Strong link found between tooth loss and inflammatory bowel disease

Inflammatory bowel disease is linked to an increased risk of periodontitis, i.e. periodontal disease. This is according to new publications from a European research project that explored the link between the two diseases.

How does inflammatory bowel disease affect oral health? And how does the mouth affect our gut? It is already well known that periodontitis can be linked to diabetes and cardiovascular disease. But the link between periodontitis and inflammatory bowel disease (IBD) has not so far been explored on a large scale in a European context.

Now, two publications from a large research project involving Danish patients show that there is a strong link between the diseases. 

– The study shows that patients with IBD have more periodontitis and fewer teeth compared to people without IBD. We also see that patients with both IBD and periodontitis have worsened bowel disease with higher activity than patients with IBD who have a healthy mouth, says Andreas Stavropoulos, professor, and senior dentist at the Faculty of Dentistry at Malmö University, and one of the researchers behind the study.

– Both diseases can be described as creating a strong overreaction of the immune system to a bacterial trigger. You could say that the immune system is attacking your own body.

Oral health more affected in patients with Crohn's

In the study, around 1,100 patients answered questions in an online survey. Around half of the participants had Crohn's disease and the other half had ulcerative colitis. The study also included about 3,400 people without IBD, who were randomly selected but also matched for certain criteria to the patients with inflammatory bowel disease.

– The study showed not only that patients with inflammatory bowel disease had poorer oral health than people without IBD, but also that the oral health of patients with Crohn's disease was more affected. They lost more teeth than patients with ulcerative colitis, says Kristina Bertl, lecturer and dentist at the Faculty of Dentistry.

"Patients with IBD should be followed up better"

Through contacts with the Danish crohn's disease and ulcerative colitis patient association Colitis-Crohn Foreningen (CCF), the researchers were able to find participants for the study. Within the association, it was well known that many patients had recurring problems with their teeth and infections and ulcers in their mouths. At the same time, they felt that this was not really addressed in their contact with the health care system.

– The Association was therefore very keen to help. The survey confirms this picture. Participants reported that they were not informed about the possible link between the two diseases, and in general that problems with the teeth and mouth were under-prioritized, says Andreas Stavropoulos.

Periodontitis initially causes relatively mild symptoms, such as bleeding gums when brushing, but can lead to tooth loss if not treated in time.

– Overall, the studies show that the oral health of patients with IBD should be better monitored to prevent the development of periodontitis and tooth loss in this patient group, concludes Kristina Bertl.