Are Dental Implants Safe for People With Ankylosing Spondylitis?

If you live with ankylosing spondylitis (AS) and are considering dental implants to replace missing teeth, it is entirely natural to wonder whether the procedure is appropriate for your situation. Many people with autoimmune or inflammatory conditions search online for guidance before speaking with a dental professional — wanting to understand potential risks before committing to any treatment.

Ankylosing spondylitis is a chronic inflammatory condition that primarily affects the spine and joints, but it can have implications for oral health too. From the medications used to manage AS to changes in bone density and immune function, there are several factors a dental team will consider when assessing implant suitability.

This article aims to provide clear, balanced educational information about dental implants and ankylosing spondylitis. It covers what AS is, how it may interact with implant treatment, the questions you should raise with your clinician, and when a professional dental assessment would be appropriate. It is not a substitute for personalised clinical advice.

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Dental implants may be a suitable tooth replacement option for people with ankylosing spondylitis, but individual suitability depends on a thorough clinical assessment. Factors including bone quality, disease activity, medication use — particularly biologic drugs or bisphosphonates — and immune health all influence whether dental implants are appropriate. A qualified dental professional will evaluate each case individually.

What Is Ankylosing Spondylitis?

Ankylosing spondylitis is a type of inflammatory arthritis that predominantly affects the spine, sacroiliac joints, and, in some cases, other joints throughout the body. The word "ankylosing" refers to the fusion of bones, which can occur in advanced stages of the condition. "Spondylitis" indicates inflammation of the spinal vertebrae.

AS is classified as an autoimmune-related condition, meaning the immune system plays a central role in driving inflammation. It most commonly presents in young adults and is more frequently diagnosed in men, though it affects people of all genders.

Common features of ankylosing spondylitis include:

• Chronic lower back and pelvic pain, typically worse in the morning or after periods of inactivity
• Stiffness in the spine and surrounding joints
• Fatigue, which can be significant during active disease flares
• Inflammation in other areas including the eyes (uveitis), bowel, and occasionally the jaw or temporomandibular joint (TMJ)

Because AS is a systemic inflammatory condition, its effects are not confined to the spine alone. This is why dental professionals need a comprehensive understanding of a patient's medical history before recommending any surgical treatment, including dental implants.

How Might Ankylosing Spondylitis Affect Oral Health?

People living with ankylosing spondylitis may experience a range of oral health considerations linked both to the condition itself and to the medications used to manage it.

Temporomandibular Joint Involvement

In some individuals, AS can cause inflammation in the temporomandibular joint (the jaw joint). This may lead to pain, limited mouth opening, or jaw stiffness — all of which can have implications for dental treatment, including the ability to undergo implant procedures comfortably.

Dry Mouth (Xerostomia)

Certain medications used to manage AS, including non-steroidal anti-inflammatory drugs (NSAIDs), may contribute to a reduction in saliva production. Saliva plays a critical protective role in oral health by neutralising acids, washing away bacteria, and aiding in the remineralisation of tooth enamel. Reduced saliva flow can increase the risk of tooth decay and gum disease.

Gum Disease and Inflammation

Research suggests a link between systemic inflammatory conditions and a higher susceptibility to periodontal (gum) disease. Since gum disease is also driven by inflammatory processes, individuals with AS may find they are more prone to gum-related problems. Notably, untreated gum disease is associated with poorer dental implant outcomes.

Bone Health Considerations

Chronic inflammation and certain medications — including corticosteroids — used in the management of AS can affect bone density over time. Since dental implants rely on healthy jawbone for successful osseointegration (the process by which the implant fuses with the bone), bone quality is an important clinical factor.

Understanding How Dental Implants Work

To assess whether dental implants are suitable for someone with ankylosing spondylitis, it helps to understand the clinical process involved.

A dental implant is a small titanium post that is surgically placed into the jawbone to act as an artificial tooth root. Over a period of weeks to months, the implant undergoes a process called osseointegration, during which the surrounding bone gradually bonds with the titanium surface. Once integration is complete, a custom-made crown, bridge, or denture can be attached.

For osseointegration to succeed, certain biological conditions must be met:

• Adequate bone volume and density to support and anchor the implant
• Healthy gum tissue free from active infection or significant gum disease
• A functioning immune response capable of healing after surgery without excessive risk of infection
• Good blood supply to the implant site to support tissue healing

Each of these factors can be influenced by ankylosing spondylitis or by the medications commonly used to treat it. This is why a thorough pre-implant assessment is essential for every patient, and especially for those with complex medical histories.

