2017 Volume 59 Issue 1 Pages 48-55
This is a case report of a rheumatoid arthritis (RA) patient with generalized severe chronic periodontitis who was treated in cooperation with an internist, with resultant improvement of both the periodontitis and rheumatoid arthritis.
The patient was a 42-year-old female, who presented to us with a history of gingival bleeding and swelling in the region of the right molar teeth. Generalized swelling was observed and the average probing depth (PD) was 5.1 mm, the percentage of sites with PD ≥4 mm was 75.6%, the percentage of sites with bleeding on probing (BOP) was 82.2%, and the plaque control record (PCR) was 80.4%. Dental X-ray images indicated severe horizontal and vertical bone resorption. Based on the results of the examinations, the patient was diagnosed as having generalized severe chronic periodontitis. According to the patient's medical history, the initial diagnosis of RA had been made 10 years ago, and the patient had received treatment with adrenocorticosteroids for nine years.
As part of the initial periodontal therapy, after the plaque control had improved, scaling and root planing (SRP) were performed. The blood reports were sent to an internist, and the progression of the rheumatic symptoms was monitored with the cooperation of the physician. Periodontal surgery was performed to stabilize the periodontal tissue, after which the treatment stage was changed to supportive periodontal therapy (SPT).
After SPT for two years and six months, satisfactory results were obtained, as follows: average PD, 2.6 mm; percentage of sites with PD ≥4 mm, 6.0%; percentage of sites with BOP, 8.7%; PCR score, 15%. At the time of the patient's first visit to our clinic, her daily life was constrained by chronic joint pains throughout her body. As the periodontal health improved, the patient also reported reduction of the joint pains. Nevertheless, since the stabilization of the RA symptoms could not be confirmed from the results of the blood test for rheumatoid factor (RF), there was no correlation between the RF titer in the blood and the periodontal tissue stabilization.
