Rheumatoid arthritis (RA) is a chronic autoimmune disease in which a person’s synovial linings are attacked by their immune system throughout the body. RA causes joint inflammation, which, in extreme cases, can progress to permanent joint damage and disability.[i]
Affecting at least 1 in every 200 adults worldwide, rheumatoid arthritis has long been categorised as a disease of the musculoskeletal system.[ii] However, research also indicates that RA extends beyond joints, with oral health – particularly periodontitis – being regarded as a factor in the onset and progression of the disease. Research surrounding the connection between oral conditions and inflammatory arthritis dates back centuries, with Hippocrates suggesting that tooth removal could cure arthritis.[iii]
Shared inflammatory responses
Rheumatoid arthritis and periodontitis share the same processes of chronic inflammation – the suffix of “-itis” itself quite literally connotes inflammation.[iv] In RA, the joint linings’ destruction causes stiffness, extreme swelling, and ultimately, complete joint deterioration.
Similarly, in periodontitis, microbial plaque builds up along the gingival margin, instigating an intense immune response. This eventually provokes an exaggerated reaction, resulting in the disintegration of periodontal tissue and the alveolar bone.[v]
The interchange between these inflammatory mechanisms has led to evidence surrounding the bidirectionality of the relationship. There is a high correlation between patients suffering with RA and their rate of periodontitis compared to the general population. Furthermore, severe periodontitis can intensify systemic inflammation and exacerbate the symptoms of RA further.
Rheumatoid arthritis and xerostomia
Dependent upon the severity of the condition, RA is treated through various methods. This ranges from over-the-counter analgesics, anti-inflammatory medication, disease-modifying antirheumatic drugs, and in some cases, surgery.[vi] Unfortunately, a side effect of many of these medications is decreased salivary flow.
RA is strongly associated with xerostomia symptoms indicative of reduced salivary flow even in patients who are not taking xerogenic medications – affecting more than 50% of RA patients.[vii] Furthermore, RA is linked to conditions such as Sjögren’s syndrome (SS), which is also associated with xerostomia.[viii] Due to this connection, patients with RA are more likely to experience periodontitis as a result of xerostomia reducing the oral clearance effect of the saliva.
Joints and dexterity
RA can directly impact the temporomandibular joint (TMJ), causing severe pain in the entire orofacial region.[ix] Due to the inflammation in the TMJ, the cartilage and other structures become damaged, causing stiffness and restricted movement, particularly in opening the mouth.
The relationship between RA and oral health is far from restricted to biology – there is also a functional element of bidirectionality. RA is renowned for compromising dexterity and grip strength, which further impairs patients’ ability to perform effective oral hygiene procedures and routines. Consequently, more plaque accumulates, instigating greater susceptibility to gingival inflammation. This vicious cycle is sustained by the individual’s inability to efficiently manage their oral health – an issue that is exacerbated by RA to begin with.
The systemic and practical challenges that RA patients face must be considered by dental professionals, with considerate oral health interventions tailored to each individual’s capability.
Prevention and management
The right strategies and support can alleviate the symptoms of both RA and periodontitis. Oral health can be proactively managed with twice-daily toothbrushing, daily plaque control, the use of fluoride products, and effective interdental cleaning.
Even without the dexterity difficulties associated with toothbrushing, it is commonly understood that using toothbrushes alone is inadequate in removing dental plaque, with evidence suggesting that 40% of dental plaque remains.[x] This means that combined with limited dexterity, the effectiveness of toothbrushing alone is insufficient.
The role of interdental cleaning
Interdental areas are extremely susceptible to gingival inflammation which makes thoroughly cleaning them vital to reduce the risk of periodontal disease, which may in turn reduce the risk of developing RA. For individuals living with RA, interdental cleaning often presents a challenge. Regular floss is difficult to operate due to patients’ minimal hand function. This is evident through the anatomical and neuromuscular changes, the muscle, grip, and pinch strength loss, and diminishment of sensory management and coordination experienced by those with RA.[xi] Due to this, the success of conventional dental flossing is limited for RA patients. Interdental brushes, however, provide a practical and effective alternative.
