RA and Your Mouth

Imagine a beautiful weekend morning.  The weather is sunny and warm, and with no commitments to go anywhere until after noon, you can stay home and tackle all those outdoor projects that you’ve been wanting to do.  You might change the oil in the car, mow the lawn, weed the garden, or prune the hedge.  After a few hours, your tummy starts growling and you head inside for lunch.

Do you head straight for the refrigerator?  I hope not!  Most of us would wash our hands before touching food.  Even though we’re busy and it takes extra time, we know how important it is to clean our hands first.

Just as it’s important to clean our hands before eating, it’s important to clean our teeth after eating.  The fact that we’re busy is irrelevant.  If we have time to eat, we have time to brush our teeth afterward.  It’s especially important if you have RA.

There have been many studies published about a possible link between RA and gum disease.  The results are by no means conclusive.  Some studies suggest that people with gum disease have a greater likelihood of developing RA.  Other say that those with RA are more likely to develop gum disease.  Peridontists reject the idea that there is a link, claiming selection bias and other errors in the studies that suggest a link between the two.  One alternate-med site goes so far as to claim that RA is caused by dental infection, particularly dental work (root canals, fillings, etc.) that got infected but was never treated.  I would scoff, except that the timeline between my first crown and the onset of my RA symptoms makes me wonder.  It would certainly explain why some people respond so well to antibiotic therapy.

Regardless of how you view the evidence, the consensus seems to be that there are at least two factors involved:

  • RA is a systemic disease, and the immune malfunction that causes joints and organs to be inflamed also causes gum inflammation.
  • People with RA are sometimes in too much pain to properly clean their teeth, which can quickly lead to/worsen gum disease.

People with RA need to be particularly vigilant about dental care.  We need to take three important steps.

Floss at least twice a day.  If swollen, painful hands can’t grasp dental floss or a holder, consider a waterpik.  If flossing hurts and causes your gums to bleed, it is especially important to floss.  Two weeks of careful flossing should eliminate bleeding gums (which does not imply that it’s okay to stop flossing!) — if not, dentists recommend a checkup.

Brush after eating. Every time.  No excuses.  If you have time to eat, you have time to brush.  Brushing right before bedtime is also recommended — especially if you’ve snacked after supper.

When uncontrolled RA makes the toothbrush difficult to hold, it’s possible to pad the handle of a “normal” toothbrush to make it easier to grasp:

  • Slip a bicycle hand grip over the toothbrush handle
  • Stab a hole in a tennis ball, then put it on the end of the toothbrush
  • Shove the toothbrush handle into a wrist- or thumb brace

Another good option is an electric toothbrush; they have larger handles and also brush more effectively.  If you’re no more willing to spend $130 for a toothbrush than I am, there are other options than the pricey model recommended by dentists.  The toothpaste aisle in the grocery store now carries a variety of battery-powered toothbrushes.  Most of them oscillate (not what my dentist recommends), but I found one for $30 that has a rotating head and does not hurt the mouth.

toothbrushesAs you can see from this picture, the handle of this electric toothbrush is significantly larger than the handle of a standard toothbrush.  It is very easy to hold.

Finally, use mouthwash every night.  There are many different kinds.  Some dentists recommend an antibacterial mouthwash.  Also, some dentists recommend that the mouthwash also contain flouride, calcium, and phosphate to help repair tooth enamel.

Sometimes we’re tired and sore, but following these three simple steps is important.  We’d all like to have pearly-white teeth.  There is a bonus.  Many people discover that keeping their teeth scrupulously clean leads to an improvement in RA symptoms.

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Protect Your Dental Health From Symptoms of Rheumatoid Arthritis

Associations between Periodontitis and Systemic Inflammatory Diseases: Response to Treatment.

Don’t Let Disability Keep the Dentist Away

Inter-relationship Between Rheumatoid Arthritis and Periodontitis

Periodontal Systemic Associations: Review of the Evidence

I Can. Can You?

“How do you have the energy to do all that?!  I’d be exhausted!”  That’s a comment I’ve heard quite a bit these past few weeks.  Truth be told, I am exhausted.  I’m also mighty happy to be accomplishing things.

Instead of avoiding taxing activities, I try to find the most efficient (and least expensive) way to get them done.  Yes, I get tired.  No, I can’t work a full-time job and then spend seven hours in the evening canning fruit like I did twenty years ago, but I can still manage to put enough by that we have food to eat without wondering how to pronounce all the chemicals on an ingredient label.

My tips for how I manage canning season with RA would just as easily apply to other situations:

Know Your Limitations
In preserving foods, the hardest part, for me, is picking.  There’s much more fruit than I’m physically able to pick – especially when the fruit is overhead and my rotator cuffs don’t want to do their job.  When I pick, I pick from the lower branches, and leave the upper branches for people who are a) taller, b) tree-climbers, or c) comfortable picking from ladders.  I know my limitations.

It can be difficult admitting that we have limitations.  We’d like to think we’re invincible.  RA teaches us otherwise.  Work with what you have.  Whether it’s canning or anything else, knowing our limitations is important.

Work Smart
One of my favorite quotes, by R.G. LeTourneau, is “Work smart, not hard.”

