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Dental Infections Pose Risks For Hospitalized Patients With Rheumatoid Arthritis
High infection rates among younger adults suggest they either delay routine dental care and only seek treatment when conditions become severe, or face more barriers.
Patients with rheumatoid arthritis (RA) face a 40% higher risk of being hospitalized for serious dental infections compared with those without RA, underscoring the need to integrate oral health into chronic disease care, according to a national analysis of over 14 million hospitalizations in the US.1
The study, published in Cureus, evaluated data from the National Inpatient Sample to determine whether RA increases the likelihood of hospitalization for cellulitis or abscess of the mouth. While these infections were rare, affecting just 0.07% of nearly 15 million adults hospitalized between 2016 and 2022, their severity and connection to chronic inflammatory disease are increasingly recognized by clinicians and researchers.
Researchers called for multidisciplinary care models to integrate dental services into the routine management of chronic diseases like RA.Image credit: D Theron/peopleimages.Com – stock.Adobe.Com
Researchers identified 281,142 patients with RA from the sample. After adjusting for confounding variables such as age, race, sex, smoking status, and length of stay, the presence of RA was significantly associated with dental infection–related hospitalization (OR, 1.399; 95% CI, 1.210-1.618; P < .0001).
"This result adds to and validates earlier research highlighting RA patients' increased susceptibility to infections as a result of immunosuppressive medications and immunological dysregulation," the authors said.
Black Men Had Highest Odds of InfectionThe study also highlighted broader health disparities and modifiable risk factors. Men were significantly more likely to be hospitalized for dental infections than women (OR, 1.79), and Black patients had higher odds than White patients (OR, 1.23). Smokers (OR, 1.33) and patients with longer hospital stays (OR, 1.44) also faced increased risk, and adults 65 and older were less likely to be hospitalized for oral infections than younger adults (OR, 0.25).
"These disparities are reflective of systemic inequities in healthcare access, oral health literacy, and socioeconomic status, which have been well-documented in literature," the authors said.
They also found the highest infection rates relative to group size among patients aged 18 to 49, suggesting younger adults may delay routine dental care and only seek treatment when conditions become severe.2 Of more than 2 million hospitalizations for oral infections, 3097 (0.11%) adults aged 18 to 34 and 2837 (0.13%) aged 35 to 49 were specifically hospitalized for cellulitis or a mouth abscess.1 Adults aged 65 and older had a notably lower infection rate of 0.03%.
"This finding is unexpected, as younger adults are generally considered to be at lower risk for serious infections," they said. "However, it may reflect barriers to preventive dental care, including lack of insurance coverage, reduced healthcare-seeking behavior, or limited oral health literacy in this age group."
Autoimmune Disorders and Dental CareRA affects about 1.3 million Americans and is known to impair the body's immune defenses while increasing susceptibility to inflammation throughout the body, including in the oral cavity.3 Taking immunosuppressive therapies like corticosteroids and disease-modifying antirheumatic drugs also reduces the body's ability to fight off bacterial infections, putting these patients at risk while trying to manage RA.1 According to the authors, the oral cavity is particularly vulnerable to pathogens like Porphyromonas gingivalis, a known trigger of both periodontitis and autoimmunity.
While the analysis benefited from a large, nationally representative sample, the authors acknowledged that the cross-sectional design cannot confirm causality and that relying on administrative coding could have led them to underestimate the true prevalence of infections.
At the same time, they noted that these findings underscore the need for multidisciplinary care models that integrate dental services into the routine management of chronic illnesses like autoimmune diseases; public health efforts should also focus on expanding access to preventive dental care through early screenings, educational outreach, and affordable services for high-risk populations. Together, the authors wrote these strategies could reduce the incidence of preventable oral infections and the serious complications that follow.
"Our findings support the growing consensus that oral diseases do not occur in isolation but rather intersect with broader health trajectories, particularly in immunocompromised populations," they concluded.
References
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7 Common Mouth Infections You Can Treat At Home Now - Rolling Out
These painful conditions affect millions but effective treatments can provide quick relief
Mouth infections represent one of the most widespread health concerns affecting people of all ages, yet many individuals remain unaware of the various types and effective treatment options available. These conditions can range from minor irritations to serious complications requiring immediate attention, making awareness and proper care essential for maintaining optimal oral health.
