PSA and Tooth Extraction

Morning or evening (where ever you are),
I have a tooth extraction and bone grafting scheduled in a few weeks after a failed root canal and crown and it got me thinking, does PSA weaken our teeth, causes inflammation in the teeth/jaw, or cause dental procedures to fail? After a bit of reading I can’t say for sure one way or the other but PSA does effect the jaw and nerves of the tooth.
So, get to the point Amie!
I have rested my injured tooth for a month now, chewing on the opposite side, and there is no pain or discomfort. The tooth original cracked for no reason, just one day, CRACK. The oral surgeon thinks there are tiny fractures still in the tooth so it needs to be extracted. I opted for a fake tooth to be added, so bone grafting is needed to build up the jaw for the screw that will eventually go in. My thoughts are, even if I extract the tooth and add the screw in the bone, will this always be a source of inflammation and pain for me? My jaws are already a mess, pain, swelling, inflammation, clenching, and popping, I dont want a tooth issue too.

I am going to try chewing on my bad tooth side for a bit to see if the pain/inflammation returns. Thanks for reading my thoughts and any insight is most welcomed.

In my view this was my first PsA symptom long before I knew anything about PsA. For no good reason teeth weren’t happy in my mouth and several of them got removed. I couldn’t afford implants so I don’t know if the implant would still irritate but definitely now from others’ experiences inexplicable teeth issues with no good reason seems to be a part of PsA for many people.

1 Like

As far as I can tell, there is an established link between periodontitis and inflammatory arthritis, including PsA.

Inflammation of the gums seems like a bit of an additional risk to me when it comes to grafting etc, have you specifically asked your oral surgeon about it? I would hope an experienced one might be able to give you more information on possible risks and outcomes.

I have read this from several accounts that teeth or mouth issues predated “traditional” PsA symptoms. I do have older fillings that have been removed of the old metal and replaced with the newer methods but besides this one tooth, my teeth are in excellent health. I grew up with bad nutrition and thus bad oral health. My first visit to the dentist was in my high school years when I paid for the visit. I have made very sure that my teeth stay as healthy as they can up until now. Being someone who likes being in control and having this stupid illness that allows almost no control, I am having a hard time letting go of my teeth or this one tooth. @Poo_therapy Did you still have pain or inflammation in the tooth socket after it they were removed?

@Jen75 I completely agree. My concern is by adding the screw into my jaw (which is expensive!!) I will create an inflammation point. If I remove the tooth and leave the socket empty to heal, will the inflammation go away even if chewing on that side is limited? I know these are questions you might not be able to answer but its nice to have a place to type them out and get some feedback.

Honestly I would like to have the fake tooth. I would like to be able to chew with this first molar and when I smile you won’t see a missing tooth. BUT, I dont want a source of pain! Something to think about.

No once they were removed everything healed up fine. But I went through huge efforts to save them, varying root canal stuff and crowns etc. And unlike you, up to then my oral health was excellent all the way from being a child. There was no discernible reason for my teeth suddently starting to deveop such issues. My dentist did ask if I had any inflammatory disease but of course then PsA wasn’t showing a whisper of itself so I said no.

Now it seems from others I know I’m not the only one with these inexplicable teeth issues who gets a PsA diagnosis later. All anecdotal obviously but…

I ended up with a partial dental plate (thankfully I still have all my front teeth) but one side has no back teeth on the top and the other side has too few. It took some getting used to emotionally more than anything else but I have had zero other problems more so since my PsA meds now work so well for me.

1 Like

Thank you for telling me. I dont know why I am so hung up on my teeth. I’m sure it stems from some childhood something but I refuse to let them go, though I may not have a choice in the matter. I am going to make an appointment with my rheumy to talk teeth.

The oral surgeon was familiar with autoimmune diseases and MTX use, biologics, etc. He gave me a break down of recovery time, which is longer than average people. We also discussed antibiotics and medications. I am confident in him. He has no way of knowing if I will continue to experience pain in that tooth socket with a screw placed in, and my rheumy may not either, but I would like to go into the procedure with all the facts.

From what I read science has no idea why PsA sufferers start loosing teeth. There seems to be more research on RA. I will keep reading and if I find anything I will post it here.