I look for ways to work smart.  When heavily laden branches are relieved of their burden, the boughs rise – usually several feet.   If I started picking apples closest to the ground, and worked my way upward, the branches would quickly spring up out of my reach, limiting how many apples I’d be able to pick.  Instead, I start picking as high as I can reach.  As the empty branches move upward, the lower apples are still within reach.  I’m able to pick much more by grabbing those upper apples before they move too high.

That’s true with the rest of life, too.  Hard isn’t required.  Focus on working smart.

Accept Help
Sometimes we want to prove we’re capable of doing things on our own, but it’s okay to accept help.  People want to help.  After canning twelve lug of peaches, knowing I’d be starting on apples next, I posted about it on Facebook.  The responses included:

If we put one more person in the kitchen for peaches, we’d be tripping over one another.  Apples are a different story.  Apples are tons more work than peaches, and I need help. I have to set aside my pride and ask – or accept help when it’s offered.  People really do want to help.

I’ve been thinking about this.  My children have no qualms about inviting friends over to help them pick apples.  The apples need to be picked, and it’s fun to do things with friends, so they invite friends over.  Everyone has a lot of fun. One weekend my daughters and their friend had been picking apples for about an hour when I heard a knock at the door.  It was the friend’s parents.  They’d heard we had apples to pick and wanted to help.

Whether it’s canning season, or grocery shopping, or working in an office, accept help!

Develop Efficient Processes
Know what you need to do, then figure out the best way to do it.  Apples and peaches, rhubarb and cherries, as well as beans, corn, and pumpkin are all very different foods; they need different processes.  It can be hard to break away from the habit of doing things the way we’ve always done them, but it’s a good idea to step back, analyze what’s truly needed, then eliminate all the extra (unneeded) steps to fine-tune your workflow.  Make everything as efficient as possible.

Always ask if there’s a better way to do things.  For example, every recipe I’ve ever seen for applesauce involves putting cut-up apples into a pot on the stove-top, adding apple juice/cider, then cooking carefully to avoid scorching the food.  My shoulders don’t like all that stirring.  My feet do not like standing at the stove long enough to cook apples down into sauce.  I’m guessing yours don’t, either.  There’s no need!  It’s significantly easier to make applesauce a different way.

It doesn’t apply only to canning applesauce.  I’ve found ways to streamline many different tasks.  Never settle for doing things the way others have always done them.  Aim for efficiency.

Life with rheumatoid arthritis can be tricky.  To make things easier, it’s a good idea sometimes to pause, analyze situations, know your limitations, accept help, develop efficient processes, and work smart.

Flare

flareSo much for remission.  It was good while it lasted.  Swollen feet and stiff hands/wrists are not how I like starting my days.  Recently my feet have been so sore that I’ve caught myself thinking that if I had one of those blue parking tags, I’d actually use it when I’m at the store.  That’s not something I ever thought I’d say.

This flare is affecting basic activities.  Tuesday night I went shopping and couldn’t even pick up my groceries normally.  I felt like a two-year-old with one hand on each side of the boxes so that I could get them into my cart.

In trying to figure out what changed (did anything perhaps cause this flare), I realized that I am beat!  With one child running track, and another playing baseball, it seems like I’ve been constantly on the go. These sports are in addition to the kids’ usual activities (violin, piano, lawn care job, scouts, youth group, getting ready for college…), but the two new sports seem to have pushed things over the edge.  I’m exhausted.

I’ve tried to pace myself and let some things slide since life has gotten so hectic.  That means there are dirty dishes in my kitchen sink and I’m sitting at the computer resting instead of cleaning the kitchen.  All the laundry has been washed, but it has not been folded or put away (to tell the truth, I’m happy it’s not still in the dryer, and figure people will go find their clothes when they need them).  Despite looking for ways to get some rest and not over do it, I’m exhausted.  Maybe that’s why my joints are rebelling.

My kids are trying to help.  Some people cringe at the thought of teenage drivers, but I have to say that I am thrilled to have assistance with transportation.  Unlike God, I cannot be two places at the same time.   Music lessons are 12:30-2:30, and track practice is 2:00-4:00.  Track meets are 3:30-6:00, and baseball games are 5:30-8 (sometimes in cities an hour away from each other). My daughters have been fabulous in helping out with all the driving so their brothers can participate in team sports for the first time in their lives.

Honestly, if I have to deal with a flare so that my boys can play sports and have this happy memory to look back on, I can live with a flare.  It’s worth it.  It broke my heart, when my son asked about sports this year, to discover that my daughter had wanted to turn out for volleyball back when she was that age.  She never even asked, and has felt deprived all this time, because that was the year I was diagnosed.  RA affects entire families in ways we might not even know about until later.  We had a couple pretty crummy years, and I have no idea how I could possibly have gotten any of the kids to any extra activities back then.

Despite the flare, things are way better than they were five years ago.  I don’t yelp in pain when I roll out of bed in the morning.  I’m able to sleep at night without waking in pain every time I roll onto a bursa (and my vocabulary now includes words like “trochanter”).  I can (usually) lift my arms.  Yes, I hurt.  My hands, my feet, my shoulders… But this is just a flare.

Flares burn for a while warning that there’s a problem, and then they’re gone.  Maybe, just maybe, this flare is warning me to pace myself better.  With any luck, if I heed the warning, the flare will die out.