High quality tools like the FLEXI interdental brushes from TANDEX promote healthy gingivae by reducing the amount of plaque build-up. FLEXI brushes are available in 11 different sizes, delivering tailored care to each individual circumstance – accommodating anatomical variation for all stages of RA. The ergonomic design of the brushes improves ease of use for those with joint stiffness and minimal dexterity, offering them an alternative against their physical limitations. Combining the brushes with the TANDEX PREVENT Gel allows patients to take full control of their oral health. Containing 0.12% chlorhexidine and 900 ppm fluoride, the gel delivers anti-caries and anti-inflammatory advantages which is ideal for minimising periodontitis in RA patients.
Tailored support against inflammation
The research connecting rheumatoid arthritis and oral health continues to evidence that the successful management of periodontal disease extends beyond the oral cavity, but can positively impact more systemic health and wellbeing too. Supporting patients with tailored, accessible, and effective advice and tools allows dental professionals to provide more considerate and holistic inflammation control.
For more information on Tandex’s range of products, visit https://tandex.dk/
Our products are also available from DHB Oral Healthcare https://dhb.co.uk/
Author: Jacob Watwood
[i] Guo, Q., Wang, Y., Xu, D. et al. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res 6, 15 (2018). https://doi.org/10.1038/s41413-018-0016-9
[ii] Smith MH, Berman JR. What Is Rheumatoid Arthritis? JAMA. ;327(12):1194. doi:10.1001/jama.2022.0786
[iii] Bingham, C. O., 3rd, & Moni, M. (2013). Periodontal disease and rheumatoid arthritis: the evidence accumulates for complex pathobiologic interactions. Current opinion in rheumatology, 25(3), 345–353. https://doi.org/10.1097/BOR.0b013e32835fb8ec
[iv] Oronsky, B., Caroen, S., & Reid, T. (2022). What Exactly Is Inflammation (and What Is It Not?). International Journal of Molecular Sciences, 23(23), 14905. https://doi.org/10.3390/ijms232314905
[v] Loos BG, Van Dyke TE. The role of inflammation and genetics in periodontal disease. Periodontol 2000. 2020; 83: 26–39. https://doi.org/10.1111/prd.12297
[vi] Jacqueline Bullock, Syed A.A. Rizvi, Ayman M. Saleh, Sultan S. Ahmed, Duc P. Do, Rais A. Ansari, Jasmin Ahmed; Rheumatoid Arthritis: A Brief Overview of the Treatment. Med Princ Pract 1 March 2019; 27 (6): 501–507. https://doi.org/10.1159/000493390
[vii] Stefanie L. Russell, Susan Reisine, Investigation of xerostomia in patients with rheumatoid arthritis, The Journal of the American Dental Association, Volume 129, Issue 6, 1998, Pages 733-739, ISSN 0002-8177, https://doi.org/10.14219/jada.archive.1998.0315.
[viii] Glore, R.J., Spiteri-Staines, K. and Paleri, V. (2009), A patient with dry mouth. Clinical Otolaryngology, 34: 358-363. https://doi.org/10.1111/j.1749-4486.2009.01930.x
[ix] de Souza RF, Lovato da Silva CH, Nasser M, Fedorowicz Z, Al‐Muharraqi MA. Interventions for managing temporomandibular joint osteoarthritis. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD007261. DOI: 10.1002/14651858.CD007261.pub2. Accessed 21 August 2025.
[x] Ng, E., & Lim, L. P. (2019). An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dentistry journal, 7(2), 56. https://doi.org/10.3390/dj7020056
[xi] Kilic, M. C., Calik, B. B., Cobankara, V., & Balkarli, A. (2018). The relationship between hand function and activity performance in patients with rheumatoid arthritis. Age, 32(65), 50-7.
