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  • Writer's pictureDr. Natalia Trehan

Is there a Connection between Oral Healthcare and Rheumatic Diseases?

Natalia Trehan, DMD 

Oral Medicine Chief Resident, Hospital of the University of Pennsylvania  

In the intricate web of healthcare, the connection between oral health and rheumatic diseases often goes unnoticed. Yet, within this nexus lies a crucial link that can impact overall well-being. 

Recently, at the American College of Rheumatology Conference in Nov 2023, Natasha from Take a Pain Check, alongside Dr. Katherine France an Oral Medicine attending at Penn School of Dental Medicine and I, a resident in Oral Medicine at the University of Pennsylvania presented the following topic: "The ‘Tooth’ about Oral Healthcare and Rheumatic Diseases" This question sparked a discussion that shed light on a realm often overlooked in both dental and rheumatological practices.

In Oral Medicine, a specialized field dedicated to the oral healthcare of medically complex patients, we encounter diverse cases that underscore the intricate relationship between oral health and systemic conditions. From rheumatic diseases manifesting in oral symptoms to medication-induced side effects affecting salivary gland function, the impact is multifaceted. This can be a direct impact through the rheumatic disease, or a side effect of the medications you are taking or even not being able to manipulate tools. For example, for those living with arthritic conditions, your temperomandibular joint can be affected including limiting your mouth opening and ability to chew, talk and yawn. Medications such as antidepressants which can also be used for chronic pain can decrease secretions of organs including the salivary glands, commonly causing dry mouth. A consistent saliva flow is vital for oral health, aiding in the prevention of tooth decay and other oral issues. Saliva contains components that combat bacteria, oral fungi such as candida albicans (thrush), neutralizes acids, and provides essential minerals for tooth health. Insufficient saliva, increases the risk of tooth decay and thrush, and can lead to altered taste sensations, burning sensations in the mouth and bad breath.

Manipulation of tools such as toothbrushes and floss can be difficult as well, preventing individuals from maintaining good oral hygiene. 

In our survey conducted through Take a Pain Check, we sought to understand the disconnect between oral health and rheumatology. The findings, from both patients and healthcare professionals were illuminating, revealing the challenges faced by individuals navigating the complexities of managing their oral health alongside their rheumatic conditions.

Armed with insights gleaned from the survey, we crafted a resource sheet with practical recommendations (LINKED HERE). Some of the recommendations including using modifiers such as using putty or a tennis ball as the base of a toothbrush, using high fluoridated toothpastes to protect the enamel of teeth, and increasing the frequency of cleanings. 

Yet, beyond the tangible interventions lies a deeper concern - the psychological barriers that hinder access to dental care. In the era of COVID-19, where immunosuppression heightens vulnerability, anxiety surrounding dental treatments looms large.

To address this, we spotlighted pioneering initiatives like the Specialized Care Suite at the Pennsylvania School of Dental Medicine run by Dr. Miriam Robbins. This location for medically complex patients offers a haven where treatment is administered in closed rooms, accommodating individuals in stretchers and wheelchairs, while prioritizing stringent safety measures.

As we navigate the intricate landscape of healthcare, let’s not overlook the symbiotic relationship between oral health and rheumatic diseases. Through collaborative efforts and innovative solutions, we can bridge the gap, ensuring holistic care that encompasses both body and spirit.

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