I have rheumatoid arthritis: can I have dental implants?

In autoimmune conditions such as rheumatoid arthritis, the immune system attacks the body's own tissue; this can set the stage for inflammation in the gums, just as it does in the joints. But what actually decides the implant decision is not the diagnosis itself, but how well controlled the condition is and which medicines you take. Even if two patients come in with the same diagnosis, the assessment can turn out differently if their medicine regimens and disease activity differ.

Corticosteroids (steroids) are among the most commonly used medicines. If you have been taking a steroid for more than three weeks, or at a high dose, you should not stop it suddenly; sudden withdrawal carries a serious risk, because your body's own cortisol production may have been temporarily switched off. When surgery is being planned, nobody changes your steroid dose unilaterally; if a change is needed, the decision is made together with the doctor who prescribed it.

Methotrexate and biologic medicines (TNF inhibitors and similar drugs) keep joint inflammation under control by regulating the immune system. There is no single universal rule in dentistry for whether these medicines should be stopped before surgery; the decision depends on the type and dose of the medicine and your disease activity at the time. That is why this decision is made by the rheumatologist who follows you, not by your dentist.

Sjögren's syndrome is a separate autoimmune condition often seen together with rheumatoid arthritis, and it affects the salivary glands to cause dry mouth. When saliva is reduced, the mouth's own ability to clean and buffer itself drops; the risk of decay, gum disease and fungal infection rises. In patients wearing a removable denture, a dry surface also makes it easier for the denture to rub and cause sores.

Involvement of the hand and finger joints can make daily tooth cleaning directly harder. Cleaning between fixed teeth calls for a certain amount of hand dexterity and grip strength. If this is limited, your choice of brush and tools should be discussed from the outset; options such as an electric toothbrush, thick-handled interdental brushes or a water flosser can make a practical difference in this group.

Long-term use of steroids can also affect bone density; this is a separate matter concerning the quality of the bone the implant will anchor into. We cover patients taking osteoporosis medication on a separate page; the two conditions are sometimes found together in the same patient, and the assessment widens accordingly.

Having a rheumatic disease diagnosis does not mean you cannot have implants. Implant treatment can be carried out in patients whose condition is controlled, whose inflammatory activity is low and whose gum health is good. The assessment is made by getting in touch with your rheumatologist and taking your current medicine regimen into account.

The distinction below is the framework for the assessment made at examination. The final decision is made once your disease activity, medicine regimen and the condition of your mouth have all been read together.

For patients with a rheumatic disease, safety is largely achieved through the right information and the right timing.

1. 1

   Bring your complete medicine list

   Steroids, methotrexate, biologic medicines, the dose and how often you take them. This list is the basis for when and how the surgery is carried out.

2. 2

   Contact is made with your rheumatologist if needed

   Whether any adjustment to your medicine regimen is needed, and how active your condition is at the time, are assessed together with the doctor who follows you.

3. 3

   Gum health is assessed

   Inflammation in the mouth is addressed before implants; tartar removal and, if needed, gum treatment are completed before surgery.

4. 4

   Bone condition is assessed with a CBCT scan

   Because long-term steroid use can affect bone quality, 3D imaging is the core evidence the decision rests on.

5. 5

   Dry mouth is addressed separately

   If you have dry mouth from Sjögren's syndrome or from your medicines, saliva substitute products and more frequent check-ups are planned at this stage.

6. 6

   The cleaning plan is personalised to your hand dexterity

   If you have joint involvement, which brushes and tools suit you are worked out together; this is a decisive step for how long the implant lasts.

The following are routes discussed for this group, and each has its own angle in terms of disease activity and medicine regimen.

The following are conditions seen more often in patients taking steroids, methotrexate or biologic medicines; none of them is unavoidable, and all can be managed with the right planning.

For a patient with a rheumatic disease, the healing process is no different; it is simply monitored more closely.

1. The first few days

   Your medicine regimen continues without interruption; do not stop any medicine on your own decision. Swelling and tenderness stay at the usual level.

2. The first week

   Anything outside what is expected (increasing swelling, fever, a bad taste) should be reported straight away; infection can progress faster in a patient whose immune system is suppressed.

3. The first few months

   Check-ups are scheduled more often than for standard patients. Gum health and the tissue around the implant are assessed at every check-up.

4. The long term

   Regular professional care and daily cleaning are the two most important factors that determine how long the implant lasts in this group. If your hand dexterity changes over time, your cleaning method is reviewed again.

A rheumatic disease does not change the price of treatment directly; what it affects is the preparation stage and how closely you are followed up. Here are the items:

Coordination with rheumatology

Working out the medicine regimen and timing together is a step that cannot be skipped for this group.

Preparation and gum treatment

Resolving inflammation in the mouth before implants can be a separate item; its scope depends on the condition of your mouth.

Whether an additional procedure is needed

If bone quality has been affected, additional imaging or different planning may be needed; a graft-free plan reduces this item.

How often you are followed up

Check-ups are scheduled more often for this group; this means the long-term care item is a little larger, but it extends how long the implant lasts.