Clinical Oral Investigations

, Volume 20, Issue 9, pp 2575–2580 | Cite as

Oral manifestations of rheumatoid arthritis. A cross-sectional study of 73 patients

  • Javier Silvestre-RangilEmail author
  • Leticia Bagán
  • Francisco Javier Silvestre
  • José Vicente Bagán
Original Article



A study is made of the main oral manifestations of patients with rheumatoid arthritis (RA), particularly salivary flow, and of its possible association to periodontal disease.

Material and methods

A prospective comparative study was made of 146 patients (73 with RA and 73 controls), recording pocket depth, clinical attachment loss, bleeding index, plaque index, and the DMFT index to assess periodontal and dental alterations. Sialometric measurements were also made to determine resting, stimulated, and parotid salivary flow.


The patients with RA had greater periodontal pocket depths (with moderate depths in most cases), as well as greater attachment loss and more bacterial plaque. The resting whole saliva and stimulated parotid saliva rates were also clearly decreased in the RA group compared with the controls.


Patients with RA are more likely to present periodontal disease, poorer oral hygiene manifesting as an increased accumulation of bacterial plaque, and decreased salivary flow rates.

Clinical relevance

Vulnerability to periodontitis is confirmed in one of the largest samples ever studied of patients with rheumatoid arthritis (RA). Also, there is evidence of hyposialia (decrease in salivary rate) in RA patients without Sjögren’s syndrome.


Rheumatoid arthritis Periodontal disease Dental caries Salivary flow Oral manifestations 


Compliance with ethical standards

Conflict of interests

The authors declare that they have no competing interests.


