Association of Oral Health with Risk of Rheumatoid Arthritis: A Nationwide Cohort Study

Abstract

Periodontitis and rheumatoid arthritis (RA) are inflammatory diseases that share many similarities. We aimed to investigate the associations of periodontitis and oral hygiene status and behaviors with RA in a nationwide general population cohort. Participants from the National Health Screening cohort database of Korea who underwent oral health screening by dentists between 2003 and 2004 were included. The occurrence of RA was analyzed according to the presence of periodontitis, oral health examination findings, and behaviors. Overall, 2,239,586 participants were included. During a median of 16.7 years, RA occurred in 27,029 (1.2%) participants. The risk for incident RA was higher when participants had periodontitis (hazard ratio (HR) 1.2, 95% confidence interval (CI), 1.08-1.24) and an increased number of missing teeth (HR 1.5, 95% CI, 1.38-1.69). In contrast, better oral hygiene behaviors, such as a higher frequency of daily tooth brushing (HR 0.76, 95% CI 0.73-0.79, p for trend <0.001) and a recent history of dental scaling (HR 0.96, 95% CI 0.94-0.99), were associated with a lower occurrence of RA. Periodontitis and increased missing teeth were associated with an increased risk of RA. Maintaining good oral hygiene through frequent tooth brushing and regular dental scaling may reduce the risk of RA occurrence.

Keywords: dental scaling; oral hygiene; periodontitis; rheumatoid arthritis toothbrushing.

Figure 1

Flowchart of study subjects.

Figure 2

Kaplan–Meier survival curve associated with oral health status and oral hygiene behaviors for occurrence of rheumatoid arthritis. (a) Periodontitis (p < 0.001). (b) Number of missing teeth (p < 0.001). (c) Frequency of tooth brushing (times/per day) (p < 0.001). (d) Dental scaling within the previous year (p < 0.001).