Inflammatory dermatological and rheumatological conditions related to poor oral health

Patients with severe inflammatory dermatologic and rheumatologic conditions generally suffer poor oral health and oral health-related quality of life, according to a new study.

Study investigators, led by Yvonne Kiernan, BDS NUI, MFDS RCSEdin, prospectively assessed the oral health and quality of life of patients with various chronic inflammatory dermatologic/rheumatologic diseases treated with systemic/biologic therapy.

“Oral health is essential to overall health and QoL, and the impact of poor oral health on health and QoL is increasingly recognized,” they wrote. “Poor oral health has been associated with adverse pregnancy outcomes, cardiovascular disease, lung disease and diabetes, although causal relationships have not yet been clearly established.”

They also noted that those with inflammatory dermatologic and rheumatologic diseases frequently reported more oral discomfort/pain, higher levels of periodontal disease, dry mouth, and oral mucosal lesions (OML) than healthy controls.

The study

In their cross-sectional observational study, they recruited a total of 100 patients (≥18 years), with 2 groups evenly divided between those with chronic inflammatory dermatologic or rheumatologic disease and patients without a history of chronic inflammation.

Patients then received an oral health assessment, which included a 16-item questionnaire related to self-rated oral health, oral pain/discomfort, dry mouth, oral hygiene habits, quality of life related to oral health, diet, smoking, alcohol, etc. and education

The physical examination portion of the assessment, which was performed using internationally standardized World Health Organization (WHO) templates, was performed by a dentist in each patient’s dermatology or rheumatology clinic as complement to your standard clinical care. The examination included dental findings and assessed periodontal health and the presence of oral mucosal lesions.

the findings

Kiernan and colleagues found a statistically significant difference in the prevalence of dry mouth, as reported on the questionnaire, between patients with dermatological/rheumatological inflammatory diseases and the control group (82% vs 20%, respectively; p = 0.001).

In addition, patients with inflammatory disease were 18 times more likely to have dry mouth (odds ratio [OR], 18.2; 95% CI, 6.7-49.6); Up to 57% of these patients reported having dry mouth “very often”.

In addition, only 60% of patients diagnosed with dermatologic or rheumatologic inflammatory disease brushed their teeth twice a day, compared with 80% of the control group.p = 0.037).

The oral health examination revealed that patients with inflammatory diseases had an average of 7.7 missing teeth, while patients in the control group had an average of 4.4 missing teeth (p = 0.029). The first had an average of 5.6 filled teeth, and the second had an average of 7.6 teeth (p = 0.008).

And finally, patients with dermatologic/rheumatologic disease had significantly greater loss of clinical attachment (a marker of periodontal disease) in all sextants compared to controls.

The most common inflammatory diagnoses were psoriasis/psoriatic arthritis (48%), followed by rheumatoid arthritis (36%) and systemic lupus erythematosus (6%). Adalimumab (28%) was the most commonly prescribed treatment for these patients, as were etanercept (28%) and methotrexate (16%).

“This study shows an association between oral health and oral health-related quality of life in patients with severe inflammatory skin and joint disease treated with systemic and biologic therapy,” the researchers wrote.

“Dermatologists should receive specific training in oral health to optimize the oral health management of our patients with severe inflammatory diseases,” they concluded.

The study, “Oral health in patients with severe dermatologic and rheumatologic inflammatory disease,” was published online in Skin health and disease.

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