Dental Implants in Elderly Citizens Suffering from Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disorder affecting many joints, including those in the hands and feet. It affects the joint linings, causing painful swelling. In this disease, the body’s immune system attacks its own tissue, including joints. Over long periods of time, the inflammation associated with rheumatoid arthritis can cause bone erosion and joint deformity.

Nowadays dental implants are the best tooth replacement option available: they look very attractive, almost like natural teeth, help maintain an active lifestyle and restore full chewing power. Most people are candidates for them, but there are some health conditions that are causes for concern. For example, rheumatoid arthritis can interfere with dental implants.

One of the biggest concerns for rheumatoid arthritis patients when it comes to dental implants is that it can interfere with their ability to brush their teeth properly. Since these patients experience stiffness and swelling in their joints, it can be hard to hold the toothbrush and perform the fine motions to get all their teeth clean. And flossing can be even harder.

Dental implants are even more vulnerable than teeth to gum disease, which means that if the rheumatoid arthritis patient is unable to brush and floss properly, she is much more likely to develop an infection around her implant. This condition resulting from poor maintenance of oral hygiene is called Peri-implantitis, which is the inflammation of the tissues surrounding and supporting the dental implants. And such a condition will eventually lead to the failure of implants.

Also, because rheumatoid arthritis is an autoimmune disorder, most treatments involve a suppression of the immune system. In addition to the problems cleaning the teeth, this can also increase the patient’s risk of infection around the implants.

And some rheumatoid arthritis medications, like methotrexate, can also interfere with bone healing. This can make it hard for the patient’s body to incorporate dental implants. Long-term use may also reduce bone density in their jaw, making it unsuitable to support a dental implant.

What to do if a patient suffering from rheumatoid arthritis wants to go for dental implants?

First and foremost, the primary care physician of the RA patient must be consulted and informed of the patient’s treatment goals and asked whether she can safely receive the dental implant while still undergoing treatment for her rheumatoid arthritis. This way the risk of long-term problems is minimized. The physician may recommend the patient to stop taking those medications that interfere with the bone healing, during the weeks surrounding the implant surgery.

The concerned dental surgeon must also make a thorough assessment of the patient’s jawbone density, gum health, and other oral health problems and look for any pre-existing abnormalities. If required, he can recommend a 3D scan like cone beam computed tomography to determine the jaw bone density and bone height of the patient.

Once the patient receives the dental implant in her oral cavity, its success will depend on the proper maintenance of oral hygiene by the patient. She must brush her teeth with a soft-bristle toothbrush twice a day, using a low-abrasive toothpaste. Brushing under and around the implant crown is important. Also flossing once a day to clean the interdental areas is crucial for the health of dental implants.

The patient must avoid hard and sticky foods that can cause damage to the implants or the opposing teeth. Also regular visits to the dentist, twice a year preferably, is important for oral health check-up and to get oral prophylaxis done, which will improve the chances of success of the implants.

Rheumatoid arthritis is not an absolute contraindication for receiving dental implants. If a thorough preoperative evaluation is done, proper precautions are taken and patient compliance is ensured, dental implants can be a success in RA patients too and can help in optimizing their chewing functions.

Dr. Gitika Verma has done her BDS and MDS (Endodontics) from King George’s Medical University, Lucknow. She is currently working as a Dental consultant in a Govt. District Hospital. She has more than a decade of experience as a Dental Practitioner.