---
title: "Orthodontics with Autoimmune Disease UK | RA, Lupus, Sjögren's"
url: https://virtualconsultant.online/guides/autoimmune-disease-orthodontics-uk
description: "Rheumatoid arthritis, lupus and Sjögren's syndrome affect orthodontic treatment through TMJ involvement, methotrexate, dry mouth and infection risk."
updated: 2026-08-17T00:00:00Z
publisher: Virtual Consultant Online
---

Autoimmune Disease

Medical Conditions

Special Needs

# Orthodontic Treatment with Autoimmune Disease: A Guide for UK Patients

Orthodontic treatment is possible with most autoimmune conditions — but bone remodelling, infection susceptibility, joint stability and medication side effects all require careful pre-treatment planning. This guide covers the key considerations for rheumatoid arthritis, lupus, Sjögren's syndrome, Crohn's disease and TNF inhibitor therapy, and explains how to coordinate care between your orthodontist and rheumatologist.

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## How autoimmune disease affects orthodontic treatment

Autoimmune diseases influence orthodontic treatment through several mechanisms. Chronic inflammation can alter bone density and turnover, affecting how quickly and predictably teeth move. Medications used to suppress the immune system can slow bone remodelling, increase infection susceptibility, or cause oral side effects such as gingival overgrowth or ulceration. Joint involvement — particularly of the temporomandibular joint — can affect jaw stability and the long-term outcome of bite correction. Dry mouth, common in several autoimmune conditions, dramatically increases caries risk around fixed appliances. None of these factors automatically excludes orthodontic treatment, but they require careful pre-treatment planning and communication between the orthodontist and the patient's medical team.

## Rheumatoid arthritis and TMJ involvement

Rheumatoid arthritis (RA) is a systemic inflammatory disease that can affect any synovial joint, including the temporomandibular joint (TMJ). TMJ involvement in RA can cause condylar resorption — progressive loss of the condylar head — which leads to a gradually deepening anterior open bite and changes in bite alignment over time. This makes orthodontic treatment particularly challenging, as the skeletal foundations are not stable. For patients with active TMJ involvement, orthodontic treatment should ideally be deferred until the disease is in remission and condylar resorption has stabilised, confirmed on imaging. Patients with well-controlled RA and no TMJ involvement can generally undergo orthodontic treatment, though their response to tooth-moving forces may be slower.

## Lupus — oral manifestations and immunosuppressant effects

Systemic lupus erythematosus (SLE) presents a range of oral manifestations including ulceration, erythematous plaques, and mucosal sensitivity. These can make wearing fixed appliances uncomfortable and increase the risk of soft tissue irritation. Lupus is commonly managed with hydroxychloroquine, corticosteroids, and sometimes mycophenolate or azathioprine. Corticosteroids suppress bone turnover and can slow tooth movement. Long-term corticosteroid use is also associated with osteoporosis, which affects alveolar bone density. A pre-treatment dental review and liaison with the patient's rheumatologist is essential. Periods of active flare are not appropriate for starting or adjusting orthodontic treatment.

## Sjögren's syndrome — dry mouth, caries risk, and oral hygiene

Sjögren's syndrome causes destruction of the salivary and lacrimal glands, resulting in severe dry mouth (xerostomia). Saliva is critical for buffering acids, remineralising enamel, and mechanically clearing the mouth of food and bacteria. Patients with Sjögren's syndrome have a dramatically elevated caries risk — fixed appliances increase this further by creating plaque-retentive areas around brackets and under archwires. Before starting orthodontics, caries activity must be well controlled. High-fluoride toothpaste, regular fluoride varnish applications, and meticulous oral hygiene instruction are essential. Clear aligners may be preferable over fixed appliances for some patients, though they carry their own considerations. Frequent review appointments are necessary throughout treatment.

## Methotrexate and slow bone remodelling

Methotrexate is widely used in RA, psoriatic arthritis, and other autoimmune conditions. It inhibits folic acid metabolism, which affects rapidly dividing cells including osteoblasts and osteoclasts — the cells responsible for the bone resorption and deposition cycle that underlies tooth movement. Patients on methotrexate may show significantly slower tooth movement than expected, requiring lower force levels and extended treatment timelines. Folic acid supplementation, which is routinely prescribed alongside methotrexate, does not fully restore normal bone remodelling. The orthodontist should be informed of the methotrexate dose and be prepared to adjust force levels and appointment intervals accordingly.

## Biological therapies (TNF inhibitors) and infection risk

Biological therapies including adalimumab, etanercept, and infliximab are TNF inhibitors used to manage severe RA, psoriatic arthritis, ankylosing spondylitis, and Crohn's disease. These drugs suppress the immune response at the cellular level and significantly increase susceptibility to infection. In orthodontic practice, the main concern is the risk of infection around fixed appliances — particularly periodontal inflammation and, in rare cases, serious infections from soft tissue breaks. The General Dental Council and NHS guidelines require that dental treatment involving a bleeding risk be discussed with the prescribing clinician. For patients on biologicals, rigorous oral hygiene, prompt management of any mucosal irritation, and close liaison with the medical team are essential.

