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Background:
Extra-intestinal manifestations of inflammatory bowel disease (IBD) are widely studied. Oral manifestations are manifold, miscellaneous, and hardly detected by general practitioners and gastroenterologists.
Objectives:
The main purpose of this systematic review is to find all the possible correlations between inflammatory bowel disea...
Context in source publication
Context 1
... this review, seventeen papers following the search criteria were included, and data collected in 15 different countries, up to a total of 6692 study participants (2174 of which were under 18 years old). The database research identified 396 studies, but as depicted in the flow diagram (Figure 2), after removing the duplicates and screening the abstracts, only 109 were fully read and 92 excluded because they were irretrievable, irrelevant, or were not eligible after applying the exclusion criteria. Among the 17 papers, there were one cross-sectional study, one prospective study, four retrospective studies, eleven case-control studies with a total of 5369 (3558 with CD and 1811 with UC/indeterminate colitis) patients with IBD among all the different studies. ...
Citations
... Dysbiosis of the oral microflora may disturb the normal functioning of the immune system, and in this way increases the development of periodontitis which, in turn, increases the risk of IBD and other complex systemic disease processes. It is an important fact that the above-mentioned relationship is useful information in the early diagnostics and treatment of both dysbiosis of the oral cavity and the intestines, as well as related inflammatory diseases [70]. ...
Introduction and objective:
An increasing number of studies indicate that the oral cavity and gastrointestinal tract are interconnected and that there is a potential causal link between non-specific inflammatory bowel diseases (IBD) and oral diseases. Therefore, following the example of the brain-gut axis, the concept of the gum-gut axis has now been put forward. The aim of the review is to assess the literature confirming the existence of the recently proposed gum-gut axis and the resulting relationships between non-specific inflammatory bowel diseases and oral diseases, especially periodontal diseases.
Review methods:
The review sums-up information concerning the relationship between periodontal diseases and non-specific bowel diseases. A literature review was carried out by searching databases PubMed, Google Scholar, and Web of Science.
Brief description of the state of knowledge:
Previously, it was presumed that oral microflora and intestinal microflora remain separate. because it was considered that salivary microbes are killed by stomach and bile acids during translocation through the gastrointestinal tract. Presently, it has been confirmed that oral microorganisms have been found in the faeces of even healthy people. The comparison of oral and intestinal microbiomes of adults does not show full convergence; but pathogenic bacteria such as Klebsiella, Porphyromonas gingivalis and Fusobacterium nucleatum may act as the microbial bridge between periodontitis and IBD.
Summary:
Dysbiosis of oral microflora may disrupt the normal functioning of the immune system, in this way increasing the development of periodontitis which, in turn, increases the risk of IBD and other complex systemic pathological processes. The gum-gut axis plays a crucial role in these associations. Additional studies are necessary to specify the role of nutritional intervention concerning oral and intestinal microbiome for precise health management.
... The oral manifestations of UC include specific and nonspecific features, with the former including pyostomatitis vegetans (PV), characterized by pustules in the gingiva, and the latter including recurrent aphthous-like ulcers, atrophic glossitis, oral mucosal burning sensation, angular cheilitis, dry mouth, taste disturbances, halitosis and periodontitis (25,26). The oral manifestations may be asymptomatic and occur prior to or parallel with UC activity. ...
Headlines
Oral manifestations may be the first sign of a systemic condition or disease
Clinical recognition of oral manifestations related to systemic diseases may be difficult and can delay diagnosis
Oral conditions related to the treatment of systemic diseases are clinically important to recognize
Oral health personnel should be educated to be able to identify and diagnose and manage oral manifestations of systemic diseases and conditions in a timely manner
... De orale manifestationer ved UC kan vaere specifikke i form af pyostomatitis vegetans (PV), der er karakteriseret ved blaerer på gingiva, og uspecifikke i form af recidiverende aftelignende ulcerationer, atrofisk glossitis, svien og braenden i mundslimhinden, angulaer cheilitis, mundtørhed, smagsforstyrrelser, halitose og parodontitis (25,26). De orale manifestationer kan vaere asymptomatiske og forekommer inden eller samtidig med UC-aktivitet. ...
... Вовлечение слизистой ротовой полости. Согласно недавнему систематическому обзору уровень распространенности проявлений в полости рта колеблется от 0,7 до 37,0% среди взрослого населения с ВЗК [61,62]. Чаще ротовая полость вовлекается в процесс у пациентов с БК -у 10% больных, при ЯК -у 4%. ...
... Афтозный стоматит является наиболее частым реактивным ВКП при ВЗК в ротовой полости и встречается у 20% взрослых и 47% детей [61]. Другие проявления в ротовой полости включают пародонтит, вегетативный пиостоматит, образование камней на слизистой оболочке и орофациальный гранулематоз (синдром Мелькерссона-Розенталя/гранулематозный хейлит Мишера) [60,61,63]. ...
