Mtx & periodontal disease

Hi all,

I had periodontal disease before RA & Mtx & was told to stop smoking, which I've done (I've blogged about this before.) But I've had 2 teeth out in the last 3 months and now another one is aching & feels loose - & for me that tends to mean extraction looms. Previously my last tooth extraction was at the age of 14.

I think I have a good dentist (but how to judge? If you get what you pay for she must be a very good dentist!) and the hygienist is happy with my oral hygiene.

As I understand it my jaw, which is quite badly affected by periodontal disease, will not take crowns or whatever without extensive work e.g. bone grafts. And this latest loose tooth is at the front.

My dentist seems to have a working knowledge of the drugs I take but obviously she's not a rheumatologist & so far she hasn't mentioned Mtx affecting teeth & gums. I found a thread on this site from 2011 about Mtx causing gum & tooth problems. I've got a rheumy appointment in a couple of weeks & there may be decisions to make about my treatment. If Mtx is exacerbating my tooth/gum/jaw problems then that would represent quite a serious problem with a drug that's not helping much anyway. (I take 25mg.)

Does anyone else have similar problems or know anything about all this? Luce xx

24 Replies

  • Ever since I have been diagnosed with PsA, my gums have become worse and with a loss of three teeth, two of which are in the front, one has been replaced with a false one the other is unable to be done. I have been informed that I am unable to have the dental implants as gums are the reason I am loosing my teeth. Like you have spent a fortune in the Periodontal treatment with a specialist, have been treated at the hospital as I bleed profusely, each have said the same regarding dental implants. Bridges etc are also a no,no. When I mention the treatments that I have received and used what the disease I have and all don't know if this is the actual cause of it. But it's funny that I did not have gum disease before the onset of PsA. MTX will affect the gums in relation to the bleeding so you should have any extractions from the hospital, you still have local anethestic but it's a more concentrated type. I have been informed that any teeth extractions that I have to go to the hospital also that they are to be taken out in the morning due to the blood loss.

    Any treatment that you have at the hospital you do not pay for, but are sent back to your dentist for teeth replacement.

    Hope this helps, and am sorry to hear that you have landed in the same boat as me on this one.

  • It helps to know a bit more, thanks Georje. I did have periodontal disease before RA & have erosions in my jaw as a result - the consultant showed me the x-ray & scared me half to death! I know I may have brought it on myself by smoking and obviously a drug that carries on where cigarettes left off is the last thing I need.

    It is distressing to hear that they can't use bridges etc. isn't it? The last extraction resulted from the one before it i.e. the tooth got loose without its neighbour so I'm worried that I could end up toothless at this rate! But I'm lucky in that I don't bleed much despite mtx.

    I hope you don't lose any more teeth Georje. If I get to the bottom of whether or not mtx makes this worse I'll let you know.

    Luce xx

  • I can't help on this at all Luce but as I told you before my friend has this same condition and has recently had 3 front teeth removed and is having a hip graft to get bone to fill the gap left in her jaw. She does not have RA though. I do know that next year when the graft has healed/ settled she will get three molded teeth to replace the three removed and they won't be false teeth, they will be fixed.This is not going to come cheap though although her operations are being done on the NHS.

    I would be happy to find out more if it helps as she's in the process of it all at the moment. I do hope MTX isn't exacerbating things in your jaw because it's an important drug for Biologics too - although Leflunomide might be an alternative as Georje takes this with Enbrel I believe and has similar problems to you it seems. Tilda xx

  • Oh of course mtx is often needed for Biologics ...... I'm having trouble keeping track of all the ins & outs right now!

    It is so kind of you to offer to talk to your friend. However I think that just hearing about her makes me realise I do need to investigate the less drastic surgical procedures that aim to reduce infection. (It can't usually be cured.)

    Actually from things I've looked at on line it seems that mtx can be bad news for teeth and gums but I suppose there's no way of knowing whether it is contributing to my problems or not. I think I might phone both my dentist & the rheumy nurse.

    I think I am getting a taste of the complexities you've encountered with mtx! Thanks for your thoughtful reply - you & Georje have helped me start to get my head round this. xx

  • Ugh this RA journey feels hellish to me and I've not even got any joint pain just now - what must it be like for those who have side effects AND very active RA and other health problems? - this thought usually stops me in my tracks. I really feel for your about this peridiodontal disease. And stop beating yourself up about the smoking - you've stopped now and I can tell you that the friend who is undergoing this treatment has never smoked and has always been a really healthy eater who rarely has anything sugary - and I've known her for many years! Its just very bad luck, same with RA. Xxx

