Skip to main content
Top
Published in: International Journal of Colorectal Disease 10/2018

01-10-2018 | Original Article

Increased risk of periodontitis among patients with Crohn’s disease: a population-based matched-cohort study

Authors: Ying-Chen Chi, Jiunn-Liang Chen, Li-Hsuan Wang, Koyin Chang, Chen-Long Wu, Shu-Yi Lin, Joseph Jordan Keller, Chyi-Huey Bai

Published in: International Journal of Colorectal Disease | Issue 10/2018

Login to get access

Abstract

Background

Periodontitis is a frequently cited extraintestinal manifestation of Crohn’s disease (CD). Despite a plethora of investigations and a recent meta-analysis linking CD and periodontitis, no study has estimated the risk of periodontitis among CD patients with respect to a comparison group nor has any investigation analyzed the effect of CD-specific medications on the risk of periodontitis. The present cohort study compared CD patients and matched subjects without a history of inflammatory bowel disease (IBD) to estimate the effect of CD and CD-specific pharmaceutical prescriptions on the risk of developing periodontitis by leveraging a population-based dataset in Taiwan.

Methods

We sourced 6657 CD patients and 26,628 comparison subjects without a history of IBD from the Taiwan National Health Insurance Database. Cox proportional hazards regressions were used to estimate the risk of subsequent periodontitis by CD status and pharmaceutical prescription during the follow-up period.

Results

After adjusting for socioeconomic status (SES), urbanicity, selected medical co-morbidities, and CD-specific pharmaceutical prescriptions, the hazard ratio (HR) for subsequent periodontitis among patients with CD was 1.36 (95% CI = 1.25–1.48) that of comparison subjects. There was not a significant difference in risk between genders or across ages. Steroids (95% CI = 0.66–0.77) appeared to confer a protective effect and Aspirin, Plavix, and Licodin were marginally protective (95% CI = 0.76–0.95).

