Human medicine
Orthopaedics
Advantages of membership
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Who we are
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How healthy are your orthopaedic patients' mouths?
Health begins in the mouth
The importance of oral health in orthopaedics and rheumatology is often underestimated. Yet around one in two adults in Germany is diagnosed with moderate periodontitis - and the trend is rising. Among 65- to 74-year-olds, only 1.4% still have periodontally healthy teeth. Periodontal disease is very common in patients who have undergone hip or knee joint surgery. Periodontal inflammation is classified as an independent risk factor for late complications with endoprostheses.
Up to 50% of patients with rheumatic diseases also suffer from periodontal disease. Periodontitis can presumably contribute to the development of rheumatoid arthritis (RA) and influence its course. Both diseases share the risk factor of smoking and may have a similar genetic background.
Possible complications
Is there a need for action?
Yes, on the one hand for your patients with rheumatoid arthritis, because ...
- Periodontal inflammation can aggravate the pain of arthritis or the progression of osteoarthritis.
- RA patients suffer more frequently and more severely from periodontitis and poor dental status than non-rheumatic patients.
- Even moderate periodontitis can increase the risk of developing rheumatoid arthritis by a factor of 6.
- in smokers with periodontal disease, the risk of RA can increase by a factor of 9.
Secondly, for patients with planned or completed artificial joint replacements, because …
- Patients with periodontitis have increased D-dimer levels and an increased risk of thromboembolic events.
- Periodontal disease can lead to impaired healing after joint surgery.
aMMP-8
Expanding prevention diagnostics with aMMP-8
Clinical studies prove it: In patients with rheumatoid arthritis, periodontal rehabilitation can lead to an improvement in the symptoms of the rheumatic disease.
When implanting total endoprostheses, the risk of infection can be reduced by professional dental hygiene.
At the 41st Congress of the German Society for Rheumatology (DGRh), PD Dr. Eva Reinhold-Keller advocated close collaboration between rheumatologists and dentists, particularly for the following indications:
- Temporomandibular joint involvement in rheumatic diseases
- Oral sicca symptoms with the risk of rapidly progressive caries
- Restricted mouth opening in scleroderma
- Reduced individual oral hygiene with functional restrictions
- Systemic immunosuppression (incl. biologics) with increased risk of infection
- Local infections (e.g. Candida)
- periodontal disease
With the world's first oral immunological preventive diagnostics, the PerioSafe DR test, orthopaedic surgeons and rheumatologists can now easily test their patients for hidden oral inflammation in their practice.
As a check-up in an internal medicine or orthopaedic practice to identify patients at risk of periodontitis, PerioSafe DR is an ideal addition to your prevention programs.
With PerioSafe
Advanced diagnostics with PerioSafe
- With PerioSafe DR, clinicians can detect active oral collagen degradation at a reversible stage, i.e. before the gums appear clinically conspicuous
- PerioSafe DR is particularly suitable for patients with type 1 and 2 diabetes and an increased risk of diabetes
- PerioSafe DR is easy and reliable to use in the internal medicine practice (saliva sample)
Oral health is particularly important for:
- Patients with rheumatoid arthritis
- Patients with osteoporosis
- Patients with cardiovascular and thromboembolic risks
- Patients with (planned) endoprostheses
- All patients who want to do more for their (oral) health as a preventive measure
What to do if the value is high?
In the event of a finding, a referral to a periodontist or specialist dentist for periodontology is advisable as part of an interdisciplinary collaboration. Patients should be informed about the risks of a possibly incipient or manifest chronic periodontal inflammation in connection with their individual health situation.
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Dirk-Rolf Gieselmann
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