Periodontitis & bowel disease – Is there a link?

PD Dr. Kristina Bertl, PhD MSc MBA

Inflammatory bowel disease (Crohn’s disease and ulcerative colitis) is extremely stressful for sufferers and has a serious impact on their quality of life. The condition affects around 1.3 million people across Europe and is slightly more prevalent in the northern European countries than in the southern ones. If you had to summarise the pathogenesis of inflammatory bowel disease in a single sentence, you would probably say something along the following lines: “An excessive immune response to bacteria in a susceptible individual.”

Periodontitis & bowel disease – Is there a link?

If we now turn to the pathogenesis of periodontal disease, we would probably describe this in a very similar way, so it is not surprising that a link between the two conditions has been suggested and has been the subject of scientific investigation. For a long time, there have only been smaller studies with a maximum of 200 participants for the European region, but this year saw the publication of data from a questionnaire-based survey, which included almost 5,000 subscribers (approx. 1,100 patients with inflammatory bowel disease and approx. 3,400 participants without inflammatory bowel disease). This questionnaire-based study had several objectives, and the first two questions were as follows:

1. Do patients with inflammatory bowel disease have a higher risk of periodontal disease and tooth loss? (Bertl et al 2022)
2. Do periodontal disease and tooth loss affect the progression and degree of activity of inflammatory bowel disease? (Madsen et al 2022)

The results were extremely clear and also very interesting from a dentist's perspective! Compared to patients without inflammatory bowel disease (IBD), patients with IBD have a two to three times higher risk of poor self-perceived dental condition and of severe periodontitis, and patients with Crohn’s disease in particular had a two times higher risk of a higher rate of tooth loss! In patients with IBD, these oral diseases (periodontitis and tooth loss) increased the risk that they would be even more limited by their IBD and would have a higher degree of disease activity.

What should we as dentists look out for? We should of course do the following for patients with IBD: 1) explain to them the importance of their oral health and, potentially, 2) review these patients more often and/or recommend an additional oral hygiene session to prevent serious consequences such as periodontitis and tooth loss from even occurring in the first place!

References

1. Bertl, K., Burisch, J., Pandis, N., Bruckmann, C., Klinge, B., & Stavropoulos, A. (2022). Periodontitis prevalence in patients with ulcerative colitis and Crohn's disease - PPCC: A case–control study. Journal of Clinical Periodontology, 1–13. Madsen, G.R., Bertl, K., Pandis, N., Stavropoulos, A., Burisch, J. (2022) The Impact of Periodontitis on Inflammatory Bowel Disease Activity. Inflammatory Bowel Diseases, 2022, 1–9.