## Crohn's disease and oral health

Crohn's disease is a chronic inflammatory bowel condition with well-documented oral manifestations. These include cobblestone mucosal thickening, linear ulceration, angular cheilitis, and aphthous ulceration. The mucosal changes can make wearing fixed appliances uncomfortable and may complicate impressions or intraoral scanning. Crohn's patients are often on immunosuppressants including azathioprine, steroids, and biologicals. Nutritional deficiencies — particularly of iron, B12, and vitamin D — are common and can affect bone health and healing. Assessment of nutritional status and liaison with the gastroenterology team is advisable before starting treatment. Patients whose Crohn's disease is well controlled and whose oral manifestations are minimal are generally suitable for orthodontic treatment with appropriate monitoring.

## Pre-treatment coordination with rheumatologist or GP

Before starting orthodontic treatment with any significant autoimmune condition, the orthodontist should write to the patient's rheumatologist or GP to confirm the current medication regimen, disease activity, and any contraindications to dental treatment. Key questions include whether the disease is currently in remission, whether any medication changes are planned, whether there is any TMJ or joint involvement relevant to treatment, and whether antibiotic prophylaxis is required for any procedures. This liaison protects the patient and ensures the orthodontist has the information needed to set appropriate treatment expectations and adjust force delivery if needed.

## Monitoring during treatment

Patients with autoimmune conditions require more frequent review than standard orthodontic patients. The orthodontist should monitor for signs of mucosal irritation, unusual patterns of tooth movement, gingival inflammation, early caries, and any change in jaw or bite alignment that might indicate disease progression. Patients should be encouraged to report any oral symptoms promptly rather than waiting for scheduled appointments. If there is a significant disease flare — particularly one requiring increased immunosuppression or corticosteroid treatment — orthodontic adjustments should be deferred until the flare settles. Open communication between the patient, orthodontist, and medical team is the most important safeguard throughout treatment.

## Useful related pages

[Orthodontics with Heart Conditions](https://virtualconsultant.online/guides/orthodontics-heart-conditions-uk)

[Orthodontics When Immunosuppressed](https://virtualconsultant.online/guides/immunosuppressed-orthodontics-uk)

[Medication Effects on Orthodontic Treatment](https://virtualconsultant.online/guides/medication-effects-orthodontic-treatment-uk)

[Orthodontics and Diabetes UK](https://virtualconsultant.online/guides/orthodontics-and-diabetes-uk)

[Orthodontics and Gum Disease](https://virtualconsultant.online/guides/orthodontics-gum-disease-uk)

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.

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### Frequently Asked Questions

Can I have orthodontic treatment if I have rheumatoid arthritis?

Yes, in most cases, provided your RA is well controlled and there is no active TMJ involvement. Your orthodontist should liaise with your rheumatologist before starting treatment. Tooth movement may be slower than usual, and force levels may need to be adjusted. If you have condylar resorption affecting your bite, treatment should be deferred until this is stable.

Does methotrexate slow down tooth movement?

It can. Methotrexate suppresses cell division including the osteoblasts and osteoclasts needed for bone remodelling around moving teeth. This can result in slower tooth movement, requiring extended treatment timelines or adjusted force protocols. Your orthodontist should be aware of your methotrexate dose so they can plan accordingly.

Is Sjögren's syndrome a contraindication to braces?

Not an absolute contraindication, but it requires careful management. The severe dry mouth associated with Sjögren's syndrome dramatically increases caries risk, which is already elevated around fixed appliances. Caries must be under control before treatment starts, and intensive preventive measures — high-fluoride toothpaste, fluoride varnish, rigorous hygiene — must be maintained throughout. Some patients with Sjögren's may do better with clear aligners.

Do I need to tell my orthodontist about my autoimmune disease?

Yes, absolutely. Your full medical history, including the diagnosis, current medications, and level of disease activity, is essential information for safe orthodontic planning. Withholding this information may result in inappropriate treatment planning, unexpected complications, or treatment that aggravates your condition. Your orthodontist is bound by confidentiality and needs this information to provide appropriate care.

Can biologicals like adalimumab cause problems with braces?

Biologicals significantly suppress immune function, which increases infection susceptibility. In orthodontic practice this primarily means a higher risk of periodontal problems and soft tissue infection around brackets. Your dental and medical teams should be aware you are on a biological therapy. Meticulous oral hygiene is essential, and any signs of infection should be addressed promptly. Your prescribing clinician should be informed of any planned invasive dental procedures.

Is condylar resorption always a contraindication to orthodontic treatment?

Active, progressive condylar resorption is a contraindication to orthodontic treatment because the skeletal base is unstable — any correction of the bite will be undermined as the condyle continues to resorb. Treatment should be deferred until resorption has been confirmed as inactive on serial imaging over at least 12 months. Once stable, orthodontic treatment can proceed, usually with conservative mechanics. Severe cases with significant bite changes may ultimately require orthognathic surgery after resorption has fully arrested. Your orthodontist should request an MRI or CBCT of the TMJ before committing to a treatment plan.

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Citation details

Title Orthodontics with Autoimmune Disease UK | RA, Lupus, Sjögren's

Publisher Virtual Consultant Online

Published 2024-06-01

Updated 2026-08-17

URL [https://staging.virtualconsultant.online/guides/autoimmune-disease-orthodontics-uk](https://staging.virtualconsultant.online/guides/autoimmune-disease-orthodontics-uk)