Primary immunodeficiency diseases (PIDs) are a heterogeneous group of disorders, characterized by gene defects leading to a variety of manifestations, particularly infections in different organs. According to the recent classification of PIDs, more than 250 different diseases have been described so far [Citation1]. There is evidence of more than 200 genes knockdown interference in the PIDs clinical profile primary antibody deficiencies (PADs), such as selective IgA deficiencies and common variable immunodeficiency, seem to be the most common asymptomatic and symptomatic types of PIDs, respectively [Citation2,Citation3]. PADs are a group of systemic disorders, associated with attenuated levels of secretory and protective immunoglobulins. Immunoglobulins make significant direct contributions to protection of oral cavity [Citation3]. Patients with PADs are more susceptible to various types of infections, especially in the gastrointestinal tract and the respiratory tract systems [Citation3]. Streptococcus mutans seems to be a culprit for dental caries, and the immune system is deemed to be critical in controlling the bacterial activities and development of caries and tooth loss. The increased development of dental caries and oral ulcers has been elucidated in variety of immune system disorders [Citation4,Citation5]; however, some studies designated no or low interrelationship between oral ulcers or dental caries and immunodeficiencies [Citation6,Citation7]. Concerning the involvement of the tooth and periodontium with PADs, the reporting of contradictory results underscores that studies have stumbled on two crucial issues: the oral manifestations of PADs and the oral management of patients with PADs.
Progression of dental caries leads to tooth loss and this could drastically reduce the quality of life as a result of the substantial effect on nutrition. To address this critical issue, the foremost doctors and dentists should endeavor to ameliorate the oral status of patients with PADs. Considering the fact that PAD patients have to visit their doctors occasionally, due to their systemic problems, whilst usually having less frequent visits to dentists, particularly in developing countries, the aim of this editorial is to provide essential guidelines for doctors to recommend patients with PADs. These recommendations are aimed at hindering the progression of dental caries and/or oral ulcers in both symptomatic and asymptomatic PAD patients.
Clinical recommendations
Recommendation A: Patients with PADs should be informed that there might be an elevated risk for dental caries and tooth loss, and gingival diseases.
Recommendation B: Patients with PADs are at moderate risk for dental caries [Citation8]; thereby they should be recommended to visit the dentist at least every 6 months to receive professional oral health care.
Recommendation C: Patients with PADs should be recommended to wash their mouth with water, after having any sweet food or drink. Based on Stephan curve [Citation9], they should be informed that there is a 10 minutes time limitation for rinsing the mouth after having sweet drink or food. Since 10 minutes after having sweet food or drink, salivary pH reduces to critical point.
Recommendation D: Patients with PADs could be recommended to chew gum with xylitol sugar most often (more than three times per day) [Citation10]. Xylitol precludes bacterial adherence to tooth surfaces and has a direct inhibitory effect on Streptococcus mutans. Some studies have revealed that the chewing process could enhance the caries inhibitory role of xylitol gum [Citation11–Citation14]. Chewing gum aids in the health of the teeth by mechanical cleansing of the tooth surfaces and also provides an attractive self-cleansing approach by inducing the secretion of saliva, developing more effective individualized preventive strategy.
Recommendation E: Patients with PADs should be recommended to follow a lifestyle approach to reduce intake of sweet drinks and foods.
Recommendations for future research
Although the infectious origin of dental caries provides a plausible explanation for the immunodeficiency–dental caries relationship, further research focus should be laid on unraveling the precise correlation and the mechanisms linking them and how patients with PADs should be managed to reduce the risk for dental caries and/or oral ulcers. Do periodontal and dental therapeutic interventions reduce the rate of gastrointestinal and respiratory infection in patients with PADs?
Financial & competing interest’s disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Additional information
Notes on contributors
Hila Yousefi
Asghar Aghamohammadi
Nima Rezaei
References
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