Periodontitis in systemic rheumatic diseases

Abstract

Periodontitis is a chronic inflammatory disease that is characterized by loss of the periodontal ligament and alveolar bone, and is a major cause of tooth loss. Results from clinical and epidemiologic studies have suggested that periodontitis and tooth loss are more prevalent in individuals with rheumatoid arthritis (RA). However, the strength and temporality of the association are uncertain. Several biologically plausible causal and noncausal mechanisms might account for this association between periodontitis and RA. There is evidence to suggest that periodontitis could indeed be a causal factor in the initiation and maintenance of the autoimmune inflammatory response that occurs in RA. If proven, chronic periodontitis might represent an important modifiable risk factor for RA. In addition, patients with RA might show an increased risk of developing periodontitis and tooth loss through various mechanisms. Moreover, exposure to common genetic, environmental or behavioral factors might contribute to a noncausal association between both conditions.

Key Points

  • Periodontitis and tooth loss are highly prevalent in patients with rheumatoid arthritis (RA)

  • Both causal and noncausal mechanisms might be responsible for the association between periodontitis and RA

  • Periodontitis might be an important modifiable risk factor for RA

  • Mechanistic studies into the links between periodontitis and RA and the possible causal role of oral infections in the pathogenesis of RA are warranted

  • Well-designed epidemiologic studies are needed to establish the strength and temporality of the association between RA and periodontitis/tooth loss

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Figure 1: Bone loss and inflammation in periodontitis.
Figure 2: Possible pathways in the association between periodontitis and RA.

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Acknowledgements

This work was supported by the DEPEND consortium of the Birmingham Black Country (BBC) Comprehensive Local Research Network (CLRN).

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de Pablo, P., Chapple, I., Buckley, C. et al. Periodontitis in systemic rheumatic diseases. Nat Rev Rheumatol 5, 218–224 (2009). https://doi.org/10.1038/nrrheum.2009.28

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