Ankylosing spondylitis and dental problems: What to know

The link between ankylosing spondylitis and dental health

The inflammation that AS causes can also result in inflammation in the temporomandibular joints (TMJ). The TMJ are the two joints that connect the lower jaw to the skull and sit on both sides of the lower jaw.

The TMJ functions to open the mouth and also allows for other movements such as chewing, sucking, and swallowing to occur.

AS may affect the TMJ in 4–35% of cases. TMJ restricts jaw movement, including the ability to open the mouth, which may affect oral hygiene. For example, an individual may find it difficult to brush their teeth effectively and may experience pain when trying to open their mouth. Due to the back pain that AS causes, a person who visits their dentist may also find it difficult to sit through treatment when lying on their back.

A 2019 study also found that participants with AS had a higher prevalence of oral diseases.

Additional research also suggests an association between AS and oral ulcers. The research authors also concluded that bleeding gums and other oral problems were markers of periodontitis and dental caries, or tooth decay.

Types of oral diseases that may occur in ankylosing spondylitis

The types of oral diseases include:

• Periodontitis: Periodontitis is a type of gum disease. Bacteria can trigger it, leading to long-term inflammation in the gums that can damage the teeth, including loose teeth or even tooth loss.
• Oral ulcers: These are white-reddish spots that appear on the inner mouth lining. They often feel painful and may worsen when eating food.
• Sjögren’s disease: A person with SA may also have Sjögren’s. In this condition, people may experience dry eyes and dry mouth. Dry mouth can cause severe tooth decay and gum disease. In severe cases, ulceration and fungal infections of the mouth lining can occur.
• Oral candidiasis: Oral candidiasis is a fungal infection in the mouth. The fungal organism Candida albicans causes it.
• Gingivitis: Gingivitis is a milder and reversible form of periodontitis.

Treatments

A person will likely need to consult a dentist who can diagnose any oral diseases and determine the best course of treatment.

Treatment for oral candidiasis

Treating oral infections, such as oral candidiasis, generally involves brushing the teeth regularly and using mouthwashes with anticandidal activity such as triclosan.

A doctor may prescribe topical antifungal products that people apply on the surface of the mouth, such as:

• oral nystatin suspension
• amphotericin B
• miconazole gel

Other medications that a doctor may prescribe for oral infections include:

• fluconazole
• itraconazole
• voriconazole

Treatment for periodontitis and gingivitis

A person should receive treatment to remove the bacterial plaque in the mouth. This plaque triggers the disease, and removing it may help stop the progression of periodontitis.

A dentist or a periodontist specializing in preventing and treating oral diseases will typically complete this treatment. Doctors may also prescribe antibiotics to deal with persistent infections.

Treatment for oral ulcers

Oral ulcers will normally heal after a few weeks, but they may take up to 4 weeks to heal. They do not typically require any treatment. To relieve symptoms of oral ulcers, doctors may recommend using over-the-counter (OTC) gels or mouthwashes that contain anti-inflammatory and pain-relieving components.

Treatment for Sjögren’s disease

There is no cure for Sjögren’s disease. However, treatment will focus on reducing the symptoms of the condition. Treatment options for oral symptoms include:

• saliva production stimulators
• antifungal medications
• OTC pain relief medication

Treatment for tooth decay depends on the severity. A dentist may prescribe fluoride treatments, such as mouthwash, to reverse early tooth decay. People may also need a filling if they have a cavity in their tooth. In some cases, they may require root canal treatment or tooth extraction.

Common ankylosing spondylitis symptoms

The most common symptoms of AS are chronic lower back pain and stiffness. These symptoms normally appear between the ages of 15 and 30 years.

The pain is typically worse when resting or inactive, so it may be worse when sitting for a long period or during sleep. Movement and exercise typically improve pain symptoms.

Other symptoms include:

• inflammation, pain, and stiffness in other joints, such as the shoulders, knees, feet, or ribs
• difficulty in taking deep breaths
• changes in vision and eye pain
• tiredness
• loss of appetite
• weight loss
• skin rashes
• abdominal pain
• loose bowel movements
• skin rash, or psoriasis

Outlook

There is no cure for AS. However, a person with AS may slow the condition’s progression with effective medication and physical therapy.

People with AS may take a combination of different medications, including:

• nonsteroidal anti-inflammatory medication to relieve pain
• biologic medicines that target the inflammation
• corticosteroids to reduce more severe inflammation and pain symptoms
• Janus kinase inhibitors in cases where people are unresponsive to other treatments — these medications send messages to specific cells to stop inflammation from inside the cell

Additionally, individuals with AS may benefit from physical therapy to improve mobility, strengthen their neck and back muscles, and reduce pain symptoms.

Severe AS may require advanced treatment, such as surgical replacement of joints or joint repairs. Anyone with AS and oral conditions should practice good dental hygiene where possible and seek advice from their doctor or dentist.

Summary

AS is a lifelong inflammatory condition that results in back pain and stiffness.

A person with AS may also experience oral conditions due to dry mouth and TMJ inflammation. Types of oral conditions include oral ulcers, tooth decay, and periodontitis.

Treatments for these conditions may require antifungal medication, antibiotics, or dental treatment to remove bacterial plaque.

While there is no cure for AS, a person can slow the progression of the disease with medications and physical therapy. People with AS may also help prevent oral conditions by practicing good oral hygiene where possible.