Skip to main content

Advertisement

Log in

Oral health-related quality of life depending on oral health in patients with rheumatoid arthritis

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to evaluate the oral health-related quality of life (OHRQoL) in patients with rheumatoid arthritis (RA) depending on their oral health in comparison with healthy controls (HCs).

Methods

One hundred three RA patients (55.5 years, female 58) were included. A healthy control group (HC n = 104; 56.7 years, female 68) was matched according to age, gender, and smoking habits. The OHRQoL was determined by Oral Health Impact Profile (OHIP)-G14 questionnaire. Oral examination included dental findings (DMF-T), gingival inflammation (PBI), periodontal probing depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP). Based on CAL and/or PPD, periodontitis was categorized as healthy/mild, moderate, or severe. Statistical analysis: trend test (Cochran-Armitage) and Wilcoxon rank-sum test (α = 5%).

Results

For DMF-T (RA 17.6 ± 6.1, HC 16.0 ± 6.5) and PBI (RA 0.10 ± 0.18, HC 0.08 ± 0.18), no significant differences between both groups were found (p > 0.05). Approximately 65% of RA group and 79% of HC group showed moderate to severe periodontitis (p = 0.02); RA patients showed significantly higher BOP values (p < 0.01). OHRQoL was significantly worse in RA group compared to HC group (mean OHIP value RA = 7.3 ± 7.2, HC = 1.6 ± 2.1; p < 0.001). In the HC group, a significant effect of DMF-T, M-T, and PD on OHRQoL was detected (p < 0.01), whereas in the RA group, no influence was determined (p > 0.05).

Conclusion

RA patients showed a worse OHRQoL than HC patients, which was independent of dental and periodontal conditions. RA patients require a more intensive care in consideration of dental, medical, and psychological factors.

Clinical relevance

Interdisciplinary collaboration between dentists and rheumatologists is necessary, whereby psychological factors should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Matcham F, Scott IC, Rayner L, Hotopf M, Kingsley GH, Norton S et al (2014) The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: a systematic review and meta-analysis. Semin Arthritis Rheum 44:123–130

    Article  PubMed  Google Scholar 

  2. Ramiro S, Gaujoux-Viala C, Nam JL, Smolen JS, Buch M, Gossec L et al (2014) Safety of synthetic and biological DMARDs: a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis 73:529–535

    Article  PubMed  Google Scholar 

  3. Azevedo AF, Petribú KC, Lima Mde N, Silva AS, Rocha Filho Jde A, Mariano MH et al (2015) Quality of life of patients with rheumatoid arthritis under biological therapy. Rev Assoc Med Bras 61:126–131

    Article  PubMed  Google Scholar 

  4. Tvete IF, Natvig B, Gåsemyr J, Meland N, Røine M, Klemp M et al (2015) Comparing effects of biologic agents in treating patients with rheumatoid arthritis: a multiple treatment comparison regression analysis. PLoS One 10:e0137258

    Article  PubMed  PubMed Central  Google Scholar 

  5. Uutela T, Kautiainen H, Järvenpää S, Salomaa S, Hakala M, Häkkinen A (2015) Patients with rheumatoid arthritis have better functional and working ability but poorer general health and higher comorbidity rates today than in the late 1990s. Scand J Rheumatol 44:173–181

    Article  PubMed  Google Scholar 

  6. de Pablo P, Chapple IL, Buckley CD, Dietrich T (2009) Periodontitis in systemic rheumatic diseases. Nat Rev Rheumatol 5:218–224

    Article  PubMed  Google Scholar 

  7. Bingham CO, Moni M (2013) Periodontal disease and rheumatoid arthritis. Curr Opin Rheumatol 25:345–353

    Article  PubMed  PubMed Central  Google Scholar 

  8. de Smit MJ, Westra J, Brouwer E, Janssen KM, Vissink A, van Winkelhoff AJ (2015) Periodontitis and rheumatoid arthritis: what do we know? J Periodontol 86:1013–1019

    Article  PubMed  Google Scholar 

  9. Persson GR (2012) Rheumatoid arthritis and periodontitis—inflammatory and infectious connections. Review of the literature. J Oral Microbiol 4. doi:10.3402/jom.v4i0.11829

  10. Kaur S, White S, Bartold PM (2013) Periodontal disease and rheumatoid arthritis: a systematic review. J Dent Res 92:399–408

    Article  PubMed  Google Scholar 

  11. Leech MT, Bartold PM (2015) The association between rheumatoid arthritis and periodontitis. Best Practice & Research Clin Rheumatol 29:189–201

    Article  Google Scholar 

  12. Payne JB, Golub LM, Thiele GM, Mikuls TR (2015) The link between periodontitis and rheumatoid arthritis: a periodontist’s perspective. Curr Oral Health Rep 2:20–29

    Article  PubMed  Google Scholar 

  13. Gerhold K, Richter A, Schneider M, Bergerhausen HJ, Demary W, Liebhaber A et al (2015) Health-related quality of life in patients with long-standing rheumatoid arthritis in the era of biologics: data from the German biologics register RABBIT. Rheumatology 54:1858–1866

