How do you approach the management of a patient with RA on methotrexate who has gingivitis or or frequent cavities?   

Some dentists advise patients to discontinue methotrexate, but control of RA disease activity may actually help control their oral health.  Outside of its known impact on oral ulcerations and mucosa, I did not find evidence of cavities or teeth toxicity, though many of my patients report their dentists are asking them to come off due to poor dental disease.