Periodontitis and IBD

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Noted hygienist Deborah M. Lyle discusses the links between Inflammatory Bowel Disease and periodontitis

Periodontal disease and inflammatory bowel disease (IBD) are significant problems across the world, both having rising prevalence in developing countries [1]. Their pathogenesis is mediated by a complex interplay between a dysbiotic microbiota and the host immune-inflammatory response, and both are influenced by genetic and environmental factors [2].

IBD is associated with many debilitating symptoms, including urgent diarrhoea, rectal bleeding, vomiting, anorexia and lethargy, which frequently lead to poor psychosocial well-being with extensive consequences [1]. It affects people of any age, but is usually diagnosed between the ages of 15 and 40. There is currently no cure for the two main forms of IBD – ulcerative colitis and Crohn’s disease – with treatment aimed at relieving the symptoms [2].

Crohn’s disease is characterised by macrophage aggregation, frequently forming non-caseating granulomas and transmural inflammation. The terminal ileum is the most common site affected, but the disease can involve any area of the gastrointestinal tract. Ulcerative colitis is characterised by a significant infiltration of neutrophils within the lamina propria and the crypts, forming micro-abscesses and superficial mucosal ulceration. Interestingly, both cell types, macrophages and neutrophils, are also relevant to the pathogenesis of periodontal disease, suggesting that under a similar cytokine signalling, these diseases might share similar pathways [2].

Research has shown that the presence of periodontal disease is more frequent in patients with IBD when compared to control groups. In addition, both greater severity and extent of periodontitis have been found in IBD patients when compared to healthy controls. The reasons why IBD patients presented with poorer periodontal health have not been comprehensively investigated. Since both diseases share pathogenic similarities and their development is related to an aberrant immune response to a dysbiotic microbiota, disturbances of these factors are proposed as the main mechanisms responsible for the interaction between the diseases [2].

It is thought that the inflammation evoked by periodontitis might influence IBD. Locally produced pro-inflammatory cytokines might enter the systemic circulation, induce an acute-inflammatory response in the liver, and contribute to several processes. It has also been proposed that swallowed P. gingivalis may cause alterations to the gut microbiota. In a study evaluating the subgingival microbiota, researchers found that IBD patients harbour higher levels of bacteria that are related to opportunistic infections [2].

The suggestion that oral bacterial species could invade the gut and lead to IBD, highlights the importance of maintaining optimal oral health. Recommending effective adjuncts, such as the Waterpik® Complete Care can help patients look after their oral health lifelong. Combining proven Water Flosser and Sensonic® toothbrush technologies, the Waterpik Complete Care delivers effective brushing and flossing in one convenient device.

Patients with IBD are at an increased risk of periodontal disease. In addition, the induction of periodontitis seems to result in gut dysbiosis and altered gut epithelial cell barrier function, which might contribute to the pathogenesis of IBD. Maintaining optimum oral health must be a priority for every patient.

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1] Papageorgiou SN, et al. Inflammatory bowel disease and oral health: systematic review and meta-analysis. J Clin Periodontol 2017;44:382-393.
2] Lira-Junior R, Figueredo CM. Periodontal and inflammatory bowel diseases: is there evidence of complex pathogenic interactions? World J Gastroenterol 2016;22(35):7963-7972.