Inflammatory dermatological, rheumatological conditions associated with poor oral health

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

Study investigators, led by Yvonne Kiernan, BDS NUI, MFDS RCSEdin, prospectively assessed the oral health and quality of life of patients with various chronic inflammatory dermatological/rheumatological diseases treated with systemic/biological therapy.

“Oral health is essential to overall health and QoL, and the impact of poor oral health on health and QoL is increasingly recognized,” they wrote. “Poor oral health has been associated with adverse pregnancy outcomes, cardiovascular disease, pulmonary disease and diabetes, although causal relationships have yet to be clearly established.”

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


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

Patients then received an oral health assessment, which included a 16-item questionnaire dealing with self-reported 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, which was performed using internationally standardized templates from the World Health Organization (WHO), was performed by a dentist in each patient’s respective dermatology or rheumatology clinic as an adjunct to their standard clinical care. The examination included dental findings and assessed periodontal health and the presence of oral mucosal lesions.


Kiernan and colleagues found a statistically significant difference in the prevalence of questionnaire-reported dry mouth between patients with inflammatory dermatologic/rheumatologic disease and controls (82% vs 20%, respectively; P = .001).

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

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

Oral health examination revealed that patients with inflammatory disease had an average of 7.7 missing teeth, while patients in the control group had an average of 4.4 teeth (P = .029). The first had an average of 5.6 filled teeth, and the second had an average of 7.6 filled teeth (P = .008).

And finally, patients with dermatologic/rheumatologic disease had a significantly greater loss of clinical connectivity (a marker for periodontal disease) in all sextants compared to 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 common treatment prescribed for these patients, as were etanercept (28%) and methotrexate (16%).

“This study demonstrates an association between oral health and oral health-related quality of life in patients with severe inflammatory skin and joint disease treated with systemic and biologic therapy,” the investigators wrote.

“Dermatologists should receive specific oral health training to optimize oral health management in our patients with severe inflammatory disease,” they concluded.

The study, “Oral health in patients with severe inflammatory dermatologic and rheumatologic disease,” was published online at Skin health and diseases.

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