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Periodontal Disease and Ankylosing Spondylitis

Although ankylosing spondylitis (AS) primarily affects the spine, other parts of the body can also be affected, including the mouth. About 15% of people with AS experience jaw involvement, where the joints of the jaw become stiff and make it difficult to open the mouth.1 In addition, people with AS are at an increased risk of developing gum disease.2

What is periodontal disease?

Gum disease is a broad term that encompasses any disorder of the tissue surrounding and supporting the teeth.3 It can range in severity from a simple gum inflammation (gingivitis) to more serious disease that can damage the bone and soft tissue that support the teeth.4

What are symptoms of periodontal disease?

Common symptoms of gum disease include bad breath, swollen or bleeding gums, painful chewing, sensitive teeth, loose teeth, and receding gums.4

What causes periodontal disease?

Gum disease is caused by bacteria, which is commonly in the mouth. The bacteria combine with mucus and other particles to form plaque on the teeth. Plaque can be removed by brushing and flossing. If plaque is not removed, it can harden and form tartar, which can only be removed with a professional dental cleaning. If plaque and tartar are left on the teeth for a long time, they can irritate the gums and cause gingivitis. Gingivitis may be noticeable by the gums being swollen, red, and bleeding easily. Gingivitis is reversible with proper dental care and hygiene, including daily brushing and flossing.4

If gingivitis is not treated, it can progress to periodontitis, a serious condition in which the gums begin to pull away from the teeth. This forms pockets that can become infected. The inflammatory response of the body to these infections can break down the bone and connective tissue that sustain the teeth, and in some cases, the teeth may become loose and require removal.4

Does AS increase the risk of gum disease?

It is not fully understood how AS increases the risk of periodontal disease, although many systemic diseases are also associated with greater risk for gum disease, such as diabetes, heart disease, rheumatoid arthritis, and cancer. One theory is that the increased inflammation that occurs in the body of someone with AS may also predispose them to inflammatory conditions in the mouth.3

In addition to the disease processes of AS increasing the risk of gum disease, the medications used to treat AS can cause side effects that affect the mouth. Many medications cause a reduction in saliva. Saliva has a protective effect on the mouth, and when there is less saliva in the mouth, bacteria can increase.4

What other factors increase a person’s risk of gum disease?

There are several other characteristics and behaviors that can increase a person’s risk of gum disease, including:

  • Smoking
  • Hormonal fluctuations in women
  • Diabetes
  • Family history

How is gum disease treated?

Treatment for gum disease aims at controlling the infection. The types of treatment will vary based on the severity of the disease. All treatment for periodontal disease must include good daily care (daily brushing and flossing of teeth) by the individual at home. Other treatment options may include professional cleaning to remove the tartar, medications, and/or surgery.4

Written by: Emily Downward | Last reviewed: February 2019
  1. How is a person affected? Spondylitis Association of America. Available at https://www.spondylitis.org/Possible-Complications. Accessed 1/3/19.
  2. Pischon N, Pischon T, Gülmez E, et al. Periodontal disease in patients with ankylosing spondylitis. Ann Rheum Dis. 2010 Jan;69(1):34-8. doi: 10.1136/ard.2008.097212.
  3. Ratz T, Dean LE, Atzeni F, et al. A possible link between ankylosing spondylitis and periodontitis: a systematic review and meta-analysis. Rheumatology. 2015 Mar;54(3):500-510. doi: https://doi.org/10.1093/rheumatology/keu356.
  4. Periodontal (gum) disease, causes, symptoms, and treatment. U.S. Department of Health and Human Services. Available at https://www.nidcr.nih.gov/sites/default/files/2017-09/periodontal-disease_0.pdf. Accessed 1/3/19.