    Article  PubMed  PubMed Central  Google Scholar 

  14. Reissmann DR, John MT, Schierz O, Kriston L, Hinz A (2013) Association between perceived oral and general health. J Dent 41:581–589

    Article  PubMed  Google Scholar 

  15. Needleman I, McGrath C, Floyd P, Biddle A (2004) Impact of oral health on the life quality of periodontal patients. J Clin Periodontol 31:454–457

    Article  PubMed  Google Scholar 

  16. Bernabé E, Marcenes W (2010) Periodontal disease and quality of life in British adults. J Clin Periodontol 37:968–972

    Article  PubMed  Google Scholar 

  17. Durham J, Fraser HM, McCracken GI, Stone KM, John MT, Preshaw PM (2013) Impact of periodontitis on oral health-related quality of life. J Dent 41:370–376

    Article  PubMed  Google Scholar 

  18. Al-Harthi LS, Cullinan MP, Leichter JW, Thomson WM (2013) The impact of periodontitis on oral health-related quality of life: a review of the evidence from observational studies. Aust Dent J 58:274–277

    Article  PubMed  Google Scholar 

  19. Blaizot A, Monsarrat P, Constantin A, Vergnes JN, de Grado GF, Nabet C et al (2013) Oral health-related quality of life among outpatients with rheumatoid arthritis. Int Dent J 63:145–153

    Article  PubMed  Google Scholar 

  20. Ahola K, Saarinen A, Kuuliala A, Leirisalo-Repo M, Murtomaa H, Meurman JH (2015) Impact of rheumatic diseases on oral health and quality of life. Oral Dis 21:342–348

    Article  PubMed  Google Scholar 

  21. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO (2010) Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69:1580–1588

    Article  PubMed  Google Scholar 

  22. Slade GD, Spencer AJ (1994) Development and evaluation of the oral health impact profile. Community Dent Health 11:3–11

    PubMed  Google Scholar 

  23. John MT, Patrick DL, Slade GD (2002) The German version of the oral health impact profile—translation and psychometric properties. Eur J Oral Sci 110:425–433

    Article  PubMed  Google Scholar 

  24. World Health Organization (WHO) Geneva: Oral Health Surveys 1997; Basic Methods. 4th Edition

  25. Page RC, Eke PI (2007) Case definitions for use in population-based surveillance of periodontitis. J Periodontol 78:1387–1399

    Article  PubMed  Google Scholar 

  26. Lange DE, Plagmann HC, Eenboom A, Promesberger A (1977) Clinical methods for the objective evaluation of oral hygiene. Germ Dent J 32:44–47 [in German]

    Google Scholar 

  27. Farah Vakar M, Syed Afroz A, Ather SA (2010) Evaluation of correlation between periodontitis and rheumatoid arthritis in an Indian population. Journal of Clinical AND Diagnostic Research 3654–8

  28. Susanto H, Nesse W, Kertia N, Soeroso J, van Huijser RY, Hoedemaker E et al (2013) Prevalence and severity of periodontitis in Indonesian patients with rheumatoid arthritis. J Periodontol 84:1067–1074

    Article  PubMed  Google Scholar 

  29. de Smit M, Westra J, Vissink A, Doornbos-van der Meer B, Brouwer E, van Winkelhoff AJ (2012) Periodontitis in established rheumatoid arthritis patients: a cross-sectional clinical, microbiological and serological study. Arthritis Res Ther 14:R222

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pischon N, Pischon T, Kröger J, Gülmez E, Kleber BM, Bernimoulin JP et al (2008) Association among rheumatoid arthritis, oral hygiene, and periodontitis. J Periodontol 79:979–986

    Article  PubMed  Google Scholar 

  31. Joseph R, Rajappan S, Nath SG, Paul BJ (2013) Association between chronic periodontitis and rheumatoid arthritis: a hospital-based case–control study. Rheumatol Int 33:103–109

    Article  PubMed  Google Scholar 

  32. Scher JU, Ubeda C, Equinda M, Khanin R, Buischi Y, Viale A et al (2012) Periodontal disease and the oral microbiota in new-onset rheumatoid arthritis. Arthritis Rheum 64:3083–3094

    Article  PubMed  PubMed Central  Google Scholar 

  33. Wolff B, Berger T, Frese C, Max R, Blank N, Lorenz H-M, Wolff D (2014) Oral status in patients with early rheumatoid arthritis: a prospective, case-control study. Rheumatology 53:526–531

    Article  PubMed  Google Scholar 

  34. John MT, Micheelis W, Biffar R (2004) Reference values in oral health-related quality of life for the abbreviated version of the Oral Health Impact Profile. Swiss Dent J 114:784–791

    Google Scholar 

  35. Reissmann DR, Krautz M, Schierz O, John MT, Rudolph M, Szentpétery A (2008) Assessment of clinically significant changes in oral health. German Dent J 63:668–680 [in German]

