How Ankylosing Spondylitis Affects Your Oral Health

Ankylosing spondylitis can affect your teeth, gums, and many areas of your mouth.

This disease and the common drugs that treat it can change the health of your mouth. At the same time, pain and stiffness can make it hard to brush and floss. The effect can make it challenging to maintain good oral health.

This article describes how this disease affects your mouth, common oral problems that can occur, and ways to improve and maintain good oral health if you have this illness.

Ankylosing Spondylitis and Teeth Problems

Ankylosing spondylitis is linked with oral issues that cause teeth problems.

In a 2021 study in the Journal of Clinical Medicine, researchers reported that higher disease activity levels were linked with lower numbers of remaining original teeth. However, the link between ankylosing spondylitis and tooth loss is complex.

The increased risk of tooth problems with ankylosing spondylitis is often linked to secondary factors related to the disease. The effects of some medications for ankylosing spondylitis compromise your immune system and make you more susceptible to mouth infections from bacteria, viruses, or fungi. These conditions can destroy the soft tissue and cause degeneration of the jawbone that supports your teeth.

Other drug side effects, like dry mouth, increase your risk of cavities by allowing plaque buildup to remain on your teeth, which promotes cavities. At the same time, restrictions in movement can interfere with your ability to brush and floss properly, increasing your risk of tooth decay.

Secondary osteoporosis and brittle bones can also occur with ankylosing spondylitis. These conditions can result in poor bone quality, leading to tooth loss. Some drugs that treat osteoporosis can also contribute to tooth loss by promoting osteonecrosis, a disruption of the blood supply to the bone tissue, which can cause the crumbling of the bone that supports your teeth.

Oral Health Conditions That Can Occur With AS

Many factors contribute to the development of oral health conditions. In addition to risk factors like age, poor dental hygiene, and unhealthy diet, research shows that having ankylosing spondylitis may also be a factor in the occurrence of these conditions.

A 2019 Journal of Applied Oral Science study reported that participants with ankylosing spondylitis generally had a higher prevalence of oral conditions compared to the control group that did not have the disease.

Gingivitis and Periodontitis

Research shows that people with ankylosing spondylitis have a significantly higher risk of gum disease, also known as periodontal disease. These problems can include gingivitis, a mild inflammation of the gums, or gingiva. Without treatment, it can lead to periodontitis, a more advanced form of gum disease that can cause severe complications like tooth loss.

A 2015 systematic review of the link between ankylosing spondylitis and periodontitis reported that having the disease was linked with a risk of periodontitis that was almost double that of people without the disease in case-control studies. A subsequent systematic review in 2020 yielded similar results that showed a higher prevalence of periodontitis among people with ankylosing spondylitis.

Research also shows that rheumatic diseases, like ankylosing spondylitis and rheumatic arthritis, can be related to inflamed gums and tooth loss. Inflamed gums are symptoms of gingivitis and periodontitis.

Preventing gingivitis and periodontitis is important to your oral health. In its early stages, gingivitis can often be treated without major problems. However, periodontitis can damage the soft tissue and bone that holds your teeth in place if it progresses to periodontitis. Without this firm anchor, your teeth can loosen and eventually fall out.

Oral Ulcers

Oral ulcers are painful sores that occur as breaks in the tissue lining of your mouth. They can develop inside your cheeks, lips, tongue, or gums. Oral ulcers can appear alone or in clusters.

In a 2019 study of the link between ankylosing spondylitis and oral health conditions, researchers identified a strong link between the disease and oral ulcers. Researchers concluded that people with ankylosing spondylitis have an increased risk of oral ulcers. The finding was consistent with the fact that oral ulcers have also been linked to other rheumatic diseases like reactive arthritis.

There are many causes of oral ulcers, including side effects of certain drugs used in spondylitis treatment. Oral ulcers are a recognized side effect of methotrexate, even at lower doses. Methotrexate is an immunosuppressant drug that reduces pain and swelling in ankylosing spondylitis. It can also help slow disease progression.

Temporomandibular Joint Dysfunction

Temporomandibular (TMJ) dysfunction occurs when there is a problem with the temporomandibular joint. This joint is on each side of your head, in front of your ears. It joins your lower jaw to your skull and allows you to open and close your mouth.

TMJ dysfunction is commonly linked to rheumatoid arthritis. Research indicates it can also be involved in ankylosing spondylitis, though it is less common than in rheumatoid arthritis. The reason for this link is unclear, though factors such as joint degeneration may contribute to the condition.

In a cross-sectional study of the prevalence of TMJ dysfunction in patients with ankylosing spondylitis, patients with the disease had a higher prevalence of the disorder. TMJ dysfunction occurred in up to 59% of people with ankylosing spondylitis. Those who had TMJ dysfunction had degenerative forms of the disease.

Sjogren's Syndrome

Sjogren's syndrome is an autoimmune disease that attacks the glands that make tears and saliva. The condition can cause dry mouth and dry eyes. It can also cause dryness in places that need natural moisture, such as your throat, nose, and skin.

Sjogren's syndrome can be a primary disease or secondary to another autoimmune disease like ankylosing spondylitis. It can also occur as a side effect of certain medications.