Conclusion

This is the first study to report an increased HR for subsequent periodontitis among CD patients when compared to matched comparison subjects without IBD. The protective effect of some pharmaceuticals may suggest that treatment of CD protects against periodontitis.
Literature
1.
go back to reference Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EI, Panaccione R, Ghosh S, Barkema HW, Kaplan GG (2012) Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142:46–54.e42CrossRefPubMed Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EI, Panaccione R, Ghosh S, Barkema HW, Kaplan GG (2012) Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142:46–54.e42CrossRefPubMed
2.
go back to reference Knowles SR, Graff LA, Wilding H et al (2018) Qu ality of life in inflammatory bowel disease: a systematic review and meta-analyses—part I. Inflamm Bowel Dis 19(24):742–751CrossRef Knowles SR, Graff LA, Wilding H et al (2018) Qu ality of life in inflammatory bowel disease: a systematic review and meta-analyses—part I. Inflamm Bowel Dis 19(24):742–751CrossRef
3.
go back to reference Everhart JE, Ruhl CE (2009) Burden of digestive diseases in the United States. Part I: overall and upper gastrointestinal diseases. Gastroenterology 136:376–386CrossRefPubMed Everhart JE, Ruhl CE (2009) Burden of digestive diseases in the United States. Part I: overall and upper gastrointestinal diseases. Gastroenterology 136:376–386CrossRefPubMed
4.
go back to reference Jostins L, Ripke S, Weersma RK et al (2012) Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature 491:119–124CrossRefPubMedPubMedCentral Jostins L, Ripke S, Weersma RK et al (2012) Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature 491:119–124CrossRefPubMedPubMedCentral
5.
go back to reference Chandan JS, Thomas T et al (2017) The impact of inflammatory bowel disease on oral health. Br Dent J 222:549–553CrossRefPubMed Chandan JS, Thomas T et al (2017) The impact of inflammatory bowel disease on oral health. Br Dent J 222:549–553CrossRefPubMed
6.
go back to reference Williams H, Walker D, Orchard TR (2008) Extraintestinal manifestations of inflammatory bowel disease. Curr Gastroenterol Rep 10:597–605CrossRefPubMed Williams H, Walker D, Orchard TR (2008) Extraintestinal manifestations of inflammatory bowel disease. Curr Gastroenterol Rep 10:597–605CrossRefPubMed
7.
go back to reference Papageorgiou SN, Hagner M, Nogueira AV et al (2017) Inflammatory bowel disease and oral health: systematic review and a meta-analysis. J Clin Periodontol 44:382–393CrossRefPubMed Papageorgiou SN, Hagner M, Nogueira AV et al (2017) Inflammatory bowel disease and oral health: systematic review and a meta-analysis. J Clin Periodontol 44:382–393CrossRefPubMed
8.
go back to reference Brandtzaeg P (2001) Inflammatory bowel disease: clinics and pathology. Do inflammatory bowel disease and periodontal disease have similar immunopathogeneses? Acta Odontol Scand 59:235–243CrossRefPubMed Brandtzaeg P (2001) Inflammatory bowel disease: clinics and pathology. Do inflammatory bowel disease and periodontal disease have similar immunopathogeneses? Acta Odontol Scand 59:235–243CrossRefPubMed
9.
go back to reference Kinane DF, Bartold PM (2007) Clinical relevance of the host responses of periodontitis. Periodontology 2000(43):278–293CrossRef Kinane DF, Bartold PM (2007) Clinical relevance of the host responses of periodontitis. Periodontology 2000(43):278–293CrossRef
10.
go back to reference Indriolo A, Greco S, Ravelli P, Fagiuoli S (2011) What can we learn about biofilm/host interactions from the study of inflammatory bowel disease. J Clin Periodontol 38:36–43CrossRefPubMed Indriolo A, Greco S, Ravelli P, Fagiuoli S (2011) What can we learn about biofilm/host interactions from the study of inflammatory bowel disease. J Clin Periodontol 38:36–43CrossRefPubMed
11.
go back to reference Pischon N, Pischon T, Gülmez E et al (2010) Periodontal disease in patients with ankylosing spondylitis. Ann Rheum Dis 69:34–38CrossRefPubMed Pischon N, Pischon T, Gülmez E et al (2010) Periodontal disease in patients with ankylosing spondylitis. Ann Rheum Dis 69:34–38CrossRefPubMed
12.
go back to reference Preus HR, Khanifam P, Kolltveit K et al (2010) Periodontitis in psoriasis patients. A blinded, case-controlled study. Acta Odontol Scand 68:165–170CrossRefPubMed Preus HR, Khanifam P, Kolltveit K et al (2010) Periodontitis in psoriasis patients. A blinded, case-controlled study. Acta Odontol Scand 68:165–170CrossRefPubMed
13.
go back to reference Lira-Junior R, Figueredo CM (2016) Periodontal and inflammatory bowel diseases: is there evidence of complex pathogenic interactions? World J Gastroenterol 22:7963–7972CrossRefPubMedPubMedCentral Lira-Junior R, Figueredo CM (2016) Periodontal and inflammatory bowel diseases: is there evidence of complex pathogenic interactions? World J Gastroenterol 22:7963–7972CrossRefPubMedPubMedCentral
14.
16.