The human mouth creates an ideal environment for bacterial growth due to its warm, moist conditions and constant exposure to food particles. While saliva naturally helps cleanse the mouth and neutralize harmful bacteria, various factors can disrupt this delicate balance, leading to infections that cause pain, discomfort, and potential long-term complications if left untreated.
Understanding the most prevalent mouth infections and their treatment approaches empowers individuals to take proactive steps in managing their oral health and seeking appropriate care when necessary.
1. Gingivitis leads the pack as most frequent infectionGingivitis stands as the most common form of gum disease, affecting nearly half of all adults over age 30. This inflammatory condition develops when plaque accumulates along the gum line, causing the gums to become red, swollen, and prone to bleeding during brushing or flossing.
The primary culprit behind gingivitis involves poor oral hygiene habits that allow bacterial plaque to build up on teeth and gums. Additional risk factors include smoking, hormonal changes during pregnancy, certain medications, and underlying health conditions such as diabetes.
Treatment for gingivitis focuses on removing plaque and preventing its accumulation. Professional dental cleanings prove essential for eliminating hardened plaque that regular brushing cannot remove. At-home care involves brushing twice daily with fluoride toothpaste, flossing regularly, and using an antimicrobial mouthwash to reduce bacterial levels.
Most cases of gingivitis reverse completely with proper treatment and improved oral hygiene practices. However, without intervention, this condition can progress to more serious forms of gum disease that may result in tooth loss.
2. Canker sores create painful mouth ulcersCanker sores, also known as aphthous ulcers, appear as small, round lesions with white or yellow centers surrounded by red borders. These painful sores typically develop on the soft tissues inside the mouth, including the tongue, inner cheeks, and gums.
Multiple factors can trigger canker sore development, including minor injuries from dental work, aggressive brushing, accidental biting, stress, hormonal fluctuations, certain foods, and nutritional deficiencies. Unlike cold sores, canker sores are not contagious and do not appear on the lips.
Treatment options for canker sores focus on pain relief and promoting faster healing. Over-the-counter topical medications containing benzocaine or lidocaine can provide temporary numbing relief. Antimicrobial mouth rinses help prevent secondary bacterial infections while the sores heal.
Natural remedies such as saltwater rinses, applying honey directly to the sore, or using chamomile tea bags as compresses may also provide comfort and support healing. Most canker sores heal naturally within one to two weeks without scarring.
3. Cold sores spread through viral infectionCold sores result from the herpes simplex virus type 1 and typically appear as fluid-filled blisters on or around the lips. These contagious lesions often begin with tingling or burning sensations before developing into visible sores that eventually crust over and heal.
The herpes simplex virus remains dormant in nerve cells after the initial infection and can reactivate due to various triggers including stress, illness, sun exposure, hormonal changes, or immune system suppression. Once infected, individuals may experience periodic outbreaks throughout their lives.
Antiviral medications such as acyclovir, valacyclovir, or famciclovir can reduce the severity and duration of cold sore outbreaks when taken at the first sign of symptoms. Topical antiviral creams may also help speed healing and reduce pain.
Preventive measures include avoiding known triggers, using lip balm with sun protection, managing stress levels, and avoiding direct contact with active cold sores to prevent spreading the infection to others or other parts of the body.
4. Oral thrush affects tongue and mouth liningOral thrush, caused by an overgrowth of Candida fungus, creates white patches on the tongue, inner cheeks, and roof of the mouth. These patches can be wiped away, revealing red, potentially bleeding tissue underneath.
This fungal infection commonly occurs in infants, elderly individuals, and people with compromised immune systems. Risk factors include antibiotic use, diabetes, dry mouth conditions, smoking, and wearing ill-fitting dentures.
Antifungal medications form the cornerstone of thrush treatment. Prescription antifungal mouthwashes, lozenges, or oral medications effectively eliminate the fungal overgrowth. For individuals wearing dentures, proper cleaning and disinfection of dental appliances is crucial for preventing reinfection.
