Rheumatoid Arthritis: Contraindication for Implants?

Dr. M. asks:

I have a 55 year old female patient with rheumatoid arthritis (RA). She is otherwise healthy. I have treatment planned her for multiple implant placement to support a bridge. I believe that rheumatoid arthritis is a disorder that is caused by a pathological autoimmune response and this also results in depression of the immune system. Is this a contraindication to placing dental implants? Does the patient need an antibiotic prophylaxis to place implants?

13 thoughts on: Rheumatoid Arthritis: Contraindication for Implants?

  1. charles Schlesinger, DDS says:

    I believe the bigger issue would be if the patient has been on long term steroid therapy for the treatment of her RA. That would definately be a contra-indication. Does she have trouble performing oral hygiene? That would be a consideration also.

    If she is good on both of the above, then she should be Ok for treatment. Go ahead and give antibiotics- it is a belt and suspenders approach.

  2. Alejandro Berg says:

    Arthritis is not a contraindication at all, steroids its a matter to consider but besides from that… remember implants were created a long long time ago for old patients most of which had arthritis and that wasnt a real consideration then.

  3. Dale Miles says:

    Hi all….just a clarification, Alejandro…not all athritides are the same…RA is most often early onset, biateral and symmetrical as well as destructive, often resulting in anterior open bites if condyles are involved. OA on the other hand is the one you’re characterizing in your description below…

    So, while not a total contraindication, patient’s with RA whould be considered at higher risk for implant failure if there is condylar change…cone beam imaging of the condyles would be indicated, initially and possibly at some later interval if any signs or symptoms are encountered in the TM joints….so you cannot say “not at all”…

    Hope this help clarify, Dale

    “Arthritis is not a contraindication at all, steroids its a matter to consider but besides from that… remember implants were created a long long time ago for old patients most of which had arthritis and that wasnt a real consideration then.

  4. Dr. Mehdi Jafari says:

    Rheumatoid arthritis is an exaggerated inflammatory process that attacks the synovium of the joints and eventually results in their deformity. Since rheumatoid arthritis is an ever-lasting condition, the patients need to cope with all its complications and sequelae for the rest of their life. In that case, it is very difficult to deprive them from a high quality life and a good nutrition. On the other hand, the problem of the patients’ medications comes along, which does not merely limit to steroids and their complications.A vast majority of rheumatoid arthritis patients are under treatment by immunosuppressive agents.These kinds of drugs suppress the patient’s immune system, which is usually over-active in rheumatoid arthritis. In addition, some of these drugs attack and eliminate white blood cells that not only are associated with the disease, but have a key role in body defense mechanim as well. Some of the commonly used immunosuppressants include leflunomide, azathioprine, cyclosporine, and cyclophosphamide that can have serious side effects such as increased susceptibility to infections and eventual loss of the implants.

    • Nancy Richards-Eisener. M.Ed. says:

      Thank you Dr. Jafari, for your informative commentary on RA and dental implants. In addition to RA, which has just been diagnosed, I have Multiple Sclerosis, which requires me to have intermittent steroid therapy. I also take an autojected drug called Copaxone (glatiramir acetate). Do you believe that a titanium implant would pose problems for me? I have one scheduled for February; I would not want to inconvenience a professional person. Thank you for your help.


  5. Robert Lemke says:

    The above medications are all very important to consider. I have had one patient who came off of 2 of three arthritic medications AFTER a full mouth extraction, immediate implant placement and load of her implants. I believe the poor periodontal condition was a chronic inflammatory stimulator for her arthritic condition. Removing the baseline inflammatory “seeding” allowed her arthritic condition to calm down.

  6. Beverly says:

    I am an RA patient (47 years old), on two medications (methotrexate and Enbrel) for my arthritis. I had a dental implant, bottom left molar (last one in back), and after several weeks of excruciating pain, I rejected the implant, (lifted right out). After the pain and disapointing outcome, I declined a second attempt. Now I have lost a top molar and my dentist would like to revisit the implant option. I would like any and all feedback on your collective experience as to whether my RA and/or immunosuppressive meds, (and one failure), would make me a poor risk.

    Thank you

  7. Eileen says:

    I am hearing conflicting information on the safety of dental implants for people with Rheumatoid Arthritis. I recently went to a Periodontist who I like. He seems very patient and sincere. He said that I do need 3 implants. He also said that my dental hygiene is excellent. I was diagnosed with Rheumatoid Arthritis almost 1 year ago. The medicine I am taking is methotrexate, sulfasalzine and mobic. He mentioned that I would need to come off of methotrexate at least 2 weeks before the scheduled implant and 1 month after the procedure. My R.A. level when first tested was very high. My mother has severe R.A. and she is taking methotrexate, enbrel, fosomax and prednisone. We both have heard that there could be deterioration in the jaw bone especially the lowere jaw bone. Is this something that I should be concerned about? What are the chances that this would happen to me? I may eventually have to go on biologics, and my mom thinks that I may eventually have to go on fosomax. Where can I find a good resource of information?

  8. Pam says:

    I have been recently diagnosed with RA. I believe that I have had this for many years, but just a few months ago I experienced my first major “flare up”. I have had problems with my TM joint for many years. It gets stuck all of the time and it hurts alot. I cannot open my mouth completely without dislocating. It seems that this may be related to RA, I think. I’m pretty sure my TM joint is severely deteriorated.

  9. Anita Washington says:

    I am a 67 year old female who received an implant about 3 years ago. The implant was performed after several years of failed procedures to save my lower left molar tooth: a failed root canal, a failed root amputation, and failed removal and replacement of the tooth. A bone graft was provided to prepare for the implant. After the implant, I frequently felt pulsating in my blood vessel below the implant, and mild pain, especially after consuming a sugar substitute (Splenda). I developed a stiff neck on the side of the implant (left side). I now have been diagnosed with RA in my spine and the heel of my right foot. Could this RA have resulted from inflammation from the implant?

  10. Beverly says:

    I am a 50 yr old female with mild RA and otherwise healthy. At 47 I had a dental implant placed which my body rejected. My dentist, who is highly regarded in this field, did not think RA was a contributing cause and convinced me to try again. Several weeks ago I had another implant at a different site. It was healing beautifully…and then last night fell out in my sleep. I think more research in connective tissue disorders and autoimmune disorders should be conducted. By the way, I have not taken steroids and am only on Enbrel at this time.

  11. Tes says:

    I have the same questions.. doubts about implants because of my RA.. I’ve been on Enbrel for 12 years.. and implants was recommended by my dentist.. I asked him about possible adverse effect due to my my current condition.. I am 54 years old with RA, my dentist told me it’s ok.. it’s not contraindicated.. I’m not on methotrexate. I don’t know if I push through or not. I’m still hesitant to do it.

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