Could arthritis be connected to oral health?

If you only have time for one health podcast this week, make it this one:

Dr. Steven Gundry’s “The Arthritis Lie: Why ‘Wear and Tear’ Isn’t Wearing Out Your Joints” (Ep. 412a). 

His argument is that rheumatoid arthritis and heart disease aren’t two diseases that happen to show up in the same patients, rather, they are one disease process showing up in two places.

He says about half his patients with blood-confirmed RA had no joint pain at all—the antibodies were there years before anything ached. Some of them found out something was wrong when they had a heart attack. He also cites a stat worth sitting with: patients who’ve had a stent or bypass have roughly a 50% chance of needing a joint replacement within five years.

So what’s the process? Inflammation. Not “inflammation” as a vague wellness buzzword, but chronic, low-grade, systemic inflammatory signaling that erodes joints, arteries, and eventually most other tissue in the body given enough time. If that’s true (and the immunology backs it up) then any serious conversation about arthritis or cardiovascular disease has to ask where the inflammation is coming from.

Gundry’s answer for where it comes from is the gut: leaky gut, dysbiosis, bacterial byproducts crossing into circulation. He’s not wrong!

But here’s what I would add: the same molecular signature Gundry is finding years ahead of joint symptoms in his RA patients has a documented starting point in the mouth.

I want to add the piece that gets left out of this conversation almost every time: the mouth. Here’s the chain:

1. Infected gums are an open wound with a blood supply. The tissue around infected teeth is ulcerated, and it sits directly against circulation.
2. The bacteria get into your bloodstream and drive the same cascade Gundry is describing. Periodontal pathogens—chiefly Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans—don’t stay in the pocket around the tooth. Once they’re in circulation: elevated IL-6, elevated TNF-alpha, endothelial dysfunction, insulin resistance.
3. P. gingivalis runs the same chemistry your own cells do. It produces peptidylarginine deiminase (PAD), an enzyme that converts arginine into citrulline inside proteins. That process is called citrullination. Almost no other bacterium on earth makes one.
4. Your immune system starts attacking those altered proteins. In someone with the right genetic susceptibility, it builds anti-citrullinated protein antibodies—measured clinically as anti-CCP. That is the exact antibody rheumatologists use to diagnose RA, and it’s frequently positive years before a single joint swells.

In plain English: the molecular signature Gundry is finding years ahead of joint symptoms has a documented starting point at the base of your teeth. Periodontal disease doesn’t just correlate with rheumatoid arthritis. It appears to be one of the places where the loss of immune tolerance that defines RA actually gets manufactured. And P. gingivalis is independently implicated in cardiovascular disease.

What to do about it

Trials of periodontal treatment (deep cleaning, scaling and root planing) in RA patients have shown reductions in systemic inflammatory markers and, in some studies, measurable improvement in RA disease activity, so much so that rheumatology and periodontal literature both stopped treating the mouth-joint axis as speculative.

So:

1. Ask for a periodontal exam, not just a cavity check. Ask specifically whether you have active gum disease.
2. Get the cleaning. Even if it’s tempting to skip, it’s something that could be protecting your joints.
3. If you’re already working on your gut, don’t stop there. Work on your oral microbiome; the headwaters of the gut. I truly cannot overstate the importance of the health of your oral microbiome for your overall health.

A dental exam is not a cosmetic errand. It’s a screening test for one of the most common and most under-diagnosed sources of chronic systemic inflammation in the body—and the antibodies show up years before the symptoms do.

This topic will get the full treatment in my upcoming book for Penguin Life on oral health and its ties to systemic disease—so hit reply and let me know your questions.

Make sure to get that perio exam,

Mark

P.S. What I use every day to support my oral (and overall) health: This toothpaste, this mouthwash alternative, this tongue scraper, this ultra clean floss, this green tea, this throat spray, these enzymes with meals, this Vitamin D3/K2, this CoQ10, this magnesium, this zinc, and these electrolytes.

Citations & Further Reading:

• Centers for Disease Control and Prevention. About Periodontal (Gum) Disease. https://www.cdc.gov/oral-health/about/gum-periodontal-disease.html
• Oral Microbiome Dysbiosis and Citrullination in Rheumatoid Arthritis. https://eprints.whiterose.ac.uk/id/eprint/228696/
• Dysbiosis in the oral microbiomes of anti-CCP positive individuals at risk of developing rheumatoid arthritis. https://www.sciencedirect.com/science/article/abs/pii/S0003496724010586
• Periodontal Disease Augments Cardiovascular Disease Risk Biomarkers in Rheumatoid Arthritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8945365/
• Gundry, S. The Arthritis Lie: Why “Wear and Tear” Isn’t Wearing Out Your Joints, Ep. 412a, The Dr. Gundry Podcast.