Do you have periodontal disease too?

Hi all, hope you are all enjoying lovely chewy things to eat & nice hot tea & coffee because I'm not & it's probably all my fault.

I was diagnosed with moderate to severe periodontal disease a few years ago which means that I have bone erosion on my jaw and my flipping teeth are getting loose. I saw a specialist who showed me a hair-raising picture of my skull with holes in the jawline & said that it was not a question of whether my teeth fell out, but when. He attributed it to smoking or, possibly, hereditary.

I didn't stop smoking then but I did when I was diagnosed with RA a year or so later. I have hung on to my teeth till now but today I had the first one out since diagnosis - a big, fat, infected molar & it was a struggle despite the apparent looseness of it. I did not like it one little bit. Might have taken it in my stride more were it not for the unpleasant feeling that I'd brought it all on myself & also fearing that my jaw would crumble during the process (it didn't).

I've been reading about the possible connection between RA and periodontal disease. I've been aware of it for some time but my Rheumy poo-pooed it & to be honest I didn't particularly want to go there before. But some of the articles I've been reading today are quite convincing about a possible link - the most credible seeming sites don't seem to say that there's definitely a connection but come up with interesting theories and some compelling statistics.

Obviously theories about the causes of RA don't help anyone fight the disease once they've got it. But personally the thought of smoking leading to one which might lead to another - double trouble - helps keeps me off the fags & anything that does that is worth it.

And now I'm just interested in whether loads of others have periodontal disease. (it's quite common anyway but much more prevalent in people with RA apparently.) And also interested in whether you reckon there's a connection.

Yours gummily,

Luce xx

[Hidden]

Poor you that does sound foul. And I understand about the feelings of guilt because that's the way I feel about having allowed myself to become obese over the years with a family history of diabetes waving at me whenever I peeped over the parapet (or the belly!). I blame my RA on this too and that's why I often think it might have gone away with me now being 4 stone lighter and very much fitter.

I have read that there are strong connections between gum disease and RA but not periodontal disease - but then I haven't really looked. There are of course very well documented links between smoking and RA and my guess is that these things are all closely connected - as well as the links with other autoimmune diseases arriving in secondary form.

My friend who arrives on Friday has Periodontal disease very severely indeed. She has never smoked but hers is so serious that in April she has to have three front teeth removed in one go and then they will operate to take bone from her hip and graft it onto her front jawbone - which has completely decayed so that her teeth are brown and loose and her front jaw has a caved in look she tells me. She explained that this happened over many years when she was undiagnosed and they only found out recently - so she says it's like dry rot of her jawbone. If you know about it and can catch it then this kind of damage can be averted but they didn't find hers until too late. I hope this is a bit consoling in some ways to you at least. Tilda xx

[Hidden]

(Periodontal disease is what gum disease (Gingivitis) leads to.) Like you I tend to hope that the big lifestyle change - in my case stopping smoking rather than losing weight - might shift something RA-wise. The thinking goes: if, and it is a very wobbly IF I know, if smoking caused PD & that then fired up my RA then maybe stopping smoking & calming down my PD might calm down the RA too. Actually my RA was relatively well-behaved for ages after I stopped smoking so you never know .......

Your friend's situation is horrible. You tend to think it just should not happen to a non-smoker especially. Apparently the process is similar in some respects to that which causes joint damage i.e. the body's own responses to infection also do some harm. But actually I'm not too sure how to deal with Periodontal Disease .... I'd better find an online forum!

Thanks Tilda!

[cris1728]

Hi Luce

I have been diagnosed with mild to moderate gum disease and had a back tooth extracted 2 weeks ago had an xray at the time of the tooth and was told very little bone around the root, The extraction was simple and painless and to be honest was a relief as it had become so loose it had dropped and was making eating difficult as it caught on another tooth and I had also started lisping as I could not shut my front teeth properly. My dentist told me that my gum disease is probably smoking related as I smoked for many years before giving up last sept. I was diagnosed with undifferentiated inflammatory arthritis in Nov and had symptoms for some time before that. My dentist did however tell me that the gum disease is potentially reversible with cleaning and good dental hygeine as well as me stopping smoking. My Rheumy has not mentioned dental problems and this has not been mentioned by the research team who I see either. wishing you well crisxx

[Hidden in reply to cris1728]

Thanks for your reply cris. I think the possibility of a link with RA has been around for a long time though my Rheumy did say that it was a 'trendy' notion. It seems to belong in the murky waters of research that's never sufficiently well-funded to reach any firm conclusions.

I'm just casting around as you probably realise so it's interesting that at least one other ex-smoker RA-er has Periodontal Disease. Something it raises the possibility of is a connection between certain bacteria and the onset of RA ..... years ago RA was treated with antibiotics, I believe, and some cases did respond well.

Anyway, glad yours doesn't seem to bad & you are not missing your tooth!

Luce x

[cris1728]

Yes Iv'e read of a possible connection but would have thought that I may have been asked about this as I am taking part in a research project about inflammatory arthritis although this is looking at DNA and possible genetic links. I feel I am fortunate in that I live in an area and am attatched to a rheumatology unit that is involved in a lot of research work into RA butr dental health has never been mentioned.I have worked in an area where stress levels were very high but this has not been mentioned either although I have read that there can be a link between this and auto immune diseases and there are 20% at least of the staff who have one of these

good luck with your dental problems and well done in kicking the weed

crisxx

[Hidden in reply to cris1728]

Stress levels surely are a trigger factor for RA - definitely agree with you there & I've read loads of archive discussions here in which people attribute the start of their RA to a very stressful lifestyle or event.

