Recent evidence has shown that people with rheumatoid arthritis (RA) have a higher incidence of periodontal disease and that the extent and severity of both the periodontal disease and RA are linked. Furthermore periodontal therapy has been shown to have a beneficial effect on the severity of the RA. Moderate to severe periodontitis may also be a risk factor in the development of RA in non-smokers. One of the most important factors in oral care is access to dental health practitioners. In the UK it is well reported in the media about lack of access to dental care. We decided to audit the access to dental care in a sample of our patient cohort with inflammatory arthritis. A patient dental care leaflet was produced highlighting the importance of dental care which was distributed to all our inflammatory arthritis patients. We then re-audited a sample of patients to determine if there had been any change in behaviour or access to dental care.
The first audit took place in 2009. All adult patients attending for rheumatology follow-up during a one month period were given an approved questionnaire to complete. Questionnaires were anonymous and included questions on access to both NHS and Private dental care. During 2010 a Trust approved patient leaflet about the importance of dental care was devised and given to all patients with inflammatory arthritis who attended the hospital rheumatology department. Six months later a second questionnaire was given to all adult patients attending for rheumatology follow-up during a one month period. This second questionnaire included questions on the dental care leaflet along with access to dental care.
Demographics for both audits were similar. In the second audit 139 (95%) patients admitted to receiving the leaflet on dental care. All patients agreed or strongly agreed that the leaflet was easy to understand. Only 10 patients thought the leaflet contained no new information. 74 patients thought the leaflet applied to them and 125 patients thought the leaflet was helpful. Despite this very little change in behaviour was seen although 8 patients admitted that hey could not afford the dentist.
Dental care has become increasingly important in the light of new evidence linking severity of RA disease with both smoking and poor periodontal health. In our department a patient education leaflet led to minimal change in behaviour, with a slight increase in the amount of people accessing dental care and a moderate increase in access to NHS instead of private dentistry but no increase in the use of electric toothbrushes. Increasing the awareness of the potential link between poor oral hygiene and RA may have a useful impact on disease severity, however future studies need to concentrate on barriers to changing behaviour which may be due to cost or fear of dentists.
Disclosure: P. J. Cornell, Abbott Immunology Pharmaceuticals, UCB, Roche, 5 ; S. Richards, None; S. Westlake, None.