Background/Purpose: Periodontal disease (PD) and inflammatory arthritis (IA) share features of inflammation and bone loss and are linked in epidemiologic studies.  Severe PD may be one environmental trigger for the development of seropositive rheumatoid arthritis. We evaluated the prevalence of periodontal disease in patients with inflammatory arthritis and determined the validity of self-reported dental symptoms and hygiene habits for periodontal disease.

Methods: Sixty one patients with IA (mean age 50.3 (±11.1) years; rheumatoid arthritis n=47 or undifferentiated arthritis n= 14) answered questions about their periodontal symptoms (bleeding gums, metallic taste, halitosis, xerostomia, loose teeth, pain with food impaction) and dental habits (frequency of brushing, flossing and dental visits), functional status (modified health assessment questionnaire mHAQ), co-morbid medical conditions, and smoking history.  All were examined by a periodontist using the periodontal screening and recording index (PSR) a validated screening tool which records the presence of bleeding on probing, calculus, and defective restorative margins at six points per tooth in six segments of the mouth.  The highest score in each sextant was recorded. Patients were classified as periodontically healthy, gingivitis, mild, moderate or severe periodontitis based on the PSR. Associations between dental exam findings, arthritis severity and symptoms, arthritis serology (CCP2, RF) and dental symptoms and habits and the validity of the self-reported dental questionnaire were tested.  Percentages or means(SD) are reported.

Results: No patients were periodontically healthy; 23 gingivitis, 14 mild periodontitis, 16 moderate periodontitis and 3 severe periodontitis, 5 edentulous.  The mean PSR score was 2 (0.5).  Patients were seropositive (RF 67%, CCP2 67%) with moderate disease activity (DAS28CRP(3var) 2.69(±1.05) and function (mHAQ 0.4(±0.41) despite 95% taking DMARDs, 49% combination DMARDs and 36% biologics. There was no correlation between the PSR score and disease activity (DAS28CRP(3var), functional status (mHAQ), arthritis duration or age at the time of the dental exam.  There were no robust associations between PSR and RF, CCP2, or diabetes, a known risk for PD.  Increased total pack years of smoking was moderately associated with worse periodontal health (p=0.05). The majority (28/42) rated their overall oral health as very good or good.  The sensitivity for  self-reported responses of “sometimes” “often” or “always” for moderate or severe PD based on the PSR was greatest for reporting bleeding gums (72%), metallic taste (89%) loose teeth (95%) and pain on food impaction (84%).  However, the sensitivity of these questions for moderate or severe PD was poor (32%, 5%, 21% and11% respectively). 

Conclusion: Periodontal disease is common in patients with inflammatory arthritis but does not correlate with severity or activity of arthritis.  Self-reported dental symptoms have reasonable specificity but poor sensitivity for detecting significant periodontal disease thus a formal periodontal examination should be part of arthritis care.  Periodontal disease may play a more important role in the pathogenesis of imminent or very early arthritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/self-reported-dental-symptoms-do-not-predict-periodontal-status-in-patients-with-rheumatoid-arthritis/