Katie Melko, RDH, MSDH
Katie works as a public health hygienist and educator and as adjunct faculty at Lincoln College of New England. She is involved in ADHA and currently serves as Immediate Past President in Connecticut.
Patients with arthritis face a number of challenges when it comes to oral hygiene, including dry mouth and limited mobility. Here’s some guidance on how to help your patients manage the effects arthritis has on their oral health care.
What is arthritis?
Arthritis is a broad name for more than 100 types or joint pain or disease. People of all races, genders and ages can be negatively affected by arthritis, and it is one of the top reasons for disability in America.1
Arthritis is swelling of the joints that can cause pain, stiffness and significantly decrease a person’s range of motion. Although arthritis is more prevalent in women and children, it can affect anyone. Symptoms for arthritis aren’t always constant, and can come and go with pain ranging from mild to severe. Some cases of arthritis steadily get worse, while others may stay the same for a period of time before progressing.
Every case is different, and even though arthritis is common, it is not completely understood and more research is needed to fully understand it. Arthritis can be seen physically with the naked eye, but most of the time it is only visible on x-rays of the joints. Some people may have enlarged joints and their hands may deform enough to prohibit day-to-day activities, or limit the ability to perform certain tasks.
When dexterity is compromised, it can cause a person’s oral hygiene to decline.
Arthritis can take away a lot of independence and can lead to depression. It is important to do anything we can to help arthritis sufferers gain back some independence, as this will help both mentally and physically.1
Diagnosing arthritis and its type starts at the patients’ primary physician. The doctor will run blood tests to figure out what kind of arthritis a patient might have. This usually ends up with a referral to orthopedic or a specialist who works with rheumatoid and gout, etc. Sometimes dermatologist and ophthalmologists will be recommended as well, depending on the type and severity of the arthritis.1
How does arthritis affect the oral cavity?
More than 500 prescription drugs have the side effect of dry mouth or xerostomia. Most people tell me that they thought this was just something they had to live with, so they increase their water intake to help suppress the dryness. Or people research dry mouth and get over whelmed with all of the product options, and that deters them from trying anything.
Being able to guide our patients to the right product for them will require us to do some research, as well. I always like to ask what kind of dry mouth symptoms they are experiencing because this helps me lean towards one product or another. People who suffer from arthritis are on medications to help with inflammation and pain, and dry mouth is a side effect for many.
What kind of dry mouth is a patient experiencing?
Some people experience dry mouth more during their sleep than during the day, especially if they have sleep apnea, sleep with their mouth open or wear an appliance. For these patients, I would recommend Biotene® Oral Balance Gel or Dry Mouth Melts. These help protect the tissue by holding in moisture while you sleep.
If your patients experience dry mouth during the day, I ask about their diet and habits. Patients usually try water, mints and/or gum. I usually recommend ACT Dry Mouth Lozenges, sugar-free candy or gum that contains xylitol (such as Trident) which is a very important part of salivary production. I also recommend patients limit caffeine intake, as it is a diuretic and will dehydrate them more.
Sometimes a patient won’t try a product long enough to see if it actually works. I like to recommend patients to use products as directed for at least seven days before giving up on a product. I also like to tell them that there are so many products on the market and we will find the one that works for them. Oasis is another great mouth rinse that I like to recommend – some people tend to like the taste better. There are also nasal sprays, mouth sprays and toothpastes that can help alleviate dry mouth-induced effects from medication and aging.
Something else to keep in mind
Another thing to consider when it comes to patients with arthritis is their dexterity, and whether they are having any issues flossing or gripping a toothbrush. Patients who experience arthritis in their hands end up losing fine motor skills that are required to floss, and they also lose the ability to close their fists tight enough to hold a small handle like a toothbrush.
Some options you can offer for brushing and flossing are a bike handle, tennis ball or stress ball, washcloth with a rubber band, putty or clay to mold around it, an electric toothbrush, or a WaterPik®. Some people like to use Y flossers, but I find that patients still need to thread the floss which can be challenging, and the flat handle may be hard to grip. I often recommend the Reach Flosser with an enlarged handle option that is listed above.
Oral hygiene education is especially important when a patient is compromised. Their high caries risk puts them at risk for root caries, gingival disease and infection. Having the proper knowledge and tools will help reduce the effects of dry mouth and their limited range of motion. Recommending fluoride varnish treatments or MI Paste® can be beneficial, too, depending on the severity and what the patient presents with.
Remember: when you see arthritis checked off on a patient’s medical history, investigate to figure out how you can help make their disease more manageable and help them avoid more complications in the future. Prevention and education are so important; remind them of their recalls and help them realize the importance of that, too.