Patients with inflammatory bowel disease have a higher chance of developing periodontitis: A systematic review and meta-analysis

Abstract

Background and objectivePeriodontitis affects up to one billion people worldwide, and has been proven to be associated with several systemic inflammatory conditions. This study investigates the specific relationship between two multifactorial diseases: Inflammatory bowel disease (IBD) and periodontitis. To thoroughly explore this issue, we investigated separately whether IBD patients have a higher chance of developing periodontitis, and equally, whether patients with periodontitis have a higher chance of developing IBD.MethodsThe systematic search was performed in three databases: MEDLINE, Cochrane Trials, and Embase, up to 26 October 2021. The protocol was registered in PROSPERO. All eligible studies investigating the association between IBD and periodontitis from either direction were included. The Newcastle-Ottawa Scale was used to assess the risk of bias. As a primary outcome, we investigated the prevalence of IBD and periodontitis, and calculated the odds ratio (OR). Our secondary outcomes involved comparing the clinical periodontal outcomes of IBD patients to those of IBD-free patients.ResultsThe systematic search resulted in 1,715 records, 14 of which were eligible for qualitative synthesis and 8 for quantitative synthesis. On the basis of the results of the primary outcome, IBD diagnosis was associated with significantly higher odds of periodontitis: OR = 2.65 (CI: 2.09-3.36, I2 = 0 (CI: 0-0.75)). For subgroup analysis, we investigated separately the odds in Crohn’s disease (CD) patients: OR = 2.22 (CI: 1.49-3.31, I2 = 0.05 (CI: 0-0.76)) and in ulcerative colitis (UC) patients: OR = 3.52 (CI: 2.56 to 4.83, I2 = 0 (CI: 0-0.75)); the odds were significantly higher in all cases. Two studies investigated whether patients with periodontitis were more susceptible to IBD, and both found that periodontitis was significantly associated with the risk of subsequent UC, but not with subsequent CD. However, more studies are needed to prove an association.ConclusionOur analysis confirmed that IBD patients have a higher chance of developing periodontitis, and are a higher risk population in dentistry. Both dentists and gastroenterologists should be aware of this relationship and should emphasize the importance of prevention even more than in the healthy population.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021286161].

The effect of the “Oral-Gut” axis on periodontitis in inflammatory bowel disease: A review of microbe and immune mechanism associations

“…The oral cavity is one of the most vulnerable areas for extraintestinal manifestations of IBD, and numerous studies have found that patients with IBD have a higher risk of periodontitis than those without IBD (Papageorgiou et al, 2017;She et al, 2020;Zhang et al, 2021c;Abrol et al, 2022). In addition, the severity and extent of periodontitis suffered by patients with IBD was found to be greater, with patients having significantly higher mean probing depth, plaque index, calculus index, sulcus bleeding index, and attachment loss than patients with general periodontitis (Zhang et al, 2020;Nijakowski et al, 2021;Domokos et al, 2022). It has also been confirmed that patients with periodontitis have a significantly higher risk of developing IBD than healthy controls without periodontitis (Lin et al, 2018;Kang et al, 2020;Madsen et al, 2022).…”

Emerging factors affecting peri‐implant bone metabolism

“…A close relationship between inflammatory diseases and periodontitis has been described in a recent systematic review and meta‐analysis 539 : Patients with inflammatory bowel disease, being a high‐risk population in dentistry, had a higher chance of developing periodontitis (OR = 2.65; ranged from OR = 2.22 in Crohn's disease patients to OR = 3.52 in ulcerative colitis patients). Moreover, periodontitis was a significant risk factor for the development of ulcerative colitis but not Crohn's disease 539 . Several hypotheses have been proposed to explain the relationship between RA and periodontal disease 540,541 .…”

“…[536][537][538] This fact may be explained by the long-term use of disease-modifying anti-rheumatic drugs (DMARDs) that may improve the periodontal condition due to their host modulatory effect. 536 A close relationship between inflammatory diseases and periodontitis has been described in a recent systematic review and meta-analysis 539 : Patients with inflammatory bowel disease, being a high-risk population in dentistry, had a higher chance of developing periodontitis (OR = 2.65; ranged from OR = 2.22 in Crohn's disease patients to OR = 3.52 in ulcerative colitis patients). Moreover, periodontitis was a significant risk factor for the development of ulcerative colitis but not Crohn's disease.…”

“…Moreover, periodontitis was a significant risk factor for the development of ulcerative colitis but not Crohn's disease. 539 Several hypotheses have been proposed to explain the relationship between RA and periodontal disease. 540,541 The "two-hit model" proposes that P. gingivalis disrupts immune tolerance to citrullinated proteins through PPAD, leading to a destructive inflammatory condition in periodontal tissues with macrophage activation, T-cell proliferation, and subsequent cytokine release, along with B-cell proliferation and the release of anti-citrullinated protein antibody (ACPA).…”

Health‐related quality of life aspects of the ‘Periodontitis prevalence in ulcerative colitis and Crohn's disease’ (PPCC) cohort

“…Inflammatory bowel disease (IBD) affects-depending on the disease entity (i.e., ulcerative colitis [UC] or Crohn's disease [CD])-parts of or the entire gastrointestinal tract, and often has extra-intestinal manifestations (EIM) involving the joints, eyes, skin, and/or the oral cavity. Additionally, IBD is associated with oral conditions such as caries and periodontitis (see for reviews Agossa et al, 2017Agossa et al, , 2021Domokos et al, 2022;Lorenzo-Pouso et al, 2021;Nijakowski et al, 2021;Papageorgiou et al, 2017;She et al, 2020;Zhang et al, 2021). In a recent large-scale, questionnaire-based, case-control study in Denmark, the association between IBD and oral health was further investigated based on answers of over 1100 IBD patients and more than 3400 matched controls.…”