A study of the prevalence of Sjogren's syndrome in people with ankylosing spondylitis showed a high incidence of Sjogren's syndrome in people with ankylosing spondylitis. In a study group of 143 patients, 10% were diagnosed with Sjogren's syndrome.

The lack of saliva created by Sjogren's syndrome can result in the following oral health complications:

• Oral infections
• Angular cheilitis (inflammation in the corners of your mouth)
• Mucositis (inflammation of the inside of your mouth)
• Traumatic oral lesions
• Problems wearing oral prostheses
• Tooth decay and cavities
• Gum disease
• Difficulty eating, swallowing, and speaking

Oral Candidiasis

Oral candidiasis, commonly referred to as thrush, is caused by a yeast called Candida. It normally lives in your mouth, throat, gut, and other places without problems but can cause an infection if the environment changes to accommodate fungal growth.

Oral candidiasis can include the following symptoms:

• White patches on the tongue, inner cheeks, throat, and roof of the mouth
• Redness or soreness
• Cotton-like feeling in the mouth
• Loss of taste
• Pain while swallowing or eating
• Redness or cracking at the corners of your mouth

Dry mouth that occurs due to Sjogren's syndrome and some medications that treat ankylosing spondylitis can create an environment favorable to developing an oral candidiasis infection.

Researchers have identified a decreased response to fungi among a class of new anti-inflammatory drugs, called interleukin-17, or IL-17 inhibitors, which treat ankylosing spondylitis symptoms. These drugs include secukinumab and ixekizumab. Though these drugs present an increased risk of fungal infections, researchers concluded that this side effect was manageable in comparison to the actions of the medications.

Difficulty in the Dental Chair

Ankylosing spondylitis can make it impossible to move your head, neck, and body freely. This can make it difficult to sit in a dental chair. The effect can interfere with your ability to get proper dental care to prevent or treat oral problems.

Ankylosing spondylitis can affect your experience in the dental chair in the following ways:

• Spinal stiffness, pain, and calcification of the spine can cause a hunched back, making it challenging to lay back in the position most dental chairs require.
• Decreased lung function and/or heart disease that may exist as complications of ankylosing spondylitis may interfere with your ability to receive anesthesia in a dental office setting safely.
• Having ankylosing spondylitis often requires constantly moving and readjusting the position of your neck, shoulders, and spine to accommodate pain, making it difficult for a dental professional to administer treatment.
• Temporomandibular disorders that can occur with ankylosing spondylitis can limit movement of your jaw muscles, temporomandibular joints, and nerves of the face, making it difficult to open your mouth for treatment fully.
• Biologics that treat symptoms of ankylosing spondylitis and other types of arthritis can suppress your immune system, making you more susceptible to bacterial infections during dental procedures.
• The fatigue that occurs with ankylosing spondylitis can make it difficult to endure the long periods of treatment required to complete many types of dental procedures, requiring multiple appointments or frequent breaks.

Though these aspects of ankylosing spondylitis can make it challenging to receive comprehensive dental care, they can be addressed without jeopardizing your health. Your healthcare provider can help you identify the specific types of problems that you may encounter in the dental chair so you can discuss them with your dental professional.

Oral Health Care Tips for Ankylosing Spondylitis Patients

Though ankylosing spondylitis may increase your risk of dental problems, you can protect your oral health and reduce your need for restorative dental treatments.

Follow these tips to protect your oral health:

• Brush your teeth twice daily with fluoride toothpaste for two minutes each time.
• Use a battery-powered toothbrush if holding a regular toothbrush is too difficult or painful to manage.
• Floss daily.
• Use an antimicrobial mouthwash to reduce your risk of gum disease.
• Eat a healthy diet that limits sticky candy, starchy foods, and snacks and beverages that are high in sugar.
• Use sugar-free gum or lozenges to increase saliva flow.
• Visit your dentist regularly, which may be twice annually or more frequently, based on your oral condition.
• Don't smoke cigarettes or use smokeless tobacco products.

Summary

Ankylosing spondylitis or any other systemic illness can increase your risk of oral problems like tooth loss and gum disease.

Though this disease mainly causes joint pain and stiffness in your lower back, it can also affect other body parts. It can impact many areas of your mouth, such as your teeth, gums, and oral tissue.

It is not fully known how the disease is linked to oral health. The effects of the disease or common drugs that treat it can cause changes in your mouth. These changes, like dry mouth, can increase your risk of dental problems like gum disease and tooth decay. 

Joint stiffness makes the problem worse, which can affect how you move your hands. The pain and stiffness common with this disease can make it difficult to brush and floss daily. This can make it harder to follow the advice that supports a healthy mouth.

A Word From Verywell

Though the chronic pain of ankylosing spondylitis can affect your quality of life, it's important to maintain other aspects of your health, including your teeth and gums. Good oral health is linked with overall health and well-being.

Finding ways to brush and floss regularly can help prevent the need for dental procedures. In many cases, restorative dental care requires lengthy procedures that can be uncomfortable if you suffer back and neck pain.

When it's time for your dental exam, find a dental professional who can accommodate your concerns and physical needs. Preventive dental care takes little time and effort compared to the more complex dental procedures needed to treat the effects of poor oral hygiene.