RA and issues with teeth

StevieB

I have RA and take injected methotrexate once a week and hydroxychloroquine twice a day. Recently I have had to have a decayed tooth removed and getting pain with some of my other teeth . Does anyone else get problems like this

SNapCrackle_Pop

I'm newly diagnosed with RA and Sjogren's. I've been on Hydroxychloroquine for the last year and now methotrexate. I take so much care of my teeth, I floss, brush, and use interdental brushes. Yet I have experienced tooth pain leading to an extraction, unusually high amounts of fillings needed and worse still, random tooth crumbling. I have spoken with my dentist and they have prescribed high flouride toothpaste to strengthen the teeth. It reduces cavities and pain. My teeth hurt after each methotrexate dose, day 2 I'd say....Perhaps ask your dentist for advice?

frogmorton

Have a read of this:

https://nras.org.uk/resource/gum-disease/

It's NRAS so a reliable source.

Toni x

Splodge

It may be nothing to do with the medication and just a coincidence. I've had awful teeth issues on and off since years before RA. Even with good oral hygiene we can be victims of random tooth-related nastiness.

Poppyjane

Hi @SNapCrackle_Pop , a belated welcome to the online community

It is great to see a new member offering support on their first post. That illustrates what our community is all about - supporting each other whist we cope with the challenges of living with arthritis. The article mentioned by @Frogmorton is an interesting read and has provoked some useful discussions. Also the V A information provided about Sjogren's mentions the potential for mouth problems.

https://www.versusarthritis.org/about-arthritis/conditions/sjoegrens-syndrome/

You are wisely following the advice of your dentist and using a sensitive toothpaste. I attach an old but still relevant discussion between some members on the subject

https://community.versusarthritis.org/discussion/comment/464933#Comment_464933

Do join us again soon we look forward to hearing from you.

Best wishes

Poppyjane

jamieA

Hi @StevieB

I take sulfasalazine, MTX tablets and adalimumab biologic injections. About a year after starting these treatments I had 3 separate instances of pieces of different teeth breaking off. I look after my teeth brushing and mouthwash at least twice a day. My dentist reckoned it may be due to the drugs I take - I also take 3 heart drugs. Like @SNapCrackle_Pop my dentist prescribed high flouride toothpaste - 2800ppm flouride. It's prescription only medication so you can't buy it over the counter. I ran out of it last month and I can't get an appointment with my dentist until May. However the receptionist said although it's prescription only medication the dental practice can sell it. It was £10 for a 75ml tube!

Gadgetgirl

Hi @StevieB I am having similar issues. Had cavity inside of tooth and now sensitive teeth. Dentist asked if I drink lots of sugary drinks which I don't hardly have any. Since found out that it's common for RA to effect the gums and through gum disease the above can start. I will be calling my dentist and seeing if I can get a prescription for higher fluoride dentist and I have an oral clean booked in but I will now make sure I have these on a more regular basis. I always brush 2/3 times a day and floss, so was surprised when the dentist thought I was overdoing it with fizzy drinks and I hardly ever have them. I hope you get on ok.

BettyMac

I’m a retired Dental Hygienist.
Oral health education and treating patients with gum diseases were my daily life for many years.

I loved my profession and my patients - and would still be doing it, had RA not decided to wreck my hands.

You bring up some interesting and upsetting experiences.

This is a huge area with lots of different factors coming into play, which is why it’s important to get tailored advice from your own dental professionals.

However, there are some simple facts.

• To avoid tooth decay - avoid sugar and remove plaque daily.
  Frequency of sugar consumption is even more important than quantity.
  (To give a daft example - it would be safer to drink one cup of tea with 4 spoons of sugar than it would be to have 4 cups of tea with 1 sugar, spread through the day. The first counts as one exposure, the second as four.)
  The bacteria, which are what soft plaque mainly consists of, are able to take sugar and make an acid which is strong enough to demineralise enamel and dentine. Once there’s a break in the enamel, other bacteria can get in there and do their own kinds of damage.The newer plaque is, the more of the bugs associated with decay you’ll find there. So…
  Careful toothbrushing, using a fluoride paste, twice a day AND some form of daily interdental cleaning AND keep sugar frequency to a minimum. If you like to use a mouth rinse, get one with fluoride and use it at a different time from when you brush your teeth. Don’t rinse your mouth after brushing - just spit out the excess and let that fluoride from the paste sit around and remineralise the tooth surfaces. Replace your toothbrush regularly - a worn brush won’t work well. (Incidentally, one of the best small headed, medium textured brushes on the market can be had for around £1.25 in big supermarkets.Its a well known brand)
  
• To avoid gum disease - clean all tooth surfaces carefully, every day. Fronts, backs, tops and sides.
  Other types of bacteria in that plaque, numbers of which climb when it’s been sitting around for a few days, are what’s responsible for gingivitis and periodontal disease. Some people are more prone to developing periodontal disease - and I’m sure our over-active immune systems, and our depressed immune systems when we’re on DMARDs, may also play a part in this, but some people are genetically predisposed to developing gum disease. If you're already having gum problems, careful daily cleaning is even more important.
  Another huge factor is smoking. Amongst other damaging effects, it causes vasoconstriction which stops your defence cells getting on site to deal with bacteria and their toxins.
  
• Have regular dental check-ups and a professional clean, if your dentist prescribes one. Ask your dentist/hygienist/therapist to explain things and show you best cleaning techniques for your mouth. Some of us will need to learn specific techniques for cleaning under the gum and it’s best to be shown how to do this.
  THE most important things YOU can do are minimising the frequency of sugar consumption, careful daily cleaning and not smoking. It’s what you do every day that makes the biggest difference.
  

To address some specifics mentioned by posters above

When we start getting a bit “long in the tooth”, the softer dentine of the root becomes exposed. It’s less highly mineralised than the crown so is more prone to being abraded. Don’t brush too soon after consuming acidic foods/drinks and make sure your technique isn’t too “aggressive”. Fluoride is your friend. Ask your own dental professional for specific advice re techniques and timing of toothbrushing. It could be worth considering an electric TB. Also worth using a toothpaste specifically for sensitivity.

Those of us who’ve been lumbered with Sjögrens will produce much less saliva than normal. Saliva, in its owners own mouth is wonderful stuff - containing minerals and antibacterials - and helping to rinse tooth surfaces. Again, fluoride is your friend - and ask your dental professional about saliva replacement products.

Having said all of the above - at far greater length than I intended when I started this post 🙈 - I do sympathise with other posters on this thread because I’m also getting to the stage where bits are falling apart. I can blame lack of fluoride toothpaste and poor diet as I was growing up. We just didn’t know any better in those days.