Archive | 2019
Periodontal Disease and Associated Factors in Patients with Rheumatoid Arthritis
Abstract
Correspondence (İletişim): Sena Tolu, M.D. Medipol Universitesi Tip Fakultesi, Fiziksel Tip ve Rehabilitasyon Anabilim Dali, Istanbul, Turkey Phone (Telefon): +90 505 442 47 22 E-mail (E-posta): [email protected] Submitted Date (Başvuru Tarihi): 07.11.2019 Accepted Date (Kabul Tarihi): 29.12.2019 Copyright 2020 Haydarpaşa Numune Medical Journal OPEN ACCESS This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). 134 Tolu et al., Periodontal Disease in Patients with Rheumatoid Arthritis / doi: 10.14744/hnhj.2019.48992 with the prevalence of mild PD being 35% and moderate to severe PD as 11% in 2010, affecting 3.9 billion people[9]. As the world s population is aging, PD has become an important public health problem that causes a burden on the healthcare system[10]. The potential influence of periodontal pathogens and PD on initiation and/or progression of several systemic diseases, such as malignancy, type 2 diabetes mellitus (DM), cardiovascular and respiratory diseases, adverse pregnancy outcomes and neurodegenerative disease, has been postulated[11–13]. The possible mechanisms involving the modulations of an inflammatory pathway and systemic immunity are associated with a bacterial challenge and represent a portal of entry for periodontal pathogens, bacterial endotoxins, and pro-inflammatory cytokines[11]. In a systematic review, PD has been confounded as a factor in the initiation and maintenance of the autoimmune inflammatory responses that occur in RA and also reported as an important factor for increased disease activity and refractoriness[14]. RA and PD share similar genetic and environmental risk factors, such as expression of the MHC class II HLA-DRB1 allele and smoking. Besides, the destructive mechanisms that drive chronic bone erosion in RA and chronic gum destruction in PD are similar in both diseases[4, 5]. The recent evidence has showed that PD and RA are closely linked and share elements regarding pathogenic mechanisms[6–8]. Colonization of bacterial complex in dental plaque induces chronic periodontal inflammation[6, 7]. Gram-negative anaerobic bacteria, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in the dental plaque biofilm, are commonly known peri¬odontal pathogens involved in RA pathogenesis by creating a pro-inflammatory environment and inducing citrullinated autoantigens targeted by anticitrullinated protein antibodies (ACPA)[7]. The association between the concentration of circulating antibodies to Porphyromonas gingivalis and expression ACPA has been demonstrated[8]. The results from population-based studies on the potential association between PD and RA are inconsistent[15–17]. This discrepancy may depend on variables in different ethnic groups, small numbers of subjects with RA and/or the lack of uniformity in the definition of PD. In Turkey, the prevalence of RA adjusted for the general population aged 16 or over was estimated at 0.56%[18]. Currently, we lack detailed examination data about the oral health of patients with RA. Ay et al.,[19] in a study of 78 participants with 33 healthy participants and 45 patients with RA, reported significant higher clinical periodontal parameters in the RA group than the control group. The present study aims to evaluate the periodontal status and its association with sociodemographic and clinical factors in patients with RA. Materials and Methods