Chronic Periodontitis and Tooth Loss in Patients With Rheumatoid Arthritis

Chronic periodontitis is arguably the most prevalent chronic inflammatory disease in humans. The defining feature of periodontitis is chronic inflammation of the tooth-supporting tissues, leading to the progressive destruction of periodontal ligament and alveolar bone. Periodontitis is a very common disease, affecting over 30% of adults aged 65 years or above in the UK. Results from a growing number of clinical studies point towards a potential association between chronic periodontitis and systemic rheumatic diseases- in particular, rheumatoid arthritis (RA). If proven, such an association would be very important from a clinical and public health perspective for several reasons. First, there are several processes through which chronic periodontitis might be part of a causal pathway in the pathogenesis and/or disease activity status of RA. Given the high prevalence of chronic periodontitis, a large proportion of the incidence and/or morbidity of RA could be attributable to chronic periodontitis, if causality was confirmed.

Importantly, chronic periodontitis would represent a modifiable risk factor, as effective treatments for this disease are available. Second, chronic periodontitis would contribute to morbidity in patients with RA even if the association was noncausal. Periodontitis is a leading cause of tooth loss in adults, which can have important clinical consequences, including impaired nutritional status and quality of life. Furthermore, chronic periodontitis is associated with an increased incidence of coronary heart disease and stroke, and emerging evidence indicates that this association might, in part, be causal, and thus periodontitis may contribute to the increased cardiovascular morbidity and mortality in RA.