Chronic inflammatory bowel disease and dental caries: a direct relationship

THE BEST OF EVIDENCE-BASED DENTISTRY

Clinical status
Crohn’s disease and ulcerative colitis are the most common of the chronic inflammatory diseases of the gastrointestinal tract. They are characterized by significant morphological and functional alterations of the intestinal mucosa and also of the oral cavity. These are disorders related to an excessive response of the body’s immune system and a genetic predisposition, with phenomena of intestinal dysbiosis and environmental factors such as smoking, abuse of antibiotics, oral contraceptives and diet.
Clinical manifestations of Crohn’s disease and ulcerative colitis manifest not only in the intestine but also in the oral cavity, with the appearance of foot-and-mouth ulcers and periodontitis. Given the prevalence of periodontitis in these patients, the international literature reports that there is an association ratio of about three times higher than that of patients not affected by these conditions (She et al. BMC Oral Health 2020).

The international literature also reports that there is a positive association between patients suffering from chronic inflammatory bowel disease and dental caries. Many hypotheses have been proposed to give you a rational explanation: the most plausible is the observation that in these patients there is an increase in the salivary concentration of cariogenic bacteria such as S. mutans and Lactobacilli and, above all, that during the phases Affected patients have significant dietary changes linked to increased consumption of refined sugars which, as is well known, are used by cariogenic bacteria to produce acids capable of demineralizing the hard tissues of the tooth. The increased presence of cariogenic bacteria (acidic and acid-resistant producers) creates dysbiosis within the oral cavity, with a prevalence of the latter species at the expense of other human and non-pathogenic commensal bacterial species.

Data from scientific evidence
A recent systematic review and meta-analysis investigated the relationship between chronic inflammatory bowel disease and an increased prevalence of caries lesions in the oral cavity. The result used to measure the caries experience was caries lacking full teeth (dmft).
The systematic review highlighted a larger and significant increase (p <0.05) in the dmft parameter in patients with chronic bowel disease compared to patients not affected by this condition.
Even the meta-analysis, expressed as a quantification of the weighted mean difference in dmft between subjects affected by chronic inflammatory diseases and healthy subjects, shows a shifted value in favor of sick subjects with these conditions compared to healthy subjects.
The level of evidence from the individual studies included (both in the review and in the meta-analysis) was defined as moderate / high.
The increase in the experience of caries in these patients has been reported, in the first place, in an increase in the frequency of meals and, in particular, in the consumption of foods with a high concentration of fermentable sugars and carbohydrates. carbon in general. This tendency to increase sugar consumption was manifested mainly during the active and exacerbation phases of the chronic intestinal disease in question, although there is a tendency towards increased sugar consumption even in patients in remission of the disease. compared to unaffected subjects. condition.
The combination of dysbiosis linked to a higher salivary presence of cariogenic bacteria and a higher frequency of ingestion of fermentable sugars is, as is well known, a very favorable condition for the development of caries lesions affecting the hard tissues of the tooth.

Clinical implications
1) Patients diagnosed with chronic inflammatory disease – Crohn’s disease or ulcerative colitis – should also be part of a dental treatment / prevention plan aimed primarily at controlling their daily intake of refined sugars.
2) Patients suffering from chronic inflammatory bowel disease should undergo regular dental check-ups more often than unaffected patients, in order to better motivate the patient to home oral hygiene and possibly intercept caries lesions in the early stages. and early.

Source: Marruganti C, Discepoli N, Gaeta C, Franciosi G, Ferrari M, Grandini S. Dental Caries Occurrence in Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis. Caries Nothing. 2021, 55 (5): 485-495.


Column edited by
Stefano Daniele
dentist


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