The work was supported by the Unidad de Estomatología, Hospital Doctor Peset, Valencia.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Kobayashi T, Ito S, Kuroda T, Yamamoto K, Sugita N, Narita I, et al. (2007) The interleukin-1 and Fcgamma receptor gene polymorphisms in Japanese patients with rheumatoid arthritis and periodontitis. J Periodontol 78:2311–2318. doi: 10.1902/jop.2007.070136 CrossRefPubMedGoogle Scholar
  2. 2.
    Helenius LM, Tervahartiala P, Helenius I, Al-Sukhun J, Kivisaari L, Suuronen R, et al. (2006) Clinical, radiographic and MRI findings of the temporomandibular joint in patients with different rheumatic diseases. Int J Oral Maxillofac Surg 35:983–989. doi: 10.1016/j.ijom.2006.08.001 CrossRefPubMedGoogle Scholar
  3. 3.
    Treister N, Glick M (1999) Rheumatoid arthritis: a review and suggested dental care considerations. J Am Dent Assoc 130:689–698CrossRefPubMedGoogle Scholar
  4. 4.
    Pischon N, Pischon T, Kröger J, Gülmez E, Kleber BM, Bernimoulin JP, et al. (2008) Association among rheumatoid arthritis, oral hygiene, and periodontitis. J Periodontol 79:979–986. doi: 10.1902/jop.2008.070501 CrossRefPubMedGoogle Scholar
  5. 5.
    Russell SL, Reisine S (1998) Investigation of xerostomia in patients with rheumatoid arthritis. J Am Dent Assoc 129:733–739CrossRefPubMedGoogle Scholar
  6. 6.
    Kässer UR, Gleissner C, Dehne F, Michel A, Willershausen-Zönnchen B, Bolten WW (1997) Risk for periodontal disease in patients with longstanding rheumatoid arthritis. Arthritis Rheum 40:2248–2251CrossRefPubMedGoogle Scholar
  7. 7.
    Bartold PM, Marshall RI, Haynes DR (2005) Periodontitis and rheumatoid arthritis: a review. J Periodontol 76:2066–2074. doi: 10.1111/j.1600-051X.2010.01552.x CrossRefPubMedGoogle Scholar
  8. 8.
    Martinez-Martinez RE, Abud-Mendoza C, Patiño-Marin N, Rizo-Rodríguez JC, Little JW, Loyola-Rodríguez JP (2009) Detection of periodontal bacterial DNA in serum and synovial fluid in refractory rheumatoid arthritis patients. J Clin Periodontol 36:1004–1010. doi: 10.1111/j.1600-051X.2009.01496.x CrossRefPubMedGoogle Scholar
  9. 9.
    Sjöstrom L, Laurell L, Hugoson A, Hakansson JP (1989) Periodontal conditions in adults with rheumatoid arthritis. Community Dent Oral Epidemiol 17:234–236CrossRefPubMedGoogle Scholar
  10. 10.
    Susanto H, Nesse W, Kertia N, Soeroso J, Huijser van Reenen Y, Hoedemaker E, et al. (2013) Prevalence and severity of periodontitis in Indonesian patients with rheumatoid arthritis. J Periodontol 84:1067–1074. doi: 10.1902/jop.2012.110321 CrossRefPubMedGoogle Scholar
  11. 11.
    Matthews RW, Bhoola KD, Rasker JJ, Jayson MI (1985) Salivary secretion and connective tissue disease in man. Ann Rheum Dis 44:20–26CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Nagler R, Salameh F, Reznick AZ, Livshits V, Nahir AM (2003) Salivary gland involvement in rheumatoid arthritis and its relationship to induced oxidative stress. Rheumatol 42:1234–1241. doi: 10.1093/rheumatology/keg362 CrossRefGoogle Scholar
  13. 13.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324CrossRefPubMedGoogle Scholar
  14. 14.
    Silness J, Löe H (1964) Periodontal disease in pregnancy. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135CrossRefPubMedGoogle Scholar
  15. 15.
    Ziebolz D, Pabel SO, Lange K, Krohn-Grimberghe B, Hornecker E, Mausberg RF (2011) Clinical periodontal and microbiologic parameters in patients with rheumatoid arthritis. J Periodontol 82:1424–1432. doi: 10.1902/jop.2011.100481 CrossRefPubMedGoogle Scholar
  16. 16.
    Mercado FB, Marshall RI, Klestov AC, Bartold PM (2001) Relationship between rheumatoid arthritis and periodontitis. J Periodontol 72:779–787. doi: 10.1902/jop.2001.72.6.779 CrossRefPubMedGoogle Scholar
  17. 17.
    Abdelsalam SK, Hashim NT, Elsalamabi EM, Gismalla BG (2011) Periodontal status of rheumatoid arthritis patients in Khartoum state. BMC Res Notes 28:460. doi: 10.1186/1756-0500-4-460 CrossRefGoogle Scholar
  18. 18.
    Joseph R, Rajappan S, Nath SG, Paul BJ (2013) Association between chronic periodontitis and rheumatoid arthritis: a hospital-based case-control study. Rheumatol Int 33:103–109. doi: 10.1007/s00296-011-2284-1 CrossRefPubMedGoogle Scholar
  19. 19.
    Biyikoğlu B, Buduneli N, Kardeşler L, Aksu K, Pitkala M, Sorsa T (2009) Gingival crevicular fluid MMP-8 and −13 and TIMP-1 levels in patients with rheumatoid arthritis and inflammatory periodontal disease. J Periodontol 80:1307–1314. doi: 10.1902/jop.2009.090130 CrossRefPubMedGoogle Scholar
  20. 20.
    Havemose-Poulsen A, Sørensen LK, Bendtzen K, Holmstrup P (2007) Polymorphisms within the IL-1 gene cluster: effects on cytokine profiles in peripheral blood and whole blood cell cultures of patients with aggressive periodontitis, juvenile idiopathic arthritis, and rheumatoid arthritis. J Periodontol 78:475–492. doi: 10.1902/jop.2007.060135 CrossRefPubMedGoogle Scholar
  21. 21.
    Mirrielees J, Crofford LJ, Lin Y, Kryscio RJ, Dawson DR, Ebersole JL, et al. (2010) Rheumatoid arthritis and salivary biomarkers of periodontal disease. J Clin Periodontol 37:1068–1074. doi: 10.1111/j.1600-051X.2010.01625.x CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Garib BT, Qaradaxi SS (2011) Temporomandibular joint problems and periodontal condition in rheumatoid arthritis patients in relation to their rheumatologic status. J Oral Maxillofac Surg 69:2971–2978. doi: 10.1016/j.joms.2011.02.131 CrossRefPubMedGoogle Scholar
  23. 23.
    Ishi Ede P, Bertolo MB, Rossa C Jr, Kirkwood KL, Onofre MA (2008) Periodontal condition in patients with rheumatoid arthritis. Braz Oral Res 22:72–77. doi: 10.1590/S1806-83242008000100013 CrossRefPubMedGoogle Scholar
  24. 24.
    Risheim H, Kjaerheim V, Arneberg P (1992) Improvement of oral hygiene in patients with rheumatoid arthritis. Scand J Dent Res 100:172–175PubMedGoogle Scholar
  25. 25.
    Guobis Z, Baseviciene N, Paipaliene P, Niedzelskiene I, Januseviciūte G (2008) Aspects of xerostomia prevalence and treatment among rheumatic inpatients. Medicina (Kaunas) 44:960–968Google Scholar
  26. 26.
    Sullivan S, Fernandes L, McFarlane IG, Wojcicka B, Eddleston AL, Doniach D, et al. (1978) Impairment of lachrymal and salivary secretion and cellular immune responses to salivary antigens in rheumatoid arthritis. Ann Rheum Dis 37:164–167CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Moen K, Brun JG, Madland TM, Tynning T, Jonsson R (2003) Immunoglobulin G and A antibody responses to Bacteroides forsythus and Prevotella intermedia in sera and synovial fluids of arthritis patients. Clin Diagn Lab Immunol 10:1043–1050PubMedPubMedCentralGoogle Scholar
  28. 28.
    Zalewska A, Knaś M, Waszkiewicz N, Waszkiel D, Sierakowski S, Zwierz K (2013) Rheumatoid arthritis patients with xerostomia have reduced production of key salivary constituents. Oral Surg Oral Med Oral Pathol Oral Radiol 115:483–490. doi: 10.1016/j.oooo.2012.10.013 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of StomatologyUniversity of ValenciaValenciaSpain
  2. 2.European University of ValenciaValenciaSpain
  3. 3.Faculty of Medicine and OdontologyUniversity of ValenciaValenciaSpain
  4. 4.Valencia University Medical and Dental School. Chairman Service of Stomatology and Maxillofacial SurgeryUniversity General HospitalValenciaSpain
  5. 5.Clínica Odontológica de la Universidad de ValenciaValenciaSpain

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