Periodontal Treatment for Chronic Periodontitis With Rheumatoid Arthritis

Sivasankari Thilagar; Ramakrishnan Theyagarajan; Maryam H Mugri; Hammam Ahmed Bahammam; Sarah Ahmed Bahammam; Maha A Bahammam; Pradeep Kumar Yadalam; A Thirumal Raj; Shilpa Bhandi; Shankargouda Patil

doi:10.1016/j.identj.2022.04.008

Periodontal Treatment for Chronic Periodontitis With Rheumatoid Arthritis

Int Dent J. 2022 Dec;72(6):832-838. doi: 10.1016/j.identj.2022.04.008. Epub 2022 Jul 7.

Affiliations

¹ Department of Periodontics, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu, India.
² Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India.
³ Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia.
⁴ Department of Pediatric Dentistry, College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
⁵ Department of Pediatric Dentistry and Orthodontics, College of Dentistry, Taibah University, Medina, Saudi Arabia.
⁶ Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; Executive Presidency of Academic Affairs, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia.
⁷ Department of Periodontics, Saveetha Dental college and Hospitals, Saveetha Institute of Medical, and Technical Sciences, Saveetha University, Chennai, India.
⁸ Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai, India.
⁹ College of Dental Medicine, Roseman University of health sciences, South Jordan, Utah, USA.
¹⁰ College of Dental Medicine, Roseman University of health sciences, South Jordan, Utah, USA. Electronic address: dr.ravipatil@gmail.com.

Abstract

Background: History of rheumatoid arthritis (RA) increases risk of periodontal diseases. A pro-inflammatory condition noted in periodontitis is considered a trigger for RA. Thus, periodontal treatment aimed at attenuating the pro-inflammatory state could aid in potentially reducing the risk of RA.

Aims: The objective of this research was to assess the effect of periodontal therapy on rheumatoid factor, Disease Activity Score-28, anti-citrullinated protein antibody, and C-reactive protein levels in patients with chronic periodontitis (CP) and RA.

Materials and methods: The sample consisted of 28 patients with CP and RA. The study was designed to be a double-blind, randomised controlled clinical study. The samples were randomly categorised to either the treatment group (n = 13) or the control group (n = 15). CP status (plaque index, bleeding on probing, probing pocket depth, clinical attachment loss), clinical rheumatologic status (Disease Activity Score), and biochemical status (C-reactive protein, anti-citrullinated protein antibody, and rheumatoid factor) were assessed at baseline and at follow-up at 8 to 12 weeks.

Results: The treatment group showed a highly statistically significant reduction in bleeding on probing (P < .005), probing pocket depth (P < .001), plaque index (P < .001), and C-reactive protein (P < .001); a gain in the clinical attachment loss (P < .001) and an improvement in Disease Activity Score-28 (P = .001) were observed at reassessment following nonsurgical periodontal treatment as compared to the control group. However, blood serum anti-citrullinated protein antibody (P = .002) and rheumatoid factor levels (P = .351) were found to increase from baseline to 8 to 12 weeks following subgingival scaling and root planing.

Conclusions: Reduction of inflammation in the periodontium by nonsurgical periodontal therapy did not reduce anti-citrullinated protein antibody and rheumatoid factor levels. However, it has shown improvement in periodontal conditions, and remarkable changes were observed in the clinical Disease Activity Score and C-reactive protein levels of individuals with RA.

Keywords: ACPA proteins; C-reactive proteins; Chronic periodontitis; Nonsurgical periodontal debridement; Rheumatoid arthritis; Rheumatoid factor.

Publication types

Randomized Controlled Trial

MeSH terms

Arthritis, Rheumatoid* / complications
Arthritis, Rheumatoid* / therapy
C-Reactive Protein / analysis
C-Reactive Protein / therapeutic use
Chronic Periodontitis* / complications
Chronic Periodontitis* / therapy
Dental Scaling
Humans
Rheumatoid Factor

Substances

Rheumatoid Factor
C-Reactive Protein