Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the joints, leading to pain, swelling, and eventual joint damage. While you may have previously heard that the cause of RA is unknown, there is a growing body of research that suggests some possible reasons. We have already discussed diet, RA, UTIs, antibiotic use, and today we will consider how oral health and dental issues may play a significant role in triggering an initial RA flare-up. Let’s dig in!
How Oral Health Affects the Body
The connection between oral health and systemic diseases has been well-documented in recent years. The mouth is a gateway to the body, and has its own microbiome. Issues with oral health, particularly infections or gum disease, can have far-reaching consequences. Poor oral hygiene can lead to the buildup of harmful bacteria in the mouth which then can access the intestinal tract, and eventually enter the bloodstream, leading to systemic inflammation.
Periodontal disease, a chronic infection of the gums, is one of the most significant dental conditions linked to systemic diseases, including RA. This condition occurs when bacteria accumulate below the gum line, leading to inflammation and infection. Over time, the immune system reacts to these bacteria, which can trigger inflammation throughout the entire body.
One key player in the connection between dental health and RA is a bacterium called Porphyromonas gingivalis. P. gingivalis produces an enzyme called peptidylarginine deiminase (PAD), which can modify certain proteins in the body. These modified proteins can be mistaken as foreign invaders by the immune system, leading to the production of autoantibodies characteristic of RA. This autoimmune response can result in the inflammation and joint damage seen in RA patients. In some cases, this process may even trigger the initial onset of RA. Therefore, in individuals diagnosed with advanced gum disease, this bacterium, p. gingivalis, which is associated with periodontitis (advanced gum disease), should be taken quite seriously as it has been shown to play a role in the development and progression of RA.
Just How Can Dental Issues Trigger an RA Flare-Up?
When the body is fighting an infection, such as periodontal disease, it responds by increasing inflammation, which is a natural part of the immune response. However, this increased inflammation can act as a catalyst for an RA flare-up if not kept in check. Following are some potential ways dental issues can contribute to an RA flare-up:
Systemic Inflammation: As already mentioned, infections in the mouth can lead to systemic inflammation. If the immune system is already compromised, this additional inflammation can overwhelm the body’s natural defenses, leading to an exacerbation of RA symptoms.
Immune System Activation: Dental infections or gum disease can cause the immune system to become hyperactive, which may worsen autoimmune responses in RA. The presence of oral bacteria like P. gingivalis can also increase the production of inflammatory cytokines and autoantibodies, fueling an RA flare.
Delayed Diagnosis: Dental problems may not always be immediately connected to RA. Therefore, chronic oral infections might go untreated, leading to prolonged immune activation and a greater risk of triggering or worsening RA flares.
What are some steps to maintain oral health and potentially reduce RA flare ups?
Avoid Sugar: Sugar inhibit proper immune system functioning. With the holidays right around the corner, we will soon be bombarded with tasty, sugary treats almost everywhere.
I was at the dentist office the other week and he asked me, “What is the worst food to eat?” Without hesitation I answered, “Sugar.” He then proceeded to tell me of another dentist that does a lot of dental mission work in Africa. She said, that after four hours into the bush she started see a significant decrease in dental caries. Six hours into the bush the natives had no significant amount of dental caries. Six hours into the bush, sugar has fallen out of the diet. Sugar is in most of our package foods.
Maintain a Balanced Diet: Shopping and eating from the fresh food area and other single ingredient, healthy options will help decrease the risk of RA and RA flare ups. A healthy diet, rich in nutrients, can help support oral health and reduce inflammation, further minimizing the risk of RA flares.
Maintain Good Oral Hygiene: A consistent oral hygiene routine helps to remove plaque, prevent gum disease, and reduce the buildup of harmful bacteria in the mouth.
Regular Dental Check-ups: Routine dental visits allow for early detection of gum disease or other dental problems, enabling timely intervention before complications arise.
Treat Gum Disease or other Dental Issues Promptly: If a dental issue arises, such as gum disease, it is important to treat it as soon as possible to minimize systemic inflammation and reduce the risk of triggering an RA flare-up.
Quit Smoking: Smoking has been linked to both periodontal disease and RA. Quitting
smoking can lower your risk for both conditions and improve overall health.
The link between dental problems and RA is complex but compelling, highlighting the importance of maintaining good oral hygiene for overall health. Understanding that the mouth has its own microbiome which can become imbalanced, can hopefully help us be more cognizant about how we feed our mouth microbiome and the impact our mouth can have on our total wellness. How it is treated can improve our health or potentially give rise to disease. The choice is our to make.
The connection between dental issues and rheumatoid arthritis is a fascinating area of research that underscores the importance of oral health in managing and potentially preventing autoimmune diseases.
For individuals with RA or those at risk, maintaining good oral hygiene can be a key step in reducing inflammation and preventing flare-ups.
Taking care of your teeth and gums is not just about your smile—it’s about protecting your overall health, including your joints.
Blue Skies,
Dana West, RDN, LD, DIPACLM
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