causes bone erosion and soft tissue damage in the rest of the body, it impacts the jaw and mouth as well.

If someone with RA also suffers from Sjogren’s Syndrome as well, that complicates things further because inflammation of the salivary glands can cause dry mouth, speeding up the process that can cause gum disease and tooth loss.

When Opening Wide Hurts: TMJ

In addition to gum disease and tooth loss, those of us with RA are more prone to TMJ, inflammation of the temporomandibular joint and muscles used to open the mouth. When TMJ comes and goes with RA flares, anti-inflammatory medicine and moist heat applied to the jawline can help to ease the pain. However, any chronic jaw pain should be discussed with your dentist, as a bite guard may be necessary to keep the jaw muscles relaxed at night. In severe cases, where there is significant bone erosion in the jaw joint, surgery may be necessary.

Keeping a Healthy Smile

The good news is that regular checkups and professional cleanings, along with a good daily routine and a healthy diet (low in sugar), can keep most dental problems manageable. Brushing and flossing are very important, and I have found that desensitizing toothpaste helps to alleviate my tooth pain.

If you struggle with brushing due to pain and stiffness in your hands, using an electric toothbrush or a tennis ball attached to your toothbrush (for gripping) can help. Flossing wands and water picks may make it easier to keep your gums clean. If dry mouth is an issue, sucking on sugar-free candy or lozenges and using alcohol-free mouthwash can help.

As with any RA symptom, keeping your rheumatologist apprised of any dental issues is important as well. In addition to inflammation caused by the disease itself, dental issues can arise with the use of some medications. When it comes to keeping your smile on, a good partnership between you, your doctor and your dentist is the key!


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