How interesting to be part of a research project - hope you blog about anything intriguing that comes up! x

[cris1728 in reply to Hidden]

will keep u all up to date on progress currently rf positive but anti ccp neg and normal esr and crp. clinical symptoms of inflammation and active disease on ultrasoound and examination so hence undifferentiated also responded well to systemic steroid injections Whoopee!! very slightly elevated urate levels although initially normal, had allopurinol and now well within normal range after only 2 weeks on meds. When I saw rheumy asked if I ate much fish? I changed diet due to high cholesterol and trying to get healthier and cut out red meat changed to fish as protien source! feel cant win. so adopting a bit of everything in moderation approach.

[Hidden in reply to cris1728]

When I hear one small thing suggested as a possible cause it reminds me of the alternative medicine industry's nastier pronouncements - 'Why Drinking Two Cups of Tea a Day Will Give You Cancer' sort of thing. But this is your Rheumy mentioning fish ..... is it about purines, I wonder .... found in shellfish more than white fish I think.

As it stands I think I'd prefer an 'Undifferentiated' diagnosis but I know it all comes down to how we feel day to day. It sounds to me like something you just might recover fully from - I hope so! But I'll look it up and probably realise I've been barking up the wrong tree again. x

[cris1728 in reply to Hidden]

Yes related to purines and whilst the level is high in shellfish it can also be raised in salmon,tuna, trout and mackerel as well as some white fish. If we worried about everything we eat we would go mad and not eat anything so I think all things in moderation now. Whilst my uraate level was raised it was not felt that my problems are related to gout although both my parents have this and there is an hereditary link. He felt that getting this blood level down would take gout out of the equation and reduce risk of problems from this in the future.

Would just like an answer to what I actually have as I feel a bit in limbo at the moment. He did mention starting me on a DMARD on my last visit but decided on a lower dose steroid injection and see how I am in June. Also gave me emergency helpline number if I need it.

crisxx

[dtech]

I am going toa conference this weekend of the top dentists in the country as I am in the dental industry, so i'll ask if anyone is researching links between ra & dental disease. But hate to be brutal but perio disease is mainly caused by poor oral hygine. People usual find out they have it when they go to a dentist when they get tooth ache or loose teeth. Yes smoking increases the risk of getting it and if it's caught early it can be reversed but takes a lot of work by a specialist periodontist and the patient.

[Hidden in reply to dtech]

You couldn't possibly be as brutal to me as I am to myself! However I'm quite bright & quite clean and boy am I good with a toothbrush as every single Dental Hygienist I've ever seen has confirmed! Like a lot of smokers I've always (rather pathetically) tried to compensate for smoking by keeping my teeth very clean.

The Consultant I saw was a very straightforward individual. He said that my PD was most likely caused by smoking although it can sometimes be an hereditary condition. Hard for me to check that as my parents smoked like chimneys & didn't give a stuff about their teeth.

Mine hasn't been caught early so apart from not smoking I'm not too sure what to do. I've been doing quite a lot of reading and several authorities say that smoking actually masks Gingivitis in many people. So gums will continue to look pink rather than red & inflamed and 'toothbrush bleeding' is not as pronounced as in non-smokers with gum disease. This makes me a little less angry with my Dentist at the time.

Thanks for your reply dtech. I would be extremely interested in anything relevant you find out. Hope you enjoy your conference. x

[helixhelix]

I do think RA and teeth are under-researched, and especially as link between gum disease and heart problems has been identified and we too have increased risk of heart problems, so maybe gums also implicated with us too? What I've noticed is that a couple of my teeth are now changing direction...after 50+ years of having perfectly straight teeth...and unless I pay attention to mouth hygiene I do seem to get bouts of manky gums quite easily. I am a bit neurotic about it all, as had very bad trench mouth as a youngster (caused by malnutrition, smoking and generally being young and foolish) and nearly lost all my teeth. Which would have caused me to be excommunicated by my mother I think from the shame of it all (she was a dentist).

And re antibiotic treatment for RA look at roadback.org. Minocycline does seem to work for the lucky few who have this type of RA. Polly

[Hidden in reply to helixhelix]

When your Mum is a dentist, how else to rebel?

I agree that RA and teeth are under-researched despite the fact that gum disease keeps surfacing in association with it and other diseases. It's as if the scientific establishment gives a big, rueful shrug because healthy teeth & gums & the modern world don't really go together so it's potentially an enormous issue. I know we have toothbrushes, dentists, clever surgical procedures and so on but on the other hand we eat loads of sugar, swim in booze and smoking's still a major factor.

Malnutrition??? Did we use to hang out together? There was a time when I'd have considered that romantic ..... god I was off my trolley. Fun though.

I'm strangely drawn to this antibiotic treatment. Will check out the link - thanks for that. I think that when your RA KEEPS (I'd prefer italics - can't find 'em) deviating from the 'norm' - even a very liberal definition of 'norm' - then you do start at least thinking about different treatments etc. x

[helixhelix in reply to Hidden]

hang out together....who knows, those years all a bit of a blur... x

[Hidden]

Just noticed your post. For me if I can control my sore gums my RA improves I have problems with periodontal disease for years. I also have bouts of SIBO. Small bowel bacterial overgrowth which took years to ease. When my gums are sore my RA flares up badly , Same when I have gut problems. I have never been a smoker. I see a dental hygienist evey 3 months use a water pick, etc but my gums will get sore for no obvious reason which then causes a flare up of my RA. They have identified the link but I cannot find a solution. Good luck.

[nomoreheels in reply to Hidden]

I’m afraid you won’t receive a response from the OP Annie. The grey avatar ‘Hidden’ instead of a username means they’ve deleted their account. Also the post is 10 years old, you’ll find that near Hidden. Maybe using the search box you’ll find a more recent post to share your helpful experiences with. All the best.