Garib Balkees Taha, Qaradaxi Sarhang S
Department of Oral Pathology, College of Dentistry, University of Sulaimani, Kurdistan Region, Iraq.
J Oral Maxillofac Surg. 2011 Dec;69(12):2971-8. doi: 10.1016/j.joms.2011.02.131. Epub 2011 Jul 20.
There are conflicting reports as to whether patients with rheumatoid arthritis (RA) are at high risk for periodontal disease (PD). However, analogous mechanisms of tissue destruction have been reported for the 2 conditions. The present study was undertaken to determine temporomandibular joint (TMJ) problems and periodontal conditions in patients with RA in relation to their rheumatologic status and identify their periodontal needs.
One hundred patients with PD, 50 with RA and 50 without RA, were assigned to 1 of 2 age groups (30 to 39 or 40 to 50 years). The plaque index, bleeding index, clinical attachment loss, radiographic bone loss, tooth loss, and TMJ problems were assessed in the 2 groups. Disease duration, level of erythrocyte sedimentation rate (ESR), Health Assessment Questionnaire, and Verbal Descriptor Pain Scale score were assessed in the RA group.
Patients with RA were predominantly women, with longer illness duration (11.84 years), higher ESR (32.08 mm/hour), and higher scores on the Health Assessment Questionnaire (0.82). Patients with RA were characterized by significant increases in clinical attachment loss (3.24 mm), bone loss (1.79 mm), missing teeth (6.22), and TMJ problems (54%) than controls. Their periodontal status significantly correlated with illness duration, Health Assessment Questionnaire score, and Verbal Descriptor Pain Scale score. However, no difference in plaque index and bleeding index were observed between the RA and control groups. Unexpectedly, 30- to 40-year-old patients with RA had a significantly higher plaque index (1.54) and greater TMJ deviation (15%) than the older subjects.
Patients with advanced RA are more likely to develop more significant periodontal and TMJ problems compared with patients with PD and without RA. There is a great need to instruct patients with RA to consult a dentist to at least decrease PD severity.
关于类风湿关节炎（RA）患者是否患牙周病（PD）的风险较高，存在相互矛盾的报道。然而，已有报道称这两种疾病存在类似的组织破坏机制。本研究旨在确定RA患者的颞下颌关节（TMJ）问题和牙周状况与其风湿病情的关系，并确定他们的牙周需求。
100例PD患者、50例RA患者和50例非RA患者被分为两个年龄组（30至39岁或40至50岁）中的一组。对两组患者的菌斑指数、出血指数、临床附着丧失、影像学骨丧失、牙齿缺失和TMJ问题进行评估。对RA组患者评估疾病持续时间、红细胞沉降率（ESR）水平、健康评估问卷和言语描述疼痛量表评分。
RA患者以女性为主，病程较长（11.84年），ESR较高（32.08毫米/小时），健康评估问卷得分较高（0.82）。与对照组相比，RA患者的临床附着丧失（3.24毫米）、骨丧失（1.79毫米）、缺牙数（6.22颗）和TMJ问题（54%）显著增加。他们的牙周状况与病程、健康评估问卷得分和言语描述疼痛量表评分显著相关。然而，RA组和对照组之间的菌斑指数和出血指数没有差异。出乎意料的是，30至40岁的RA患者的菌斑指数（1.54）和TMJ偏差（15%）明显高于年龄较大的患者。
与PD患者和非RA患者相比，晚期RA患者更有可能出现更严重的牙周和TMJ问题。非常有必要指导RA患者咨询牙医，以至少降低PD的严重程度。
