An interesting article titled “Reactive Arthritis Resulting From Postoperative Complications of Third Molar Extraction: A Case Report,” appears in Cureus in August 23, 2022, written by Lauren Maytin and Jeffrey Morrison (vol. 14, no. 8, pp. e28325). The article presents a case report of a 23 year old woman who develped reactive arthritis after wisdom teeth extraction.
In the article the authors discuss a 23 year old woman who had a history of lower back and joint pain but developed more severe of symptoms of bilateral shoulder pain, decreased range of motion in her left shoulder, and worsening lower back after having an infected infected wisdom tooth extracted. She was diagnosed with rheumatoid arthritis and and was prescribed adalimumab. Her laboratory results showed elevated indicators of inflammatory activity that were positive for HLA-B27. The woman presented to two weeks after wisdom tooth surgery and was advised to meloxicam which was previously prescribed by another doctor. The woman also began to develop worsening mandibular pain at the site of her wisdom tooth extraction. The woman was told to seek the care of another dentist and this dentist discovered an unresolved postoperative infection in the surgical wound that was treated with incision and drainage. Further, the woman was given postoperative antibiotics to resolve the infection.
After having the untreated mandibular infection treated, the woman began to experience drastic improvements in all of her symptoms. The pain she experienced near the site of the wisdom tooth surgery completed resolved as did all her lower back pain and shoulder pain and even the restricted range of motion in her left sholder. Laboratory tests performed on the woman showed levels of inflammatory markers were significantly decreased and were now within the normal range. As a result, the patients first diagnosis of rheumatoid arthritis was reevaluated and determined to be reactive arthritis, a systemic inflammatory process triggered by incomplete treatment of an infection from a wisdom tooth.
In the discussion of the case the authors mention how infections from wisdom teeth surgery may aggravate an inflammatory autoimmune response which can cause inflammation and pain in areas outside the immediate maxillofacial region. The authors also say that delocalized inflammation and dental infections may play a role in other forms of oral disease. The authors say there is a clear link between oral infections and systemic inflammation and this case as well as a few others in the literature help to show that potential causal mechanisms. The authors state:
“…our case study suggests that oral infection can serve as the catalyst for systemic inflammation in at least some cases. Our patient, a previously healthy individual, developed symptoms following [wisdom tooth] extraction surgery, which disappeared following treatment of a post-extraction infection; this, and the clearing of inflammatory markers, draws a clear causal connection between dental infection and delocalized arthritic symptoms.”
As a result the authors caution other physicians to be aware that acute arthritic conditions may result from an underlying infection and the patient may respond better to the treatment of that infection instead of antirheumatic drugs. The authors mention that clinicians should be aware of the association between bacterial infection and systemic immune dysregulation and be aware that infections and poor oral hygiene can contribute to autoimmune disease.
The authors lay out a possible mechanism for the woman in this case as she was Our patient is HLA-B27 positive and diagnosed with reactive arthritis, both of which have been associated with sequences of secretion proteins in Klebsiella pneumoniae induced molecular mimicry.
The authors feel that additional research is needed to further investigate the relationship between infections and potential to develop autoimmune inflammation. Such a study could use patients who have wisdom tooth surgery and follow them for the development of rheumatic disease symptoms in comparison to controls.