Synopsis
Early evidence indicates that there is a link between periodontitis and inflammatory bowel diseases in that they both share a common pathophysiology and the disease outcomes are worse when both conditions are present in an individual.
Information
Inflammatory bowel disease (IBD) is the broad term used to encompass conditions affecting the gastrointestinal tract including Crohn’s Disease and ulcerative colitis. It is estimated that one in 200 Australians suffer from inflammatory bowel conditions.i
In inflammatory bowel conditions, genetically susceptible individuals have increased chronic inflammation due to an aberrant immune response to gut bacteria. Manifestations of the disease can be seen in the joints, eyes, skin, liver and mouth. Signs in the mouth are usually seen at the onset of gastrointestinal inflammation or follow itii. The presentation of signs outside of the gut vary between individuals.
The link between periodontitis and IBD is thought to occur due to both conditions involving an aberrant immune response to bacteria. Multiple studies have demonstrated that patients with IBD are at increased risk of developing periodontitisii, iii.
The dysregulated inflammatory and immune response in both diseases leads to tissue destructioniv. IBD elevates systemic inflammatory mediators including IL-1. IL-6 and C-reactive protein and leads to increased levels of neutrophils contributing to a perpetual inflammatory state. Some studies have hypothesised a bidirectional link between periodontitis and IBDv. Hajishengallis and Chavakis have shown that pathogenic T-cells that proliferate during periodontitis may migrate to the gut and are activated by ectopic oral pathogensvi. This suggests that gingival microbes can worsen IBD outcomes
Systemically, both diseases have been shown to contribute to altered neutrophil chemotaxisvii. This contributes to neutrophil-mediated collateral host damage and crypts and abscesses specifically in IBD. This suggests both diseases may increase the severity of one another, however, more studies are required to elucidate this. In combination with this, both diseases contribute to chronic low-grade systemic inflammation which may increase exposure to free radicals and inflammatory cytokines. Studies are yet to determine mechanisms that these may impact.
What studies do confirm is that coexistence of both diseases show greater risks for more severe outcomes than the diseases aloneviii. Though more longitudinal studies are required, available studies do suggest a beneficial effect in oral hygiene and treatment of periodontitis.
i. Hudson Institute of Medical Research. Inflammatory Bowel disease (IBD). 2023 Website
ii. Abrol, N., Compton, S. M., Graf, D., Parashar, P., Heo, G., & Gibson, M. P. (2022). Inflammatory bowel disease and periodontitis: A retrospective chart analysis. Clinical and Experimental Dental Research, 8, 1028- 1034
iii. Vavricka S, Manser C, Hediger S, Vogelin M, Scharl M, Biedermann L, Rogler S, Seibold F, Sanderink R, Attin T, Schoepfer A, Fried M, Rogler G, Frei P. Periodontitis and Gingitivitis in Inflammatory Bowel Disease: A Case-Control Study. Inflamm Bowel Dis. 2013 19;13; 2768-277
iv. Mello-Neto, J.M.; Nunes, J.G.R.; Tadakamadla, S.K.; Figueredo, C.M. Immunological Traits of Patients with Coexistent Inflammatory Bowel Disease and Periodontal Disease: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 8958.
v. Lira-Junior, R.; Figueredo, C.M. Periodontal and inflammatory bowel diseases: Is there evidence of complex pathogenic interactions? World J. Gastroenterol. 2016, 22, 7963–7972.
vi. Hajishengallis, G.; Chavakis, T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nat. Rev. Immunol. 2021, 21, 426–440
vii. Van Dyke, T.E.; Dowell, V.R.; Offenbacher, S.; Snyder, W.; Hersh, T. Potential role of microorganisms isolated from periodontal lesions in the pathogenesis of inflammatory bowel disease. Infect. Immun. 1986, 53, 671–677.
viii. Stephan R. Vavricka, MD, Christine N. Manser, MD, Sebastian Hediger, Marius Vögelin, Michael Scharl, MD, Luc Biedermann, MD, Sebastian Rogler, Frank Seibold, MD, René Sanderink, DDM, Thomas Attin, DDM, Alain Schoepfer, MD, Michael Fried, MD, Gerhard Rogler, MD, PhD, Pascal Frei, MD, Periodontitis and Gingivitis in Inflammatory Bowel Disease: A Case–Control Study, Inflammatory Bowel Diseases, Volume 19, Issue 13, 1 December 2013, Pages 2768–2777,