Smoking Linked to Poor Oral Health in Rheumatoid Arthritis

man smoking a cigarette
man smoking a cigarette
In Denmark, researchers found an association between patients’ oral health and rheumatoid arthritis activity with a significant correlation between smoking and poor oral health most significantly in younger patients.

Patients with rheumatoid arthritis (RA), particularly patients who are smokers, report poorer oral health than those who do not smoke, and regular patient education about the importance of regular dental care should be provided to this patient population. This is according to results of a study published in International Journal of Rheumatic Diseases.

Researchers sought to clarify the relationship between patients’ self-reported oral health and RA disease activity. At the Danish outpatient clinic, 300 patients being treated for RA were eligible to participate. Investigators sent questionnaires via email, and 164 patients (61% women; mean age 65±11 years) responded.

The average value on the Disease Activity Score of 28 joints (DAS28) was 2.31±0.83; researchers found a negative linear correlation between age and DAS28: 12% of patients reported being active smokers, 41% were past smokers, and 47% had never smoked. Smokers were significantly younger (P =.02).

Overall, 3.5% of patients reported frequently experiencing dry mouth when chewing or swallowing; this symptom was less frequently reported among nonsmokers. Tooth status was reported as poor in 13% of patients, good in 46% of patients, and excellent in 40% of patients. Gingiva status was reported as poor, good, or excellent in 11%, 49%, and 40% of patients, respectively. Researchers found that patients who never smoked typically had excellent teeth and low gingiva compared with those who smoked (P =.01 and P =.03, respectively).

Spontaneous gingival bleeding was reported by 15% of patients and was significantly correlated with the rating of gingiva. Nearly half (49%) of patients reported gingival bleeding either during or after tooth brushing. Although not associated with DAS28, bleeding was more frequently found in patients who smoke. Finally, 14% of patients reported feelings of loose or moveable teeth, and 10% reported difficulties in biting or chewing. These symptoms were significantly associated with higher DAS28 scores.

“There should be an emphasis on the necessity of proper oral health monitoring and treatment or prophylaxis in [patients with RA],” the researchers concluded. “This dental care … is based on regular dental appointments, which are the key to maintaining periodontal health or preventing the recurrence of gingival/periodontal inflammation.”

The researchers of the study also noted that these “findings support that [patients with RA] should avoid smoking and be under regular dental control and advice in order to prevent or reduce any periodontal inflammation and improve oral health.”

Radwan-Oczko M, Duś-Ilnicka I, Richards P, Thomsen AM, Rasmussen C. Rheumatoid arthritis patients’ oral health and disease activity [published online May 7, 2019]. Int J Rheum Dis. doi: 10.1111/1756-185X.13590