... Афтозный стоматит является наиболее частым реактивным ВКП при ВЗК в ротовой полости и встречается у 20% взрослых и 47% детей [61]. Другие проявления в ротовой полости включают пародонтит, вегетативный пиостоматит, образование камней на слизистой оболочке и орофациальный гранулематоз (синдром Мелькерссона-Розенталя/гранулематозный хейлит Мишера) [60,61,63]. ...
Глобальное бремя воспалительных заболеваний кишечника (ВЗК) значительно и продолжает расти в связи повышением распространенности язвенного колита (ЯК) и болезни Крона (БК), с увеличением затрат на диагностику и лечение, а также из-за высокого уровня инвалидизации, что обусловливает поиск факторов риска и предикторов агрессивного течения, развития внекишечных проявлений (ВКП). По последним данным, распространенность ЯК в России составляет 16,6 на 100 тыс. населения, ежегодный регистрируемый прирост – 11,3%, распространенность БК – 5,6 на 100 тыс. населения, а прирост – 13,7%. В российской популяции пациентов с ВЗК средний возраст дебюта заболевания составляет 35,3 года для ЯК и 31,2 года – для БК. При этом у 89,3% пациентов с ЯК для верификации диагноза потребовался период не менее 2 лет, а при БК в течение 2 лет от момента начала клинических симптомов диагноз установлен только у 72,6% пациентов. Одна из доминирующих характеристик ВЗК – их мультисистемность, что приводит к развитию ВКП, которые могут отмечаться у 50–60% больных, причем до 25% пациентов с ВЗК имеют несколько ВКП, и наиболее частыми вариантами являются поражения суставов. Бόльшая частота ВКП отмечается при БК (до 45% пациентов), у пациентов женского пола, курильщиков и при большей продолжительности заболевания. Для прогноза клинической ремиссии имеют значение уровень фекального кальпротектина и C-реактивного белка, потребность в глюкокортикостероидах, для прогноза эндоскопической ремиссии – уровень фекального кальпротектина, а для прогноза гистологической ремиссии имеет значение эндоскопический индекса Шредера ≤1 баллу. Абсолютный риск развития колоректального рака при ВЗК остается относительно низким, составляя от 1,1 до 5,4% через 20 лет заболевания. Основными факторами риска при ВЗК считаются тотальное поражение кишки, высокая активность воспаления, стриктурирующий фенотип БК и наличие первичного склерозирующего холангита.
... The prevalence of CD patients with PD in our study was 47.4%. The study by Lauritano et al. shows that the prevalence of any oral manifestation (OM) in patients with CD varies from 0.7% to 37% [25], and Lankarani et al. reported in their study that the prevalence rate of extraintestinal manifestations ranges from 6 to 47% [26]. In a study by Alvarado Julio et al., the presence of OM was reported in as many as 63% of patients with IBD, the most common of which is gingivitis in as many as 55% of cases [3]. ...
... Oral manifestations that can occur in patients with CD are divided into specific ones in the form of cobblestone mucosa, granulomatous cheilitis, and seals on the mucosa, and non-specific ones in the form of aphthae, fissures, other types of cheilitis, lichen planus, periodontal disease, dental caries, and others. They are, in most cases, asymptomatic, and the prevalence of these OMs is 0.5% and 37% [27], while according to some earlier studies, it ranged from 12.7 to 21% [25]. Generally, the most common OM in IBD is aphthous ulcerations, which are clinically hard to distinguish from aphthous ulcerations in healthy people, so a biopsy and/or Anti-Saccharomyces cerevisiae antibody (ASCA) test is necessary [28]. ...
Introduction:
Crohn's disease (CD) is a chronic inflammatory granulomatous disease that can affect the entire gastrointestinal tract. It is characterized by various extraintestinal manifestations (EIMs), of which oral manifestations (OMs) are often possible. One of the possible OMs is periodontal disease (PD), a chronic inflammatory condition of the supporting tissues of the teeth. This study aimed to show the existence of a mutual relationship between the clinical activity of PD and the clinical and endoscopic activity of CD.
Materials and methods:
One clinical and two endoscopic indexes were used for the assessment of CD activity and clinical attachment loss (CAL), bleeding on probing (BOP), pocket probing depth (PPD), and radiographic bone loss (RBL) in a dental panoramic tomogram to assess PD in CD patients.
Results:
A total of 38 patients underwent the entire study process, of which 20 patients had CD and 18 patients had CD and PD. Considering all CD activity scores, there were 26 patients with active disease; half of them had PD, and 85.7% of operated patients had active CD. The values of CAL, PPD, BOP, and RBL were higher in active CD patients than those in remission, except for BOP when comparing to the CDAI score, which was higher in those in remission of CD.