    Google Scholar 

  36. Mendez M, Melchiors Angst PD, Stadler AF, Oppermann RV, Gomes S (2016) Impacts of supragingival and subgingival periodontal treatments on oral health-related quality of life. Int J Dent Hyg 2016 Jan 22. doi: 10.1111/idh.12193

  37. Schierz O, John MT, Reissmann DR, Mehrstedt M, Szentpétery A (2008) Comparison of perceived oral health in patients with temporomandibular disorders and dental anxiety using oral health-related quality of life profiles. Qual Life Res 17:857–866

    Article  PubMed  Google Scholar 

  38. Schmalz G, Kollmar O, Vasko R, Müller GA, Haak R, Ziebolz D (2016) Oral health-related quality of life in patients on chronic haemodialysis and after kidney transplantation. Oral Dis 22:665–672

    Article  PubMed  Google Scholar 

  39. Ng SK, Leung WK (2006) Oral health-related quality of life and periodontal status. Commun Dent Oral Epidemiol 34:114–122

    Article  Google Scholar 

  40. Cunha-Cruz J, Hujoel PP, Kressin NR (2007) Oral health-related quality of life of periodontal patients. J Periodontal Res 42:169–176

    Article  PubMed  Google Scholar 

  41. Jansson H, Wahlin Å, Johansson V, Åkerman S, Lundegren N, Isberg PE et al (2014) Impact of periodontal disease experience on oral health-related quality of life. J Periodontol 85:438–445

    Article  PubMed  Google Scholar 

  42. Meusel DR, Ramacciato JC, Motta RH, Brito Júnior RB, Flório FM (2015) Impact of the severity of chronic periodontal disease on quality of life. J Oral Sci 57:87–94

    Article  PubMed  Google Scholar 

  43. Habashneh RA, Khader YS, Salameh S (2012) Use of the Arabic version of Oral Health Impact Profile-14 to evaluate the impact of periodontal disease on oral health-related quality of life among Jordanian adults. J Oral Sci 54:113–120

    Article  PubMed  Google Scholar 

  44. Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NHJ (2010) Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health Qual Life Outcomes 8:126

    Article  PubMed  PubMed Central  Google Scholar 

  45. Hultin M, Davidson T, Gynther G, Helgesson G, Jemt T, Lekholm U, Nilner K, Nordenram G, Norlund A, Rohlin M, Sunnegardh-Gronberg K, Tranaeus S (2012) Oral rehabilitation of tooth loss: a systematic review of quantitative studies of OHRQoL. Int J Prosthodont 25:543–552

    PubMed  Google Scholar 

  46. Englbrecht M, Wendler J, Alten R (2012) Depression als Systemeffekt bei rheumatoider arthritis. Z Rheumatol 71:859–863 [in German]

    Article  PubMed  Google Scholar 

  47. Cordingley L, Prajapati R, Plant D, Maskell D, Morgan C, Ali FR et al (2014) Impact of psychological factors on subjective disease activity assessments in patients with severe rheumatoid arthritis. Arthritis Care Res 66:861–868

    Article  Google Scholar 

  48. Wang SL, Chang CH, Hu LY, Tsai SJ, Yang AC, You ZH et al (2014) Risk of developing depressive disorders following rheumatoid arthritis: a nationwide population-based study. PLoS One 9:e107791

    Article  PubMed  PubMed Central  Google Scholar 

  49. Dickens C, Jackson J, Tomenson B, Creed F (2003) Association of depression and rheumatoid arthritis. Psychosomatics 44:209–215

    Article  PubMed  Google Scholar 

  50. Covic T, Tyson G, Spencer D, Howe G (2006) Depression in rheumatoid arthritis patients: demographic, clinical, and psychological predictors. J Psychosom Res 60:469–476

    Article  PubMed  Google Scholar 

  51. Matcham F, Rayner L, Steer S, Hotopf M (2013) The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology 52:2136–2148

    Article  PubMed  PubMed Central  Google Scholar 

  52. Detert J, Pischon N, Burmester GR, Buttgereit F (2010) The association between rheumatoid arthritis and periodontal disease. Arthritis Res Ther 12:218

    Article  PubMed  PubMed Central  Google Scholar 

  53. Araújo VM, Melo IM, Lima V (2015) Relationship between periodontitis and rheumatoid arthritis: review of the literature. Mediat Inflamm 259074. doi:10.1155/2015/259074

Download references

Acknowledgements

None to declare.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dirk Ziebolz.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The work was not funded.

Ethical approval

The study was reviewed and approved by the Ethics Committee of the University Medical Center in Goettingen, Germany (No. 9/4/11).

Informed consent

Patients were informed verbally and in writing about the study and gave written informed consent.

Electronic supplementary material

ESM 1

(DOCX 24.5 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mühlberg, S., Jäger, J., Krohn-Grimberghe, B. et al. Oral health-related quality of life depending on oral health in patients with rheumatoid arthritis. Clin Oral Invest 21, 2661–2670 (2017). https://doi.org/10.1007/s00784-017-2068-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-017-2068-4

Keywords

Navigation