  • It's just bonkers, the whole business & so complicated factoring everything in & constructing plans of action. You are right of course about the self-flagellation - quite pointless. As for periodontal disease, if I can just hang on to this tooth the future might look a bit rosier. Hope your friend gets a great result. xx

  • Is there a way you can hang onto it Luce? You say your oral hygiene is very good and I bet you don't suck sweeties - I don't know enough about gum or periodontal disease but I bet you are doing all you can. I'm not doing very well with this group of friends just now - I just emailed our other great friend to say happy birthday and he emailed back "12th JUNE!" - heck I'm useless! XXX

  • Just have to go to the dentist & see if this tooth bucks the trend (pun in there somewhere) & can stay put. For years my dentist said my gum disease wasn't too bad. It was only when I went to a maxo-facial (can't remember the exact title) surgeon at the hospital for a completely different reason that a different picture emerged. That dentist then retired. I'd like to have a few words with him.

  • No known link between RA and perio/tooth disease. Or with MTX.

    You dont need a different local anaesthetic if you are on mtx.

    You shouldn't have to go to hospital for extractions unless you have other medical problems following extractions. If in doubt ask your dentist.

    As far as I am aware there is no greater risk of post extraction hemorrhage if you take mtx.But the dentist will assess individual risk before treatment.

    And implants are a no no if you smoke due to potential bone loss.

  • Handy to have a dental technician here for some helpful advice! Such a diverse group of dtechs , docs, nurses, admin, lawyers, retirees, housewifes/ husbands, mechanics, pharmacists, teachers, volunteers and thats only the ones i can think about, what a clever bunch you are. Xx

  • Thanks dtech. I don't smoke anymore incidentally & personally I've had no problems with extractions at the dentist whilst on mtx.

    Re. my primary concern: whether mtx might cause or exacerbate gum / tooth / jaw problems, it's somewhat reassuring to hear that you don't think it causes such problems. I think the jury might be out on this however so I'll keep digging. And the same re. possible link between periodontal disease & RA. x

  • Um - weirdo artists??!

    Not wanting to undermine you in any way Dtech, we are very fortunate to have you here (even if you are not fortunate to be here), but I was looking for info on strange tastes in relation to RA yet again and found a New York Times article about RA which listed related conditions including this; "Periodontal Disease. People with RA may be twice as likely as non-arthritic individuals to have periodontal disease. Chronic inflammation and immune dysfunction are central to both diseases.".?

  • Yes, some rheumies think there's a link or so I've heard. Others disagree. I'm sure this is a grey area.

  • It didn't sound very grey in this NY Times article Luce? Xx

  • Oi! I'm trying to be diplomatic! Actually I do think it is hard to know what to believe - I have read convincing views both ways. Periodontal disease is apparently incredibly common. So if it is the health risk that some sources claim (not just for RA by a long chalk) then the public health implications are enormous because quality of dental care & access to it are so variable. x

  • Oh, & could I possibly have the link? I THINK I've read it but not sure.

  • I would like the link as well to see where the research was carried out and how many case studies they had. My reply was based on me asking, on behalf of this group, 12 consultants and deans of most of the teaching hospitals in the uk at a conference I went to. None of them had heard of any research being done, sadly.Or any links they had found, that's not to say their arnt any of course.

  • Hi dtech, I found an article in the Journal of Periodontology that you might find interesting. It starts with a bit of a contentious statement: "In fact, adult periodontitis and rheumatoid arthritis have much in common, so much so that I have argued that they are really the same disease.’’ But the main body of the article is more about the possibility that they have a common cause & some studies are cited.

  • ..... & it would probably help if I provided the link!

  • I knew Dtech wouldn't take it personally Luce - he's far too rational and intelligent! . I will look it up again but I wasn't actually searching for periodontal disease when I saw it. It was in the New York Times so if you google RA in that context it will probably come up?

    I have no gum disease and my mouth has never been healthier since I've had RA actually so what would I know? In my case this is largely because I dropped all refined foods and sugars from my diet I think - and also since the foul taste I've been extra zealous about my oral hygiene! I've just received an email from the friend I was telling you about Luce. I will PM you with what she says as it may be reassuring I think. Tilda xx

  • Here you go - hope this works okay.

  • Works fine, many thanks!

  • My two bobs worth. The maxillofacial surgeon told me that treatment ? not sure which one he was referring to tho- causes dental problems and to get myself a good dental regime. As I am not on treatment yet and dentists in Oz charge like wounded bulls I haven;t bothered as yet.

  • 'Charge like wounded bulls'! I'm not going to forget that one! I keep seeing snippets about mtx being bad for teeth. But I found an article in the Journal of Periodontology which said that DMARDs would be used to treat Periodontal disease if they weren't so toxic - it's very confusing. x

You may also like...