1 Like

Since getting PsA, I’ve had 3 crowns go bad. I had implants placed and 1 has lead me down the road of infection and implant screw removal . It had to be removed. A bridge was done there and it still hurts 11 months later. I also have TMJ. I think there is a relationship between PsA and tooth problems.

1 Like

All of us are hung up on our teeth. The dental industry globally did a good job on indoctrination of decent oral health. Even more so in the USA. So you feel it’s all your fault when things go wrong, that somehow you didn’t do everything right or something.

I think so too, very much so.

1 Like

While we are on teeth, anyone who has PsA, and in particular TMJ with it, should really get their dentist to check and see if they grind their teeth at night (or maybe you know because of how you wake up) .

If so, you can get a soft mouth guard made reasonably affordably that will help to avoid pressure points on your teeth that then cause them to crack. These cracks when they are small can cause bits of enamel to flake off the outside of the tooth, exposing the nerve root and causing enormous sensitivity problems. I learnt the hard way, I had to get filling over mine. I shudder to think of the pain should it crack up the middle…

it really is worth a conversation with your dentist.

@michelle3 This is exactly what I am afraid of. My molar must come out but the screw… I also have TMJ.

@Poo_therapy That is very true.

@Jen75 Yes, I have asked for one and my dentist would rather a c-pap machine… um, I dont have sleep apnea. Had a test. Yes I need to find a new dentist but not many take my insurance.

Frankly I am surprised that they are doing an implant unless like too many dentists they are after the $$$$ the scrupulous ones won’t consider it and it is contra indicated. I’d check with your Rheumy on that though.

As far as the extraction and local anesthetic. Make sure the dentist knows of your inflammatory disease some blow it off but others take a very careful approach. Mine won’t use a local at all either gas or puts me to sleep. Same with my Grandaughter.

I don’t want to raise unneccesary concern but if you have inflammation its dar easy to pierce a facial nerve sheath leaving you with a lifeling nerve pain. We have a whole community of folks who have one of several facial pain conditions. Many who go there as the result of Dental procedures. Its called the suicide disease for a reason (Trimengal neuralgia)

Yes PsA causes a while raft of dental problems. Inflammation restricts blood flow to the tooth nerves which frequently cause them to die or the tooth to get brittle and crack. Crowning a tooth after a a root canal is a crap shoot. Its a $2000.00 gamble that may give you little more time with the tooth.


Thanks @tntlamb I always love your input!
I heard back from my rheumy and he says doing the implant was fine as far as he knew. I’m back to square one.

I am being knocked out for the procedure. The tooth has to come out. I started using the tooth again after a month of eating on the opposite side and it is very painful. I will continue to think on the implant and read as much as I can.
The Trimengal neuralgia sounds horrifying!!

Well I hate to talk about myself but I will. The factors effecting success of implants from a 2019 study of RA patients was immunosuppresion, peridontal disease and bone density. Its not the same for all of us as our disease take many roads. So about me (and only me) I have had two joint replacements and have 3 more under consideration as well as spinal surgery as my thoracic spine is ankylyosing (I have the ankylosis type PsA. One of my shoulders is loosening up (but then I’m almost at the 10 year mark when replacement start to have trouble.

As part of the work up for these procedures, I had to have a Dexa scan. I know the radiologist who read my scan fairly well and he is a smart a** His comment to me was, and I quote; “Why didn’t you tell me about your gender reassignment surgery???” Whaaaaat?? He went on to explain my bones were the same as woman well into menopause with no attention paid to osteo… To make a long story short no spinal surgery and joint replacements were a last ditch effort. You might want to discuss this with your gyno too. I firmly believe EVERY PsA patient should have a DEXA at some point and especially women. and followup from there.

Yeah, I’m prolly over reacting… Too much time reading bad experiences from our member and I know we don’t often hear about good experience but still…


Ah @amielynn38, that old nugget, the relationship between sleep apnea and teeth grinding.

The Sleep Foundation I think described it well;

“Sleep scientists have formulated several hypotheses about how these conditions are connected. These hypotheses include that OSA triggers sleep-related bruxism, that sleep bruxism triggers OSA, that they occur independently, and that they are involved in a complex and multidimensional relationship.”

In other words, correlation doesn’t equal causation. You are right, it is worth searching for a new dentist.

