Periodontal and dental health in inflammatory bowel diseases: a systematic review

ABSTRACT

Introduction: An increased risk of dental caries and periodontal diseases has been reported for inflammatory bowel disease (IBD) patients and are challenging conditions to manage.

Areas covered: The authors searched international databases to find all studies assessing dental/periodontal outcomes in patients with IBD and other immune-mediated inflammatory disease (IMID), as well as the association between IMID medications and dental/periodontal status.

Expert opinion: IBD are associated with a higher risk of both periodontitis and caries. Some evidence from rheumatoid arthritis suggests that periodontitis may be associated with a lower response to anti-TNF. There is no reliable evidence that IBD patients may be at greater risk of complications during routine dental care. On the basis of current data, guidelines can be proposed for the dental management focusing on the detection and eradication of infectious foci prior to the implementation of immunosuppressants/biologics and modified dental treatment protocol for invasive dental procedures that includes antibiotic prophylaxis.

KEYWORDS:

• Crohn’s disease
• ulcerative colitis
• caries
• periodontal diseases
• dental

Article highlights

• IBD patients have an increased risk of developing periodontitis due to modifications of their oral microbiota and common inflammatory processes.

• Evidence is very limited for IBD but some evidence from rheumatoid arthritis suggests that periodontitis, especially untreated periodontitis, may be associated with a lower response to anti-TNF therapy, although the underlying mechanisms are still unknown.

• There is no reliable evidence that IBD patients may be at greater risk of complications during routine dental care than the general population but there is a general acceptance that patients on steroids and other immunosuppressive therapies have an increased risk of infections but there is no clear evidence to support an increased incidence of complications associated with dental care.

• On the basis of current scientific data, guidelines can be proposed for the dental management focusing on three issues: detection and eradication of dental infectious foci prior to the implementation of immunosuppressants/biologics and modified dental treatment protocol for invasive dental procedures that includes antibiotic prophylaxis.

Declaration of interest

M Fumery has received consulting and/or lecture fees from Abbvie, Ferring, MSD, Janssen, Takeda, Tillots, Pfizer, Gilead, Celgene, Celltrion, Galapagos, Biogen, and Boehringer. C Yzet has received speaker fees from Abbvie and Janssen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.