You can learn more about the full implant placement process by visiting our dental implants treatment overview.

Medications for Ankylosing Spondylitis and Implant Considerations

One of the most clinically significant areas to discuss with your dental team when considering implants is your current medication regimen for AS.

Biologic Therapies (TNF-alpha Inhibitors and IL-17 Inhibitors)

Biologic medications such as adalimumab, etanercept, and secukinumab are increasingly used to manage moderate-to-severe ankylosing spondylitis. These drugs work by suppressing specific components of the immune system that drive inflammation. While highly effective for controlling AS, this immune modulation can potentially:

• Increase susceptibility to post-operative infection
• Slow wound healing following implant surgery
• Affect the body's ability to integrate the implant successfully

It is important to note that many patients on biologic therapy do successfully undergo dental implant treatment. The key is that the dental team works in close liaison with your rheumatologist to assess and manage any additional risk before treatment begins.

Bisphosphonates

Although not universally prescribed for AS, bisphosphonates are sometimes used to address bone density concerns associated with chronic inflammation or long-term corticosteroid use. These medications are a known risk factor for a rare but serious condition called medication-related osteonecrosis of the jaw (MRONJ), which involves poor healing or exposure of jawbone following dental surgery. Your dental team will carefully review any history of bisphosphonate use before recommending implant treatment.

NSAIDs and Corticosteroids

Long-term use of non-steroidal anti-inflammatory drugs and steroids can affect bone health and wound healing. Your dental team will factor in the duration and dosage of these medications as part of their clinical assessment.

Clinical Assessment: What Your Dental Team Will Evaluate

Suitability for dental implants is never assumed — it is determined through a comprehensive clinical assessment. For patients with ankylosing spondylitis, this evaluation is likely to be particularly thorough.

Your dental clinician will typically assess:

• Medical history including the duration and severity of your AS diagnosis
• Current and recent medications including any biologics, bisphosphonates, NSAIDs, or corticosteroids
• Bone quality and quantity using dental X-rays or CBCT (cone beam computed tomography) imaging to evaluate the jawbone in three dimensions
• Gum health to identify any signs of active periodontal disease that would need treatment before implant placement
• Mouth opening and TMJ function, particularly if jaw involvement is present
• Overall systemic health and liaison with your GP or rheumatologist where appropriate

This multidisciplinary approach — where dental and medical teams work collaboratively — is considered an established approach for patients with complex health backgrounds. Our initial dental implant consultation provides the opportunity to discuss your specific medical history in full before any decisions are made.

Oral Health Maintenance for People Living With Ankylosing Spondylitis

Regardless of whether you proceed with dental implants, maintaining good oral health is particularly important when living with a systemic inflammatory condition. Below are some evidence-based recommendations:

Maintain a Consistent Oral Hygiene Routine

Brushing twice daily with a fluoride toothpaste and cleaning between teeth with interdental brushes or floss helps to reduce plaque accumulation, which is the primary cause of gum disease and tooth decay.

Stay Well-Hydrated to Combat Dry Mouth

If your medications contribute to dry mouth, drinking water regularly throughout the day can help. Sugar-free chewing gum containing xylitol may also stimulate saliva production.

Attend Regular Dental Check-Ups

Routine dental visits allow early detection of gum changes, decay, or bone loss before problems become significant. Patients with inflammatory conditions may benefit from more frequent hygienist appointments to support gum health.

Discuss Your Medications at Every Dental Visit

Always inform your dental team of any changes to your medications, including new prescriptions, dosage adjustments, or changes to your biologic therapy. This ensures your care plan remains clinically safe and appropriate.

Manage Disease Flares Proactively

Where possible, elective dental treatment — including implant placement — is often better planned during periods of stable disease activity rather than during a flare. Discuss timing with both your rheumatologist and dental team.

When to Seek Professional Dental Advice

If you are living with ankylosing spondylitis and have any of the following concerns, it would be appropriate to arrange a dental assessment:

• Missing teeth that are affecting your ability to eat, speak, or feel confident
• Swollen, bleeding, or tender gums that persist beyond a few days
• Jaw pain or stiffness that is worsening or affecting your daily life
• Tooth sensitivity to hot, cold, or sweet foods that has developed recently
• Dry mouth that is persistent and not improving with hydration
• Mouth soreness or ulcers that are not resolving within two weeks

These situations do not necessarily indicate a serious problem, but they do warrant professional evaluation. Early assessment often leads to simpler and more effective management of any developing issues.

