Oral health in patients with Crohn's disease

Abstract

Dental caries and periodontal diseases are the most common oral diseases worldwide. They are multifactorial diseases which include several risk factors. Dental caries causes tooth ache and tooth loss, with numerous risk factors are such as cariogenic bacteria, decreased salivary flow, poor dietary habits, increased sugar consumption, and neglect of oral hygiene. Periodontal diseases, including gingivitis and periodontitis, are inflammatory processes of the gingiva and supporting structures of the teeth and is characterized by destruction of the tissues and eventually tooth loss. Risk factors for periodontitis result from a combination of genetic factors and environmental factors such as poor oral hygiene, amounts of periopathogenes, smoking and systemic diseases. Crohn´s Disease (CD) is a granulomatous chronic inflammatory disease that can affect the whole gastrointestinal tract, although it is usually localized to small and large intestine. There is no cure for CD. The aetiology of CD is poorly understood but an interaction between genetic, microbial and environmental factors may participate in the development and progression of CD.

The general hypothesis of these studies was that patients with CD have poorer oral health than people without CD. The present thesis includes three studies which all aim to investigate oral health in patients with CD.

Study I is based on a questionnaire, including 1598 patients with CD and a randomly selected control group of 1000 subjects. Study II and III are the clinical studies comprised of 150 patients with CD and a control group comprising of 75 subjects.

The first specific aim was to investigate how patients with CD perceived their oral health compared to control group (Study I). Secondly we wanted to find out in a clinical study if CD patients had a higher prevalence and risk for dental caries (Study II). The third aim was to investigate whether CD patients had a higher prevalence and severity of periodontal disease compared to controls without CD (Study III).

The main findings of all these studies revealed that patients with CD perceived their oral health to be poor (Study 1). Patients who had undergone resective surgery had a significantly higher DMF-S score (Study II) and CD patients had significantly more dental plaque and gingival inflammation (Study III). There were more smokers in the CD group when compared to the controls (Study I, II & III).

Furthermore, our results in Study I reported that CD patients had a greater need for dental treatment and there was a correlation between more severe forms of CD and oral health. This group also reported more mouth and tooth related problems. Study II, showed that men in the CD group had significantly more decayed teeth decayed surface and more dental plaque when compared to CD women. The results in Study III showed that the percentage of CAL≥3 was higher in patients than controls which indicates that they had a greater prevalence of periodontitis. No differences in radiographic bone loss was observed between CD patients and controls. However, men in the CD group had significantly more BOP, CAL, alveolar bone loss and higher prevalence with periodontitis compared to women in the same group.

In conclusion, the findings in this project indicate that CD patients and especially men had a poorer oral health, more caries, dental plaque, BOP and CAL. Thus, our finding confirmed our hypotheses. There is a need to develop an oral care program, which include the prevention of oral disease, support and motivation to take care of the oral hygiene, as well as smoking cessation.