go back to reference Vavricka SR, Manser CN, Hediger S et al (2013) Periodontitis and gingivitis in inflammatory bowel disease: a case-control study. Inflamm Bowel Dis 19:2768–2777CrossRefPubMed Vavricka SR, Manser CN, Hediger S et al (2013) Periodontitis and gingivitis in inflammatory bowel disease: a case-control study. Inflamm Bowel Dis 19:2768–2777CrossRefPubMed
17.
go back to reference Keller JJ, Wang J, Hwang YL, Chou CC, Wang LH, Hsu JL, Bai CH, Chiou HY (2015) Increased risk of stroke among patients with Crohn’s disease: a population-based matched cohort study. Int J Color Dis 30:645–653CrossRef Keller JJ, Wang J, Hwang YL, Chou CC, Wang LH, Hsu JL, Bai CH, Chiou HY (2015) Increased risk of stroke among patients with Crohn’s disease: a population-based matched cohort study. Int J Color Dis 30:645–653CrossRef
18.
go back to reference Keller JJ, Wang J, Huang YL, Chou CC, Wang LH, Hsu JL, Bai CH, Chiou HY (2014) Increased risk of stroke among patients with ulcerative colitis: a population-based matched cohort study. Int J Colorectal Dis Jul 29:805–812CrossRef Keller JJ, Wang J, Huang YL, Chou CC, Wang LH, Hsu JL, Bai CH, Chiou HY (2014) Increased risk of stroke among patients with ulcerative colitis: a population-based matched cohort study. Int J Colorectal Dis Jul 29:805–812CrossRef
19.
go back to reference Yu HC, Su NY, Huang JY, Lee SS, Chang YC (2017) Trends in the prevalence of periodontitis in Taiwan from 1997 to 2013: a nationwide population-based retrospective study. Medicine (Baltimore) 96:e8585CrossRef Yu HC, Su NY, Huang JY, Lee SS, Chang YC (2017) Trends in the prevalence of periodontitis in Taiwan from 1997 to 2013: a nationwide population-based retrospective study. Medicine (Baltimore) 96:e8585CrossRef
21.
go back to reference Ojha J, Cohen DM, Islam NM, Stewart CM, Katz J, Bhattacharyya I (2007) Gingival involvement in Crohn disease. J Am Dent Assoc 138:1574–1181 quiz 1574-181CrossRefPubMed Ojha J, Cohen DM, Islam NM, Stewart CM, Katz J, Bhattacharyya I (2007) Gingival involvement in Crohn disease. J Am Dent Assoc 138:1574–1181 quiz 1574-181CrossRefPubMed
22.
go back to reference Brito F, de Barros FC, Zaltman C et al (2008) Prevalence of periodontitis and DMFT index in patients with Crohn’s disease and ulcerative colitis. J Clin Periodontol 35:555–560CrossRefPubMed Brito F, de Barros FC, Zaltman C et al (2008) Prevalence of periodontitis and DMFT index in patients with Crohn’s disease and ulcerative colitis. J Clin Periodontol 35:555–560CrossRefPubMed
23.
go back to reference Ruiz-Roca JA, Berini-Aytés L, Gay-Escoda C, Pyostomatitis vegetans (2005) Report of two cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99:447–454CrossRefPubMed Ruiz-Roca JA, Berini-Aytés L, Gay-Escoda C, Pyostomatitis vegetans (2005) Report of two cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99:447–454CrossRefPubMed
24.
go back to reference Preshaw PM, Alba AL, Herrera D et al (2012) Periodontitis and diabetes: a two-way relationship. Diabetologia 55:21–31CrossRefPubMed Preshaw PM, Alba AL, Herrera D et al (2012) Periodontitis and diabetes: a two-way relationship. Diabetologia 55:21–31CrossRefPubMed
25.
go back to reference Habashneh RA, Khader YS, Alhumouz MK, Jadallah K, Ajlouni Y (2012) The association between inflammatory bowel disease and periodontitis among Jordanians: a 27 case-control study. J Periodontal Res 47:293–298CrossRefPubMed Habashneh RA, Khader YS, Alhumouz MK, Jadallah K, Ajlouni Y (2012) The association between inflammatory bowel disease and periodontitis among Jordanians: a 27 case-control study. J Periodontal Res 47:293–298CrossRefPubMed
26.
go back to reference Menegat JS, Lira-Junior R, Siqueira MA et al (2016) Cytokine expression in gingival and intestinal tissues of patients with periodontitis and inflammatory bowel disease: an exploratory study. Arch Oral Biol 66:141–146CrossRefPubMed Menegat JS, Lira-Junior R, Siqueira MA et al (2016) Cytokine expression in gingival and intestinal tissues of patients with periodontitis and inflammatory bowel disease: an exploratory study. Arch Oral Biol 66:141–146CrossRefPubMed
27.
go back to reference Figueredo CM, Brito F, Barros FC, Menegat JSB, Pedreira RR, Fischer RG, Gustafsson A (2011) Expression of cytokines in the gingival crevicular fluid and serum from patients with inflammatory bowel disease and untreated chronic periodontitis. J Periodontal Res 46:141–146CrossRefPubMed Figueredo CM, Brito F, Barros FC, Menegat JSB, Pedreira RR, Fischer RG, Gustafsson A (2011) Expression of cytokines in the gingival crevicular fluid and serum from patients with inflammatory bowel disease and untreated chronic periodontitis. J Periodontal Res 46:141–146CrossRefPubMed
28.
go back to reference Gao H, Hou J, Meng H, Zhang X, Zheng Y, Peng L (2017) Proinflammatory effects and mechanisms of calprotectin on human gingival fibroblasts. J Periodontal Res 52:975–983CrossRefPubMed Gao H, Hou J, Meng H, Zhang X, Zheng Y, Peng L (2017) Proinflammatory effects and mechanisms of calprotectin on human gingival fibroblasts. J Periodontal Res 52:975–983CrossRefPubMed
29.
