Inflammatory bowel disease is linked to an increased risk of periodontitis, i.e. periodontal disease. This is according to new publications from a European research project that explored the link between the two diseases.
How does inflammatory bowel disease affect oral health? And how does the mouth affect our gut? It is already well known that periodontitis can be linked to diabetes and cardiovascular disease. But the link between periodontitis and inflammatory bowel disease (IBD) has not so far been explored on a large scale in a European context.
Now, two publications from a large research project involving Danish patients show that there is a strong link between the diseases.
– The study shows that patients with IBD have more periodontitis and fewer teeth compared to people without IBD. We also see that patients with both IBD and periodontitis have worsened bowel disease with higher activity than patients with IBD who have a healthy mouth, says Andreas Stavropoulos, professor, and senior dentist at the Faculty of Dentistry at Malmö University, and one of the researchers behind the study.
– Both diseases can be described as creating a strong overreaction of the immune system to a bacterial trigger. You could say that the immune system is attacking your own body.
In the study, around 1,100 patients answered questions in an online survey. Around half of the participants had Crohn's disease and the other half had ulcerative colitis. The study also included about 3,400 people without IBD, who were randomly selected but also matched for certain criteria to the patients with inflammatory bowel disease.
– The study showed not only that patients with inflammatory bowel disease had poorer oral health than people without IBD, but also that the oral health of patients with Crohn's disease was more affected. They lost more teeth than patients with ulcerative colitis, says Kristina Bertl, lecturer and dentist at the Faculty of Dentistry.
Through contacts with the Danish crohn's disease and ulcerative colitis patient association Colitis-Crohn Foreningen (CCF), the researchers were able to find participants for the study. Within the association, it was well known that many patients had recurring problems with their teeth and infections and ulcers in their mouths. At the same time, they felt that this was not really addressed in their contact with the health care system.
– The Association was therefore very keen to help. The survey confirms this picture. Participants reported that they were not informed about the possible link between the two diseases, and in general that problems with the teeth and mouth were under-prioritized, says Andreas Stavropoulos.
Periodontitis initially causes relatively mild symptoms, such as bleeding gums when brushing, but can lead to tooth loss if not treated in time.
– Overall, the studies show that the oral health of patients with IBD should be better monitored to prevent the development of periodontitis and tooth loss in this patient group, concludes Kristina Bertl.
Why is oral health so important for everyone? The mouth is the “starting point” of the body’s defense and immunity system. When oral health is compromised by disease or injury, general health is also affected, describes Dr. Benoit Varenne, Oral Health Programme Officer at the NCD Prevention Department of the World Health Organization (WHO).
According to WHO’s Global Oral Health Status Report published on 18 November 2022, almost half of the world’s population is affected by some type of oral disease. The most vulnerable and marginalized populations are particularly affected by poor oral health.
Dr. Benoit Varenne explains in an interview for WHO: Science in 5 that poor oral health can lead to a multitude of health challenges – in more severe cases even to disability and death. Oral diseases are linked to a range of risk factors – these include tobacco use, alcohol consumption, and unhealthy food and drinks.
– These risk factors are shared with other medical conditions or noncommunicable diseases (NCDs) such as diabetes, cancer, chronic respiratory diseases, cardiovascular diseases, or mental disorders, Dr. Benoit Varenne says.
Research indicates that there is a proven relationship between oral and general health. It is reported, for example, that diabetes is linked with the development and progression of periodontitis. Meanwhile, there is also a causal link between high consumption of sugars and diabetes, obesity, and dental caries, WHO recognizes.
Periodontitis, a chronic infection caused by bacteria, is a disease that affects as many as 70% of people in Western countries. Periodontitis is the sixth most common disease in the world that can also lead to other conditions such as cardiovascular diseases. Infections in the mouth are mainly caused by accumulated dental plaque, which can lead to tartar buildup if not removed properly.
According to Dr. Varenne, the biggest challenges in terms of improving global oral health are the cost and access to oral health care. In many countries, oral health care services are not accessible or not affordable for most people. Thus, implementing prevention measures such as in schools, communities, and workplaces is important.
So, how can we maintain and improve oral health? The key to good oral health is thorough oral home care. Prevention of oral diseases requires regular brushing and flossing. Using fluoride toothpaste is also important as it helps fight against dental caries.
Secondly, to help prevent dental caries and maintain general health, it is recommended to reduce sugar consumption in food and drink. Dr. Varenne reminds that water is the best drink every day at any time.
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