Maintaining good oral hygiene, limiting sugar intake, and addressing underlying risk factors help prevent thrush recurrence. Probiotic supplements may also help restore the natural balance of microorganisms in the mouth.
5. Pericoronitis targets wisdom tooth areasPericoronitis develops when the gum tissue around partially erupted wisdom teeth becomes inflamed and infected. This condition typically affects young adults between ages 17 and 25 when wisdom teeth are emerging.
Food particles and bacteria easily become trapped beneath the gum flap covering a partially erupted tooth, leading to inflammation, pain, swelling, and potential abscess formation. Poor oral hygiene in hard-to-reach areas exacerbates the problem.
Treatment approaches vary depending on severity. Mild cases may respond to improved oral hygiene, warm saltwater rinses, and over-the-counter pain relievers. More severe infections require professional treatment including thorough cleaning of the affected area and prescription antibiotics.
In recurrent cases or when complications arise, surgical removal of the wisdom tooth may be necessary to prevent future episodes of pericoronitis and protect overall oral health.
6. Tooth abscesses demand immediate attentionTooth abscesses represent serious bacterial infections that develop at the root of a tooth or in the surrounding gum tissue. These infections can cause severe pain, swelling, fever, and potentially life-threatening complications if bacteria spread to other parts of the body.
Abscesses typically result from untreated tooth decay, gum disease, or dental trauma that allows bacteria to enter the tooth's pulp or surrounding tissues. The infection creates a pocket of pus that causes intense throbbing pain and sensitivity.
Emergency dental treatment is essential for tooth abscesses. Treatment options include draining the abscess, root canal therapy to save the tooth, or tooth extraction in severe cases. Antibiotics help control the infection and prevent its spread.
Pain management with over-the-counter medications and cold compresses can provide temporary relief until professional treatment is obtained. However, delaying treatment increases the risk of serious complications including sepsis.
7. Geographic tongue creates map-like patternsGeographic tongue, while not technically an infection, causes inflammation that creates irregular, map-like patterns on the tongue surface. These patches appear red with white or yellow borders and may change location and size over time.
The exact cause of geographic tongue remains unknown, though it may be linked to stress, hormonal changes, certain foods, or genetic factors. This benign condition typically does not require treatment unless it causes discomfort.
For individuals experiencing pain or sensitivity, avoiding spicy, acidic, or hot foods can help reduce irritation. Topical anesthetic gels or anti-inflammatory medications may provide relief during flare-ups.
Most cases of geographic tongue resolve on their own without complications, though the condition may recur periodically throughout a person's life.
Prevention strategies protect against future infectionsMaintaining excellent oral hygiene forms the foundation of mouth infection prevention. Regular brushing with fluoride toothpaste, daily flossing, and routine dental checkups help identify and address problems before they become serious infections.
Additional preventive measures include eating a balanced diet low in sugary and acidic foods, staying hydrated to maintain adequate saliva production, avoiding tobacco products, and managing stress levels that can compromise immune function.
For individuals prone to specific types of mouth infections, targeted prevention strategies such as using antimicrobial mouthwashes, taking probiotic supplements, or applying protective lip balms can help reduce recurrence rates and maintain optimal oral health.
Diabetes And Infections: UTIs, Skin Infections, Oral Infections, And More - Everyday Health
High blood sugar, also known as hyperglycemia, is the hallmark symptom of diabetes, and it puts extra stress on your body. That can impair the body's immune system and allow bacteria and fungi to thrive from your mouth down to your feet.
"When the body is under high levels of stress, the immune system can be affected, resulting in a weaker and less robust response to infection," says Lisal Folsom, MD, the medical director of the adult endocrinology division at the Wendy Novak Diabetes Institute at Norton Healthcare in Louisville, Kentucky.
High blood sugar can cause other complications that make it easier for infections to quickly take hold and start snowballing.[1]
The first line of defense against infections is keeping your blood sugar levels as close to your target range as possible. Healthy glucose levels are the best way to make sure that your body can give 100 percent when fighting harmful germs, making it easier to recuperate.
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