Q: I have RA and fibromyalgia. Every time I get my teeth cleaned, I have a flare of both conditions a few days later. Do you know why this might happen?

A: We know any type of stress – whether physical stress, such as an infection, or emotional stress, such as fear – can make fibromyalgia and perhaps RA worse, too. In the scenario you describe, I can think of at least three potential stressors that may contribute to your flares: the release of bacteria from the mouth into the bloodstream during cleaning, which stimulates the immune system just enough to increase the level of cytokines in the bloodstream and tissue; the discomfort associated with the procedure, and the anxiety caused by anticipating another flare. Once you know this has happened in the past, it would not be unreasonable to assume it might happen again.

Theoretically each of these three stressors could be dealt with to help reduce your risk of future dental-cleaning-related flares. Antibiotics could be used before and during the procedure to control the bacteria, and deep-breathing or relaxation techniques could be used to help reduce your anxiety, and therefore flares. Analgesics could be used after the procedure, if necessary, to relieve pain. Speak to your doctor or dentist about pre-cleaning medications and about specific techniques that might be helpful.

Daniel Clauw, MD, Rheumatologist