Dental Infections Pose Risks for Hospitalized Patients With Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) face a 40% higher risk of being hospitalized for serious dental infections compared with those without RA, underscoring the need to integrate oral health into chronic disease care, according to a national analysis of over 14 million hospitalizations in the US.¹

The study, published in Cureus, evaluated data from the National Inpatient Sample to determine whether RA increases the likelihood of hospitalization for cellulitis or abscess of the mouth. While these infections were rare, affecting just 0.07% of nearly 15 million adults hospitalized between 2016 and 2022, their severity and connection to chronic inflammatory disease are increasingly recognized by clinicians and researchers.

Researchers called for multidisciplinary care models to integrate dental services into the routine management of chronic diseases like RA. | Image credit: D Theron/peopleimages.com – stock.adobe.com

Researchers identified 281,142 patients with RA from the sample. After adjusting for confounding variables such as age, race, sex, smoking status, and length of stay, the presence of RA was significantly associated with dental infection–related hospitalization (OR, 1.399; 95% CI, 1.210-1.618; P < .0001).

“This result adds to and validates earlier research highlighting RA patients’ increased susceptibility to infections as a result of immunosuppressive medications and immunological dysregulation,” the authors said.

Black Men Had Highest Odds of Infection

The study also highlighted broader health disparities and modifiable risk factors. Men were significantly more likely to be hospitalized for dental infections than women (OR, 1.79), and Black patients had higher odds than White patients (OR, 1.23). Smokers (OR, 1.33) and patients with longer hospital stays (OR, 1.44) also faced increased risk, and adults 65 and older were less likely to be hospitalized for oral infections than younger adults (OR, 0.25).

“These disparities are reflective of systemic inequities in healthcare access, oral health literacy, and socioeconomic status, which have been well-documented in literature,” the authors said.

They also found the highest infection rates relative to group size among patients aged 18 to 49, suggesting younger adults may delay routine dental care and only seek treatment when conditions become severe.² Of more than 2 million hospitalizations for oral infections, 3097 (0.11%) adults aged 18 to 34 and 2837 (0.13%) aged 35 to 49 were specifically hospitalized for cellulitis or a mouth abscess.¹ Adults aged 65 and older had a notably lower infection rate of 0.03%.

“This finding is unexpected, as younger adults are generally considered to be at lower risk for serious infections,” they said. “However, it may reflect barriers to preventive dental care, including lack of insurance coverage, reduced healthcare-seeking behavior, or limited oral health literacy in this age group.”

Autoimmune Disorders and Dental Care

RA affects about 1.3 million Americans and is known to impair the body’s immune defenses while increasing susceptibility to inflammation throughout the body, including in the oral cavity.³ Taking immunosuppressive therapies like corticosteroids and disease-modifying antirheumatic drugs also reduces the body’s ability to fight off bacterial infections, putting these patients at risk while trying to manage RA.¹ According to the authors, the oral cavity is particularly vulnerable to pathogens like Porphyromonas gingivalis, a known trigger of both periodontitis and autoimmunity.

While the analysis benefited from a large, nationally representative sample, the authors acknowledged that the cross-sectional design cannot confirm causality and that relying on administrative coding could have led them to underestimate the true prevalence of infections.

At the same time, they noted that these findings underscore the need for multidisciplinary care models that integrate dental services into the routine management of chronic illnesses like autoimmune diseases; public health efforts should also focus on expanding access to preventive dental care through early screenings, educational outreach, and affordable services for high-risk populations. Together, the authors wrote these strategies could reduce the incidence of preventable oral infections and the serious complications that follow.

"Our findings support the growing consensus that oral diseases do not occur in isolation but rather intersect with broader health trajectories, particularly in immunocompromised populations," they concluded.

References

1. Noah GU, Ikwuka OV, Nwadije JC, et al. The burden of dental infections among hospitalized patients with rheumatoid arthritis: a cross-sectional analysis of the national inpatient sample database. Cureus. 2025;17(5):e83568. doi:10.7759/cureus.83568
2. Nasseh K, Vujicic M. The effect of growing income disparities on U.S. adults' dental care utilization. J Am Dent Assoc. 2014;145(5):435-442. doi:10.14219/jada.2014.1
3. Xu Y, Wu Q. Prevalence trend and disparities in rheumatoid arthritis among US adults, 2005-2018. J Clin Med. 2021;10(15):3289. doi:10.3390/jcm10153289