I also had a test. I sometimes have sleep apnea, and In my experience, that happens during certain types of flares and is probably caused by inflammation of something (in my case I think nerves). But the sleep apnea and bruxism don’t go together clearly in me - I suspect we (possibly much of the inflammatory arthritis community) are a subset of patients where the cause of bruxism is not linked to apnea in a direct, straightforward way.

Hence why I decided to go for a $120 mouth guard, not a cpap machine (but also because my sleep apnea when it was tested was so mild it is IN the range the cpap machine is targeted to get people to).

I should note I also had a $2000 mouth guard (hard, custom made thing) that insurance paid for that was supposed to realign my jaw and magically fix both my jaw arthritis and my whole my life, including neurological symptoms (I later found out were due to Humira). I wore it for as long as I could each night for a month, despite being painful, and the result was a month of very little sleep, a sore jaw, and nothing fixed. And an unwearable $2000 mouthguard. I don’t recommend!

1 Like

Just to add yet more gloom - sorry @amielynn38 I am one of those women of a certain age who has had several DEXA scans and whilst those results don’t mirror my experience with fractures, I’m now medicated as if I have osteoporisis. The DEXA scans show I’m not yet in the category of needing medication but my experience of far too many fractures shows I certainly need to be medicated.

Once you go down the osteoporisis medication route, all dental treatment becomes an extremely big deal, as in frankly they don’t want to do anything. However the osteoporisis meds only last 5 years as a general rule. I still think thereafter they don’t want to touch your teeth though.

I’m with @tntlamb on getting bone density checked out (more so as woman and more so if you’ve ever taken steroids and show me a PsA patient who hasn’t please) just anyway but possibly it might explain too (an outside chance) teeth issues.

Sadly none of that helps any decision to remove a tooth or indeed have an implant. I can say that I spent £1,500 on my partial plate (there is little insurance for dental issues in the UK) which was eceptionally better than the first one produced and quite honestly no one has a notion I’ve got a dental plate. That’s just fine by me.

Thank you for sharing! That is scary. I do worry about my bone density since I can’t have dairy. Not one of those I avoid dairy, more like dairy causes my insides to come out. TMI! I havent had success with calcium supplements either and I have tried many. My IBS has a mind of it’s own. I’ll ask about a DEXA scan at my next gyno visit.

@Jen75 I wish there were more dentists in my area that took my insurance. Maybe there are some new ones since the last time I checked. Or maybe it would be worth having a second opinion. I feel like sleep apnea is very trendy where I live. Everyone has it, it is very dumb. So all the dentists take a coarse to administer tests and cpap machines. They call themselves sleep dentists now. I have heard things about functional dentists. Maybe it is worth a shot. Did you get the $120 mouth guard from your dentist?

Thanks @Poo_therapy I will ask about the scan on my next visit. This disease messes with so so much. I feel I am at war with myself everyday!

I had a tooth implant, there was no problem.If they need to do more sugery to build up the bone, it may not be wise., and a bridge may be better.

1 Like

Thank you!

Most dentist are quick to pull a cracked tooth. Forty years ago I cracked a molar on mom’s brownies with a nutshell in it. (poor mom…never got over the guilt!) The first dentist wanted to do a root canal and crown…big $$$$ for a newly wed! I found a very experienced military dentist who laughed at the root canal and crown idea. He drilled a hole at the top of the crack so it wouldn’t spread, filled it and charged me $60. I still have that same molar as he repaired it. (Yes in my mouth, not a jar) I know it’s too late for such work for you but man I am very suspicious of dentists and veterinarians who can directly make more $$ by coming up with complex solutions.
The same dentist fixed my daughter’s very crooked teeth perfectly with braces that cost 1/3 of the price and were off in half the time as the first estimate. Numerous of my Canadian friends are going just a short ways into Mexico for dental work of all sorts at a fraction of the price and getting professional service.


Hello all. I wanted to drop in and give everyone an update. It’s been 8 days since I had my tooth extracted and the bone graft placed in. The extraction went ok but the pain level I am experiencing is very high and non stop. Seems my body said “hey, there is something going on in the mouth area! Let’s move the inflammation over there!”

After reaching out to my doc on Wednesday they want me to call back this morning. It’s 4am here and I am waiting for the next round of pain meds to kick in so I can get some sleep. Hopefully they have some answers.

I appreciate you all and your advice. While the tooth had to be removed since it was causing me daily pain, the results are still out on the bone grafting.

1 Like