go back to reference Schmidt J, Weigert M, Leuschner C et al (2018) Active Matrixmetalloproteinase-8 and periodontal bacteria—interlink between periodontitis and inflammatory bowel disease? J Periodontol [Epub ahead of print] Schmidt J, Weigert M, Leuschner C et al (2018) Active Matrixmetalloproteinase-8 and periodontal bacteria—interlink between periodontitis and inflammatory bowel disease? J Periodontol [Epub ahead of print]
30.
31.
go back to reference Boylan MR, Khalili H, Huang ES, Michaud DS, Izard J, Joshipura KJ, Chan AT (2014) A prospective study of periodontal disease and risk of gastric and duodenal ulcer in male health professionals. Clinical and Translational Gastroenterology 5(2):e49CrossRefPubMedPubMedCentral Boylan MR, Khalili H, Huang ES, Michaud DS, Izard J, Joshipura KJ, Chan AT (2014) A prospective study of periodontal disease and risk of gastric and duodenal ulcer in male health professionals. Clinical and Translational Gastroenterology 5(2):e49CrossRefPubMedPubMedCentral
32.
go back to reference Kaneto C, Toyokawa S, Inoue K, Inoue M, Senba T, Suyama Y, Miyoshi Y, Kobayashi Y (2012) Association between periodontal disease and peptic ulcers among Japanese workers: MY health up study. Glob J Health Sci 4:42–49CrossRefPubMedPubMedCentral Kaneto C, Toyokawa S, Inoue K, Inoue M, Senba T, Suyama Y, Miyoshi Y, Kobayashi Y (2012) Association between periodontal disease and peptic ulcers among Japanese workers: MY health up study. Glob J Health Sci 4:42–49CrossRefPubMedPubMedCentral
33.
go back to reference Liu Y, Lin H, Bai Y, Qin X, Zheng X, Sun Y, Zhang Y (2008) Study on the relationship between Helicobacter pylori in the dental plaque and the occurrence of dental caries or oral hygiene index. Helicobacter 13:256–260CrossRefPubMed Liu Y, Lin H, Bai Y, Qin X, Zheng X, Sun Y, Zhang Y (2008) Study on the relationship between Helicobacter pylori in the dental plaque and the occurrence of dental caries or oral hygiene index. Helicobacter 13:256–260CrossRefPubMed
34.
go back to reference Riggio MP, Lennon A (1999) Identification by PCR of Helicobacter pylori in subgingival plaque of adult periodontitis patients. J Med Microbiol 48:317–322CrossRefPubMed Riggio MP, Lennon A (1999) Identification by PCR of Helicobacter pylori in subgingival plaque of adult periodontitis patients. J Med Microbiol 48:317–322CrossRefPubMed
35.
go back to reference Suzuki N, Yoneda M, Naito T, Iwamoto T, Masuo Y, Yamada K, Hisama K, Okada I, Hirofuji T (2008) Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis. J Med Microbiol 57:1553–1559CrossRefPubMed Suzuki N, Yoneda M, Naito T, Iwamoto T, Masuo Y, Yamada K, Hisama K, Okada I, Hirofuji T (2008) Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis. J Med Microbiol 57:1553–1559CrossRefPubMed
36.
go back to reference Al Asqah M, Al Hamoudi N, Anil S et al (2009) Is the presence of Helicobacter pylori in dental plaque of patients with chronic periodontitis a risk factor for gastric infection. Can J Gastroenterol 23:177–179CrossRefPubMedPubMedCentral Al Asqah M, Al Hamoudi N, Anil S et al (2009) Is the presence of Helicobacter pylori in dental plaque of patients with chronic periodontitis a risk factor for gastric infection. Can J Gastroenterol 23:177–179CrossRefPubMedPubMedCentral
37.
go back to reference Chen J, He X, Wu L et al (2011) The correlation between oral colonization of Helicobacter pylori and gastrointestinal disease. Hua Xi Kou Qiang Yi XueZaZhi 29:351–354 Chen J, He X, Wu L et al (2011) The correlation between oral colonization of Helicobacter pylori and gastrointestinal disease. Hua Xi Kou Qiang Yi XueZaZhi 29:351–354
38.
go back to reference Liu Y, Yue H, Li A, Wang J, Jiang B, Zhang Y, Bai Y (2009) An epidemiologic study on the correlation between oral Helicobacter pylori and gastric H. pylori. Curr Microbiol 58:449–453CrossRefPubMed Liu Y, Yue H, Li A, Wang J, Jiang B, Zhang Y, Bai Y (2009) An epidemiologic study on the correlation between oral Helicobacter pylori and gastric H. pylori. Curr Microbiol 58:449–453CrossRefPubMed
39.
go back to reference Gao J, Li Y, Wang Q, Qi C, Zhu S (2011) Correlation between distribution of Helicobacter pylori in oral cavity and chronic stomach conditions. J Huazhong Univ Sci Technol Med Sci 31:409–412CrossRef Gao J, Li Y, Wang Q, Qi C, Zhu S (2011) Correlation between distribution of Helicobacter pylori in oral cavity and chronic stomach conditions. J Huazhong Univ Sci Technol Med Sci 31:409–412CrossRef
40.
go back to reference Zaric S, Bojic B, Lj J et al (2009) Periodontal therapy improves gastric Helicobacter pylori eradication. J Dent Res 88:946–950CrossRefPubMed Zaric S, Bojic B, Lj J et al (2009) Periodontal therapy improves gastric Helicobacter pylori eradication. J Dent Res 88:946–950CrossRefPubMed
Metadata
Title
Increased risk of periodontitis among patients with Crohn’s disease: a population-based matched-cohort study
Authors
Ying-Chen Chi
Jiunn-Liang Chen
Li-Hsuan Wang
Koyin Chang
Chen-Long Wu
Shu-Yi Lin
Joseph Jordan Keller
Chyi-Huey Bai
Publication date
01-10-2018
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 10/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-018-3117-4

Other articles of this Issue 10/2018

International Journal of Colorectal Disease 10/2018 Go to the issue