Key Points to Remember

• Dental implants may be suitable for people with ankylosing spondylitis, but suitability is determined individually through clinical assessment — not assumed.
• Medications matter: Biologics, bisphosphonates, corticosteroids, and NSAIDs all have potential implications for implant treatment and must be disclosed to your dental team.
• Gum health is foundational: Active gum disease should be treated before implant placement is considered.
• Jawbone quality is a critical factor; imaging will be used to evaluate this before any procedure.
• A collaborative approach between your dental team and rheumatologist is considered an established and recommended approach for complex cases.
• Good oral hygiene and regular dental visits are especially important for people with systemic inflammatory conditions.

Frequently Asked Questions

Can I have dental implants if I am taking biologic medication for ankylosing spondylitis?

Many patients on biologic therapy for ankylosing spondylitis have successfully undergone dental implant treatment. However, biologic medications work by modifying immune function, which can affect healing and infection risk following surgery. Your dental team should be made fully aware of your medication and will likely liaise with your rheumatologist. In some cases, careful timing around medication cycles may be recommended. Each case is assessed on an individual basis, and no blanket statement about suitability can be made without a clinical examination.

Does ankylosing spondylitis affect the jawbone?

In most people with ankylosing spondylitis, jaw joint involvement is uncommon but does occur in a proportion of cases. When the temporomandibular joint is affected, it can cause pain, stiffness, or reduced mouth opening. Systemic inflammation and certain AS medications may also influence bone density more broadly, including in the jaw. A CBCT scan or dental X-rays can be used to evaluate jawbone quality accurately before any implant assessment is completed.

Will my dental implant be more likely to fail if I have ankylosing spondylitis?

The presence of ankylosing spondylitis alone does not automatically increase the risk of implant failure. However, factors associated with the condition — such as active inflammation, immunosuppressive medications, reduced bone density, or poorly controlled gum disease — can influence outcomes. With thorough pre-treatment planning, appropriate medical collaboration, and excellent oral hygiene, many patients with complex health backgrounds achieve good long-term implant outcomes. Your dental team will advise on your specific risk profile.

Should I tell my rheumatologist before having dental implant treatment?

Yes. It is good practice to inform your rheumatologist that you are planning dental implant surgery. They may wish to advise on medication management around the time of the procedure and can provide your dental team with relevant medical information. A collaborative approach between healthcare professionals helps to ensure your treatment is planned as safely as possible. Never discontinue any prescribed medication without discussing it with the clinician who prescribed it.

How do I maintain good oral health with ankylosing spondylitis?

Maintaining good oral health with AS involves consistent brushing and interdental cleaning, staying hydrated to counteract any dry mouth caused by medications, and attending regular dental check-ups. Discuss your full medication list with your dentist at every appointment. If your jaw is affected, your dental team can offer tailored advice to make oral hygiene more comfortable. Ensuring gum disease is well controlled is particularly important if you are considering implants in the future.

Can gum disease make it harder to get dental implants with ankylosing spondylitis?

Yes. Active gum disease is considered a contraindication for dental implant placement in most clinical scenarios, regardless of whether a patient has AS or not. Gum disease involves bacterial infection around the gum and bone — the same tissues that support a dental implant. If gum disease is present, it will typically need to be treated and stabilised before implant treatment can proceed. Find out more about our gum health and periodontal care services and how addressing gum health can support implant candidacy.

Conclusion

Living with ankylosing spondylitis does not automatically rule out dental implants as a tooth replacement option. However, AS introduces a range of clinically relevant considerations — from the systemic effects of the condition itself to the medications used to manage it — that must be carefully evaluated before any treatment is recommended.

Bone quality, gum health, medication history, and overall disease activity are all factors that your dental team will assess thoroughly. For many patients with well-managed ankylosing spondylitis, dental implants remain a viable and effective option for restoring missing teeth and improving quality of life.

If you are considering dental implants and live with AS, the most important first step is to arrange a comprehensive consultation with an experienced dental implant clinician who can review your full medical history and develop a personalised, safe treatment plan.

Dental symptoms and treatment options should always be assessed individually during a clinical examination.

This article is intended for general educational purposes only and does not constitute personalised dental advice. Individual diagnosis and treatment recommendations require a clinical examination by a qualified dental professional.

Next Review Due: 29 July 2027