Conclusion:
The results of this study indicate that there is a connection between the activity of CD and worse conditions of the supporting tissues of the gums in the oral cavity, so it is important to keep in mind the necessity of referring patients with CD to a dentist for timely and adequate therapeutic measures.
... Given existing literature underscoring the detrimental impacts of certain oral resident bacteria (e.g., Porphyromonas gingivalis and Fusobacterium nucleatum) on intestinal homeostasis, there is a hypothesis that the oral cavity may act as a reservoir for oral pathobionts that can cause intestinal pathologies. This notion is supported by studies showing the similarity between oral and gut microbiota [12][13][14] and the increased prevalence of periodontitis in IBD patients when compared with healthy individuals [15,16]. These observations suggest a potential correlation between periodontal disease and intestinal inflammation, possibly mediated by microbial translocation. ...
Inflammatory bowel disease (IBD) is a multifactorial intractable intestinal disease. Focusing on only one facet of the pathogenesis of IBD is insufficient to fully capture the complexity of the disease, and results in limited advance in clinical management. Therefore, it is critical to dissect the interactions amongst the multifarious contributors to the pathogenesis to comprehensively understand its pathology and subsequently improve clinical outcomes. In this context, the systemic interactions between organs, particularly the oral-gut axis mediated by host immune cells and resident microorganisms, have garnered significant attention in IBD research. More specifically, periodontal disease such as periodontitis has been implicated in augmenting intestinal inflammation beyond the confines of the oral cavity. There is mounting evidence suggesting that potentially harmful oral resident bacteria, termed pathobionts, and pro-inflammatory immune cells from the oral mucosa can migrate to the gastrointestinal tract, thereby potentiating intestinal inflammation. This article aims to provide a holistic overview of the causal relationship between periodontal disease and intestinal inflammation. Furthermore, we will discuss potential determinants that facilitate the translocation of oral pathobionts into the gut, a key event underpinning the oral-gut axis. Unraveling the complex dynamics of microbiota and immunity in the oral-gut continuum will lead to a better understanding of the pathophysiology inherent in both oral and intestinal diseases and the development of prospective therapeutic strategies.
... The prevalence of CD patients with PD in our study was 47.4%. The study by Lauritano et al. shows that the prevalence of any oral manifestation (OM) in patients with CD varies from 0.7% to 37% (26), and Lankarani et al. reported in their study that the prevalence rate of extraintestinal manifestations ranges from 6%-47% (27) In a study by Alvarado Julio et al. the presence of OM was reported in as many as 63% of patients with IBD, the most common of which is gingivitis in as many as 55% of cases (3). ...
... Oral manifestations that can occur in patients with CD are divided into specific ones in the form of cobblestone mucosa, granulomatous cheilitis and seals on the mucosa, and non-specific ones in the form of aphthae, fissures, other types of cheilitis, Lichen planus, periodontal disease, dental caries, and others. They are in most cases asymptomatic and the prevalence of these OM is 0.5% and 37% (28), while according to some earlier studies it was from 12.7-21% (26). The most common OM generally in IBD is aphthous ulcerations which are clinically hard to distinguish from aphthous ulcerations in healthy people so a biopsy and/or Anti-Saccharomyces cerevisiae antibody (ASCA) test is necessary (29). ...
Introduction: Crohn's disease (CD) is a chronic inflammatory granulomatous disease that can affect the entire gastrointestinal tract. It is characterized by various extraintestinal manifestations (EIM), of which oral manifestations (OM) are often possible. One of the possible OM is periodontal disease (PD) a chronic inflammatory condition of the supporting tissues of the teeth. This study aimed to show the existence of a mutual relationship between the clinical activity of PD and the clinical and endoscopic activity of CD. Materials and methods: Using one clinical and two endoscopic indexes for the assessment of CD activity and clinical attachment loss (CAL), bleeding on probing (BOP), pocket probing depth (PPD) and radiographic bone loss (RDL) on dental panoramic tomogram to assess PD in CD patients. Results: A total of 38 patients underwent the entire study process, of which 20 patients with CD and 18 patients with CD and PD. Considering all CD activity scores, there were 26 patients with active disease, and half of them had PD, and 85.7% of operated patients had active CD. Values of CAL, PPD, BOP and RBL were higher in active CD than remission, except BOP when compared to CDAI score which was higher in remission of CD. Discussion and conclusion: The results of this study indicate that there is a connection between the activity of CD and the worse condition of the supporting tissues of the gums in the oral cavity which is important to keep in mind the necessity of referring patients with CD to a dentist for timely and adequate therapeutic measures.
