11 Tips for Getting Your Teeth Cleaned with Rheumatoid Arthritis

Getting your teeth cleaned can be difficult when you have RA and particularly if it affects your neck and jaws. Although the concept of lying in the dentist’s chair sounds comfortable (well, except for the part about being at the dentist), it can be just the opposite. The little divot for your head is guaranteed to make your neck hurt, but your visit to the hygienist can be even harder for your jaws. Keeping your mouth open for 45 minutes or more while someone pokes at your teeth can make your jaws flare. But there are ways to make the visit easier.

Talk first. Start off with a conversation about your RA and what it means for the state of your teeth in general, as well as getting your teeth cleaned. RA in your jaws and shoulders/elbow/hands can make brushing difficult, which can affect the health of your mouth and teeth. As well, taking an immunosuppressant may inflame your gums, as it gets more difficult to fight back against the bacteria in your mouth. Explain that keeping your mouth open for a long time hurts, and you may not be able to open your mouth as wide as other people. If your hygienist (and/or your dentist) doen’t understand this, or doesn’t work with you in a way that respects your RA, get another dentist! 

Take painkillers. We all hope seeing the hygienist won’t hurt too much, but assuming that it will can actually reduce that pain. Take your medication before you go to your appointments, timing it so it starts to work 10-15 minutes into your appointment. This can make the entire experience much less painful, and the meds will still work when you walk out the door. If you hurt a lot after having your teeth cleaned, make sure you take the painkillers on a regular basis for the next couple of days.
neck is guaranteed to make

Bring a pillow. Bring a small pillow that you can put between your head and that awful divot in the dentist's chair. Find a pillow that’s small enough that it won’t get in the way, but with enough cushiness that it can offer you a bit of support. This will make your neck happy, which will make you happy.

Take breaks. Before you get started, tell the hygienist that you will likely need some breaks to rest your jaws. Agree on a signal, such as raising your hand, that will give them the cue they need to back off for a bit. During those breaks, gently move your jaw to ease the strain on the muscles. Closing your mouth and trying to relax your jaw muscles can also be really helpful. Go easy on yourself, don’t do anything that doesn’t feel good. A mouth prop may also help.

Clean in quadrants. You have four quadrants in your mouth: upper right and left, and lower right and left. The hygienist will clean the inside and outside of your teeth. Getting the inside cleaned requires opening your mouth wider than the outside. Ask the hygienist to alternate between the inside and outside of different quadrants. This will enable you to naturally rest your jaws throughout the procedure.

X-rays. X-raying your teeth identifies potential cavities before they become the size of a meteor crater. X-rays are also really difficult if you can’t open your mouth very wide. The contraption into which the x-ray film is inserted (or which is a conduit for the digital x-rays) is made for people with normal mouths. Ask for the children’s version. It’s smaller, and much easier to get in position without straining your jaws.

A successful visit to the hygienist also depends on what you do in between appointments. Taking care of your teeth can make getting your teeth cleaned a much easier process, as well as limit the times you have to see the dentist. You know this already, at least in theory. But it’s hard to do. Here are a couple of tricks that will make it easier.

Get an electric toothbrush. You can get the battery-operated kinds, or the electric. The former is cheaper, but may have to be replaced more often. If you have trouble opening your mouth, get an electric toothbrush with a round brush head, as opposed to the oblong or rectangular brush head that mimics a regular toothbrush. The round brush head doesn’t require as much space.

Floss. Yeah, sure. Tangling the floss around your fingers and moving your arms and hands to floss is difficult, nevermind how far you have to open your mouth. For many of us, flossing becomes optional. It doesn’t have to be. Get yourself a flossing wand, such as this one

Use a sulca brush. This is a fantastic tool that can help you clean along your gumline, removing buildup that can turn to tartar, which in turn can lead to cavities and periodontal disease. It’s quite long, which makes it easier to get to your teeth if your arms are aching. Wrap a bunch of rubber bands around the handle to make it thicker and easier to grip.

Soft-Picks. These little things are quite literally a miracle (I just discovered them, so forgive the enthusiasm). They are a fantastic help to get at food that’s stuck between your teeth. They are also an excellent tool to supplement or replace flossing, if that’s hard for you. 

 Q-tip for size comparison

You stick them between your teeth at the gumline and move them back and forth. Because of the tiny teeth on the green part, they not only remove errant food, but also build-up, which can lead to tartar, etc. One drawback is that they’re quite small, but it that can help you with that boring exercise of making sure your thumb can meet the tips of the other fingers.

Note: you don't have to floss, use the sulca brush, and the soft-picks every day if that's too much for you, but try to do at least one, in addition to brushing your teeth. It'll go far towards making your teeth and gums healthier.

See your hygienist every four months. RA affects the health of your mouth in two ways. One, it’s difficult to take care of your teeth because of the pain and limited mobility in your jaws and shoulder/elbows/hands. Two, both the RA, as well as the medications used to treat it, can impact the health of your gums. Seeing a hygienist every four months, rather than the recommended six, can do wonders for cavity prevention, as well as staying ahead of periodontal disease.

What is your experience with pain and getting your teeth cleaned?

Neither GUM nor Oral-B paid me to say nice things about their products. I'm just a happy customer.


Great tips, Lene. I especially would like to emphasize about finding a new dentist or hygienist if they don't respect the issues between having RA and getting dental work done. My local dentist sent me to an oral surgeon to have a broken tooth removed. My dentist was not comfortable removing the tooth himself because of all the immunosuppression drugs I am on. The oral surgeon gave me extra steroids to wake up my adrenal glands as well as placing small pearls of medication in the open gap to help it to clot. It worked out nicely with good healing because the surgeon was very considerate about the meds I am on as well as being as gentle as possible about the actual removal itself, he was very conscious about putting as little pressure on my jaw as possible.

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