Dental implants can be helpful for people with tooth decay or those who have lost teeth. However, autoimmune diseases such as psoriatic arthritis (PsA) may increase the risk of infections, particularly if a person takes immunosuppressant drugs.

Immunosuppressant drugs can reduce the symptoms of PsA, but they also weaken the immune system. Inflammation from PsA may also cause bone loss, which can ultimately cause the implants to come loose.

This can pose a challenge for people with PsA, as some research suggests that PsA increases the risk of dental disease. A person’s doctor and dentist may need to work together to maintain dental health and to minimize the risk of complications should a person need implants.

Read on to learn more about psoriatic arthritis and dental implants.

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Yes, some people with PsA can get dental implants. Implants may be the best option for the dental complications PsA can present.

However, there may be some situations in which dental implants present a high risk of adverse events for those with PsA. The procedure may not be suitable if:

  • there is not enough bone in the jaw to support the implant
  • there is an active gum infection
  • the person is very unwell

The benefits and risks of dental implants will vary case by case.

Anyone who has severe tooth decay and requires a tooth replacement may need dental implants, but PsA may increase the risk of needing dental implants in several specific ways:

  • Gum disease: PsA has links to gum disease, especially severe periodontitis. This may cause more bacteria in the mouth, leading to tooth decay and tooth loss.
  • Inflammation: PsA causes chronic inflammation. Inflammation may increase the risk of gum disease and damage to tissue, including teeth.
  • Impaired healing process: PsA may change the body’s process of bone repair. This may mean that damage to the teeth and jaws does not heal as it should.
  • Comorbidities: Comorbidities are conditions that often occur together. PsA correlates with a higher rate of certain comorbidities, such as heart disease and diabetes, that also increase the risk of tooth decay.

Sometimes people also get implants because of discoloration on their teeth, broken teeth, or other cosmetic damage to their teeth.

The potential complications dental implants present are the same for those with PsA as they are for other people. The main difference is the risk level.

People with PsA may have a higher risk of:

  • Infection: PsA may increase the risk of infection due to the impact inflammatory processes can have on the body. Additionally, many PsA drugs work to suppress the immune system. This may increase the risk of implant failure and infection.
  • Bone loss: PsA increases inflammation, which triggers a complicated immune system reaction that can increase bone loss. If a person loses bone around the implants, the implants may fail.
  • Metal reactions: A person may have an allergic or hypersensitive reaction to the metals used in some dental implants. Some evidence suggests that people with psoriasis may have a higher risk of these reactions, but the research on this is contradictory.

Some strategies that dentists may use to help reduce the risk of complications in those with PsA include:

  • discussing the treatment plan with the person’s rheumatologist
  • checking what medications they use well in advance of the procedure
  • discussing temporary alternatives they could try with the person’s doctor if a person takes immunosuppressant drugs
  • discussing treatment risks, and teaching people interested in dental implants the early warning signs of infection
  • starting with just one implant for people needing multiple implants to assess how well the person responds to the procedure before moving forth with additional implants
  • using nonmetal implants

To fit a dental implant, dentists insert an artificial tooth root into the gum and jawbone, and then place an artificial tooth on top. This mimics a natural tooth.

Most people get endosteal implants, which fit into the bone. But people who do not have adequate bone sometimes get subperiosteal implants, which fit on top of the bone.

To perform the procedure, a dental professional will administer local anesthesia to numb the area. When the anesthesia has taken effect, the dentist may remove the unhealthy tooth, if it is still present.

The exact technique a dentist uses next will vary. There are several approaches:

  • Two-step process: This involves an initial surgery to insert the tooth root below the gum. When the bone starts to heal after several months, the person then undergoes a second procedure to add an attachment, which the dentist can then use to attach the artificial tooth.
  • One-step process: This involves placing both the root of the implant and the attachment for the prosthetic tooth at the same time.
  • Immediate restoration: This approach places all the parts of the implant — including the root, attachment, and top of the tooth — simultaneously.

Dental implant surgery is minimally invasive and often only requires local anesthetic, but if a person experiences dental anxiety, the dentist may also use sedation. People who receive sedation will be groggy after the procedure, so they will need someone to drive them home afterward.

In the days following the procedure to fit dental implants, a person may have swelling and pain. Sometimes this can make it difficult to eat.

A 2021 study involving people who had dental implant surgery found that most swelling disappeared within 5 days, and pain disappeared within 3 days. Most people stopped using pain medication within 2.5 days, and within 1.5 days, most people no longer had disruptions in sleep and swallowing.

No research exists on healing times for people with PsA. So the average time swelling and pain lasts may be different.

If a person develops pain or swelling that is not going away or is getting worse, it is important that they speak with their dentist. It is also important to monitor for signs of infection, such as:

  • loose or wobbly implants
  • pus coming from the wound
  • bad breath or a bad taste in the mouth
  • bleeding when brushing the teeth
  • fever

If a person has had to change their medication, part of their recovery may also involve restarting their previous prescription. Their doctor or dentist can discuss whether restarting medication is part of their recovery process.

Before beginning the process of getting dental implants, it is important to understand all the risks and benefits. A person may find it helpful to ask their dentist the following questions:

  • Do you have experience working with people who have PsA or other autoimmune diseases?
  • How do you manage the risk of complications?
  • Is there a specific type of implant that is lower risk for me?
  • What can I do to lower my risk of infection or rejection?
  • What are the early warning signs of a problem, and what should I do?
  • If my implants fail, what are my options?
  • How might complications change the cost of implants?

Psoriatic arthritis (PsA) can pose challenges for a person’s dental health, as it may increase their risk of dental conditions.

In addition, dental implants may not be as safe for people with PsA as they are for others, especially if they have comorbidities or take drugs that suppress the immune system.

It is important to discuss treatment risks and benefits of treatment, and to look for an implant dentist who has experience working with people who have autoimmune diseases. A rheumatologist may also be helpful in guiding treatment decisions and recommending appropriate medications.