... Pyostomatitis vegetans Mucogingivitis Irrespective of being specific or non-specific, these lesions in the oral cavity may also occur due to malnutrition, 12 but also due to the drugs used to treat IBD. 13 The pathogenesis of oral lesions in IBD is illustrated in (Figure 1). 14 The treatment of underlying IBD is very important and lays the foundation for treatment of any extraintestinal lesions, like in oral cavity. ...
Extra-intestinal signs of inflammatory bowel disease (IBD) can reach a site as far as oral cavity. The oral cavity manifestations of IBDs are many and more likely missed by the general practitioners and gastro- enterologists.
... Extraintestinal manifestations of IBD, which can affect nearly all organ systems, are common in both UC and CD 50-55 . Approximately 10-30% of IBD patients exhibit oral manifestations of the disease, which can precede, coincide with, or follow the onset of GI symptoms [56][57][58]63,64,67 . Commonly observed oral manifestations include aphthous ulcers, cobblestoned oral mucosa, pyostomatitis vegetans, gingivitis, periodontitis, angular cheilitis, and oral lichen planus 37,[56][57][58][59][60][61][62][63][64][65][66][67]138,139 . ...
... Approximately 10-30% of IBD patients exhibit oral manifestations of the disease, which can precede, coincide with, or follow the onset of GI symptoms [56][57][58]63,64,67 . Commonly observed oral manifestations include aphthous ulcers, cobblestoned oral mucosa, pyostomatitis vegetans, gingivitis, periodontitis, angular cheilitis, and oral lichen planus 37,[56][57][58][59][60][61][62][63][64][65][66][67]138,139 . Additionally, some individuals may present with halitosis, atrophic ...
... glossitis, burning mouth syndrome, and xerostomia [56][57][58][59][60][61][62][63][64][65][66][67] . Some of these lesions are more common in CD versus UC, and more frequently noted in children versus adults 140 . ...
Periodontitis and Inflammatory Bowel Disease (IBD) are chronic inflammatory conditions, characterized by microbial dysbiosis and hyper-immunoinflammatory responses. Growing evidence suggest an interconnection between periodontitis and IBD, implying a shift from the traditional concept of independent diseases to a complex, reciprocal cycle. This review outlines the evidence supporting an Oral-Gut axis, marked by a higher prevalence of periodontitis in IBD patients and vice versa. The specific mechanisms linking periodontitis and IBD remain to be fully elucidated, but emerging evidence points to the ectopic colonization of the gut by oral bacteria, which promote intestinal inflammation by activating host immune responses. This review presents an in-depth examination of the interconnection between periodontitis and IBD, highlighting the shared microbiological and immunological pathways, and proposing a multi-hit hypothesis in the pathogenesis of periodontitis-mediated intestinal inflammation. Furthermore, the review underscores the critical need for a collaborative approach between dentists and gastroenterologists to provide holistic oral-systemic healthcare.
... IBD is not an exception. Indeed, many recent systematic reviews reported higher prevalence rates of caries (13,31), periodontitis (13,32,33), and specific and nonspecific oral lesions (34,35) among IBD patients. Similarly, many systematic reviews showed that AP is associated with cardiovascular diseases (36,37), diabetes (30), adverse pregnancy outcomes (38), autoimmune diseases (39), and other systemic diseases (40). ...
Objective: Recent literature has suggested a potential association between inflammatory bowel diseases (IBD) and apical periodontitis (AP). The present systematic review and meta-analysis sought to analyze and appraise the available evidence regarding the reported association.
Methods: Following 2020 PRISMA guidelines, a comprehensive search of multiple online databases (PubMed, Scopus, Web of Science, and Google Scholar) was conducted for all relevant studies published from the date of inception until April 27, 2023 using various relevant keywords. All observational studies that assessed the association between IBD and AP in humans were eligible for inclusion. The quality of the selected studies was carried out independently by two reviewers, and meta-analysis was performed using Comprehensive Meta-Analysis Version 2.2.064.
Results: Six studies (five case-control studies and one cohort study) were included. A total of 657 patients (277 with IBD) were included in 5 case-control studies, and 48,223 subjects (35,740 with AP) were included in the cohort study where 188 developed IBD on follow-up. The pooled data from the five case-control studies revealed that IBD was significantly associated with a higher risk of AP (OR = 1.71, 95% CI: 1.21 – 2.42; I2 = 10.337%, fixed-effect, p = 0.002). The qualitative analysis also showed that most of the included studies found a higher mean number of teeth with AP in IBD groups compared to healthy controls. NOS-based quality appraisal results demonstrated that five studies were of high quality and one study was of moderate quality.
Conclusion: The results suggest a potential association between IBD and AP. Large-scale, and prospective studies are required to further confirm and elucidate the nature of such an association. (EEJ-2023-05-057)
