Inflammatory dermatologic, rheumatologic conditions associated with poor oral health

Patients with severe inflammatory dermatologic and rheumatologic conditions typically suffer from poor oral health and oral health-related quality of life, a new study finds.

Led by study investigators, Yvonne Kiernan, BDS NUI, MFDS RCSEdin, prospectively evaluated 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 for general health and QoL, and the impact of poor oral health on health and QoL is increasingly recognized,” they wrote. “Poor oral health is associated with adverse pregnancy outcomes, cardiovascular disease, pulmonary disease, and diabetes, although a causal relationship has not yet been clearly established.”

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

Study

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

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

The physical examination portion of the assessment, using internationally standardized templates from the World Health Organization (WHO), was conducted by a dentist at each patient’s respective dermatology or rheumatology clinic as a supplement to their standard clinical care. Examination included dental findings and assessed periodontal health and the presence of oral mucosal lesions.

Conclusions

Kiernan and colleagues found a statistically significant difference in the prevalence of dry mouth, as reported on a questionnaire, between dermatologic/rheumatologic inflammatory diseases and a control group (82% vs. 20%, respectively; P =.001).

Furthermore, patients with inflammatory disease were 18 times more likely to have dry mouth (odds ratio [OR], 18.2; 95% CI, 6.7–49.6); Most of these patients, 57%, reported dry mouth ‘very often’.

Furthermore, only 60% of patients with an inflammatory dermatological or rheumatological disease diagnosis brushed their teeth twice a day – compared to 80% of the control group (P = 037).

An oral health examination showed an average of 7.7 missing teeth in inflammatory disease patients, compared to an average of 4.4 missing teeth in control group patients.P = 029). The former averaged 5.6 filled teeth, and the latter averaged 7.6 filled teeth (P =.008).

And finally, patients with dermatological/rheumatologic disease had significantly greater loss of clinical attachment (a marker for periodontal disease) in all sextants than 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 demonstrates the relationship between oral health and oral health-related quality of life in patients with severe inflammatory skin and joint disease treated with systemic and biological therapy,” the researchers wrote.

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

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

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