Disease activity, morning stiffness and missing teeth are associated with oral health-related quality of life in individuals with rheumatoid arthritis

Abstract

Objectives The aim of this cross-sectional study was to assess oral health-related quality of life (OHRQoL) in patients with rheumatoid arthritis (RA) and its relation to specific RA characteristics. Material and methods Within the oral examination, the need for dental (carious teeth showing cavitation) and periodontal treatment (presence of a probing depth ≥ 3.5 mm) and the number of missing teeth (M-T) were recorded. OHRQoL was assessed with the German short version of the Oral Health Impact Profile (OHIP G14). The disease activity score (DAS28-ESR), disease duration, number of swollen/painful joints and duration of morning stiffness were retrieved from the patient records. Results A total of 176 patients with a mean age of 62.5 ± 10.2 years were included. The overall OHIP G14 sum score was 5.4 ± 7.1. The M-T showed a significant correlation with the dimensions of oral function (r = 0.25, p = 0.001) and psychosocial impact (r = 0.20, p = 0.009) and the sum score (r = 0.26, p = 0.001). The DAS28-ESR showed a significant correlation with psychosocial impact (r = 0.19, p = 0.012) and the sum score (r = 0.16, p = 0.041). The duration of morning stiffness was correlated with oral function (r = 0.19, p = 0.019), psychosocial impact (r = 0.18, p = 0.024) and the sum score (r = 0.22, p = 0.006). The effect size of these correlations was interpreted as small. Conclusion Disease activity, morning stiffness and missing teeth are associated to OHRQoL of patients with RA. Accordingly, multidisciplinary dental care appears necessary for these patients. Clinical relevance The prevention of tooth loss as well as the consideration of psychosocial and disease-specific parameters in the multidisciplinary dental care of RA patients is necessary.

Oral health‐related quality of life in different rheumatic diseases

“…Therefore, differences in OHRQoL between the different entities might be explainable by the different disease-related burden and its potential impact on psychosocial situation. This assumption is supported by a previous study showing disease activity of RA to be correlated with psychosocial impact within OHRQoL (Schmalz et al, 2020).…”

“…The OHIP G14 sum score in the current study lied between the scores of two previous German studies, which showed values of 5.4 and 7.7, respectively (Mühlberg et al, 2017;Schmalz et al, 2020).…”

“…One of these studies applied OHIP 14 questionnaire and found a mean value of 9.97, what is just slightly lower than in the current study (Yuen & Nelson, 2014). The largest body of studies is available for patients with RA, which also confirmed an impaired OHRQoL in this patient group (Blaizot et al, 2013;Chamani et al, 2017;de Azevedo Branco et al, 2019;Mühlberg et al, 2017;Nosratzehi, Nosratzehi, Nosratzehi, & Ghaleb, 2019;Schmalz et al, 2020;Tristiu et al, 2018).…”

“…Generally, oral health parameters like tooth loss and periodontitis severity affect the OHRQoL (Buset et al, 2016;Gerritsen, Allen, Witter, Bronkhorst, & Creugers, 2010). Some previous studies are available, confirming the association between tooth loss or denture wearing and OHRQoL of patients with rheumatic diseases, respectively (Blaizot et al, 2013;Chamani et al, 2017;Corrêa et al, 2018;Schmalz et al, 2020). In contrast, several other examinations showed no associations between oral status and OHRQoL of patients suffering from rheumatic disease (Mühlberg et al, 2017;Schmalz et al, 2018;Tristiu et al, 2018).…”

“…Furthermore, the four dimensions oral function, psychosocial impact, oral pain and orofacial appearance were considered. The questions of OHIP 14 were assigned to each dimension according to the allocation by John et al (2016) and in the same way as in a previous study by this working group (Schmalz et al, 2020). However, several important limitations need to be addressed.…”