The Challenge of Rheumatoid Arthritis and Dental Care

Rheumatoid Arthritis is a difficult condition to live with, as I don’t suffer from this myself my description probably does not do  justice to the impact that this disease has. I have many patients, friends and family who do suffer from it and this post is just a few ideas and suggestions that might make maintaining good home care a little bit easier for anyone with reduced dexterity be it as a result of arthritis or any other condition.

We recognise the need to clean around the teeth and between the teeth. 2  “separate activities,”  for which 2 separate sets of tools are needed.   Lets start with the easy one brushing.

Brushing Choices

Modern electric brushes solve a lot of problems, their handles are thicker than manual tooth brushes and generally they do most of the hard work. There are 2 main types

The oscillatory type – these have a round head that rotates a few degrees back and forwardsOral B Rotary electric toothbrush to create a rotating scrubbing motion. These were made popular by Oral B who still have an extensive range of brushes available to day although other manufacturers so now produce very similar brushes.

The second type of brush is the “sonic” type where tiny micro movements are sent through the toothbrush bristles so there is less visible motion on the head of the brush.  The most commonly brand of this type is Sonicare. The sensation with sonic brushes is definitely different to a manual or indeed an oscillatory brush and can to some people be an acquired taste.

Manufacturers will all claim that their brush technology is best and also highlight that the more you pay the more features the brush will have.  Most of the additional features may make brushing more fun / less boring,  but few of these “add on” tricks will make a quantum difference to the results you achieve. My advice is always – choose the type that you like best and then look for a low cost model with a 2 minute timer ( as this is probably the single most important add on  feature)

Cleaning Between The Teeth

This is a trickier area and for most patients it starts with trial and error.  I cannot recommend one device that will work for everyone but I can suggest a range of things that we have found work well in the hands of our patients.

The first thing to say is that mouthwashes that claim to swirl between the teeth, simply won’t do the job on their own despite the marketing hype!

Long handled interdental brushes

These are great for most sites and the version  with the  longer handle are ( for most people ) easier to use than the shorter ones. The extended handle is relatively narrow  which can make it a little harder to grip but this can be easily overcome with a customised handle.  Dental impression material works very well for this and your hygienist or dentist  should be able to rattle one of these up for you relatively quickly. Brushes are generally regarded as better than floss at cleaning between teeth so if you have spaces that are large enough to allow it these probably should be your first choice.

Flossing Devices

The best devices have a bow type arrangement and  there are many of these on the market. Rather than recommend a specific make there are some key things you should look for.  I think that this type of arrangement works best. When you put this in your mouth and place it towards the back teeth the floss is already orientated the right way and will be much more likely to fit inbetween the teeth. Devices that look a bit like a fiddle bow are not so good for the back teeth  ( Which is where it is really important to get access.)

Many patients with reduced dexterity harv told me that  they can help the floss get through the tight contact with a gentle bit of pressure from the opposing teeth. While we don’t recommend   “biting  to floss ” normally this may make the difference between getting in to the back teeth and not.

The type of floss that the bow is threaded with is also important, where possible look for a monofilament / one that will break cleanly. The last thing you want to end up with is shreds of floss wedged between the back teeth.

Ask us for help

My most important piece of advice is to be sure to ask us to help  if you are struggling to get in with floss or brushes.  Te team are always there to help and have lost of samples on hand  so that you can go rapidly through the trial and error process while you are with us.


Finally just a quick word about mouthwashes.  They can be useful, particularly if you are experiencing a higher rate of tooth decay. Many medications interfere with saliva production and can  leave your mouth dry. The lack of saliva means that any sugar in your diet will hang around for longer  and consequently have the potential to cause more damage. It is not uncommon to see someone who starts a  programme of complex medication suddenly developing tooth decay on parts of their teeth were there was none before.  I will cover this in more deail in a future blog post  but for now the key messages in relation to mouthwash are – choose a fluoride containing mouthwash, choose an alcohol free mouthwash, and use it after you have brushed and cleaned in between the teeth.