Does Rheumatoid Arthritis Affect Teeth?

People with rheumatoid arthritis (RA) tend to have higher rates of periodontal disease, which can involve gum inflammation (gingivitis) and infection of the tissues that support the teeth (periodontitis). Interestingly, research has shown that people with more pronounced gum disease also have more severe RA, and the connection ties back to a common factor: persistent inflammation.

Along with the risks this poses to your dental health, including tooth loss, untreated periodontal disease may also make certain RA medications less effective.

 Verywell / Madelyn Goodnight

How RA Affects Your Teeth

The link between rheumatoid arthritis and periodontal disease has been well established. RA is a systemic autoimmune inflammatory disease, and people with periodontal disease tend to have higher rates of chronic inflammatory diseases in general.

Some research has shown RA patients to be four times more likely to have gum disease than people without RA, and their gum disease tends to be more severe. Juvenile RA patients are at equal risk for periodontal disease as adults.

Unregulated inflammation in the body is a marker for both conditions, but as far as direct links between them, there appears to be a common inflammatory mediator.

Porphyromonas gingivalis (P. gingivalis), one of the main bacteria responsible for gum disease, is also a known contributor to the onset of RA. In fact, the presence of P. gingivalis can lead to earlier onset, faster progression, and greater severity of RA, including increased damage to bone and cartilage.

Periodontal disease is currently considered a risk factor for rheumatoid arthritis. The severity of periodontal disease also appears to go hand-in-hand with increased RA disease activity and accelerated progression.

Periodontal disease can also increase your risk of numerous additional health problems, including heart disease, stroke, diabetes, and chronic kidney disease.

Symptoms of Periodontal Disease

It's critical that RA patients be familiar with periodontal disease and its symptoms.

Between the tooth and gums, there is a V-shaped crevice called a sulcus. Periodontal disease attacks just below the gum line in the sulcus and can cause the attachment of the tooth and supporting tissues to break down. As tissues become more damaged, the sulcus develops into a pocket. With severe periodontal disease, the pocket can be quite deep.

Gingivitis and periodontitis are two stages of periodontal disease. Gingivitis is considered the less severe form of periodontal disease, in that it only affects the gums and is reversible. Periodontitis is considered more destructive and more severe than gingivitis. Untreated gingivitis can lead to periodontitis.

Be mindful of symptoms of periodontal disease, including:

  • Gums that bleed easily (for example, when brushing teeth)
  • Red, tender, or swollen gums
  • Gums that have receded or pulled away from teeth
  • A persistent problem with bad breath or taste that seems off
  • Loose teeth
  • Change in your bite
  • Change in the fit of partial dentures

Patients with more bleeding and swelling tend to have higher levels of RA disease activity.

It's possible for periodontal disease to start developing with no warning signs. That's why regular dental check-ups are critical for those with rheumatoid arthritis. If you only go to the dentist when you have a toothache, you may be missing the signs of early periodontal disease that your dentist would observe.

Managing Periodontal Disease and RA

Ongoing management of your oral hygiene and treatment of any tooth or gum problems is key for RA patients.

Research shows that RA patients with periodontal disease receiving non-surgical periodontal treatment experienced "noteworthy improvement" in their RA outcomes.

Be sure that you:

  • Brush your teeth twice a day and clean between your teeth once a day.
  • See a dentist regularly and be sure your medical history is well documented so you can receive proper care. It's possible that your dentist will want to see you more often depending on the severity of your RA.
  • Don't smoke. Smoking raises inflammation in your body and can make both gum disease and RA worse.

Additionally, make sure you stick to your RA treatment regimen. Because these medications can help quell inflammation, they may help prevent periodontal disease while also improving your RA symptoms.

A Word From Verywell

Given the established links between RA and gum and tooth health, it is critical that RA patients monitor their periodontal health daily, adhere to strict oral hygiene, and partner with a dentist to establish a dental health regimen with an eye toward reducing inflammation for both gum disease and RA.

Reducing severity and slowing progression of both conditions are the goals. Your dentist and rheumatologist can help guide your treatments.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. National Rheumatoid Arthritis Society. Gum disease.

  3. Rodríguez-Lozano B, González-Febles J, Garnier-Rodríguez JL, et al. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case–control studyArthritis Res Ther. 2019;21(1):27. doi:10.1186/s13075-019-1808-z

  4. Liccardo D, Cannavo A, Spagnuolo G, et al. Periodontal disease: A risk factor for diabetes and cardiovascular diseaseInt J Mol Sci. 2019;20(6):1414. doi:10.3390/ijms20061414

  5. Kazancioğlu R. Risk factors for chronic kidney disease: an updateKidney Int Suppl. 2013;3(4):368-371. doi:10.1038/kisup.2013.79

  6. Zhao X, Liu Z, Shu D, et al. Association of periodontitis with rheumatoid arthritis and the effect of non-surgical periodontal treatment on disease activity in patients with rheumatoid arthritisMed Sci Monit. 2018;24:5802–10. doi:10.12659/MSM.909117

By Carol Eustice
Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.