Is there an increased risks of developing periodontal diseases when suffering from psoriasis? 28 September 2016
Is there an increased risk of developing periodontal diseases when suffering from psoriasis?
Psoriasis is a frequent, chronic erythemato-squamous dermatitis that affects around 2% of the population and its cause is unknown. This autoimmune disease with an inflammatory component is mainly reflected in the skin. Its pathogenic effects are systemic. Usually a benign disease, it can be serious when dealing with psoriatic arthritis or pustular psoriasis.
Oral symptoms have been described for many years, such as the geographic tongue, cheilitis, and, as early as 1992, Yamada1 discussed a possible link between periodontitis and psoriasis.
There are several similarities between periodontitis and psoriasis - they are chronic inflammatory and multi-causal diseases, but periodontal diseases have a bacterial aetiology and are not autoimmune, whereas psoriasis is an autoimmune disease of unknown cause.
There are also several comorbidities such as stress, alcohol, tobacco, cardiovascular diseases, diabetes, etc.
Is there a link between periodontal diseases and psoriasis?
Several studies have focused on possible associations between periodontal diseases and psoriasis. Preus (2010) found that 78% of psoriatic patients had more bone and tooth loss than their controlled counterparts; Lazaridou (2012) found that psoriatic patients had 3 times more risks of developing a severe periodontitis (OR = 3.29); Sharma (2014) found higher values in the probing depth and the periodontal attachment level, and that periodontal status was associated with severity of psoriasis; Skudutyte-Rysstad (2014) concluded that periodontitis and radiographic bone loss is more common among patients with moderate or severe psoriasis compared with the general population. On the other hand, Keller (2012) found that the 1.88 patients with chronic periodontitis per 1000 developed a psoriasis per year and 1.22/1000 with comparison patients and that a patient with a chronic periodontitis had a hazard ratio of 1.52 of psoriasis with comparison patients, and that this hazard ratio lowered to 1.26 after surgical treatment. Nakib (2013) found that the risk of developing psoriasis of patients with periodontitis was of 1.4 and that 4.7% of psoriasis cases are potentially caused by a periodontitis.
However, Fadel’s study (2013) did not find any association between psoriasis and periodontitis.
Several mechanisms were suggested to explain the possible link between periodontitis and psoriasis:
- Periodontal bacteria and their toxins could stimulate psoriasis through a systemic inflammatory response.
- Psoriatic patients and patients with periodontitis are characterised by an exaggerated immune response. Dendritic cells are blamed and the activity of lymphocytes B and T is increased
- The deregulation of toll-like receptors, especially TLR2 with increased responses
- The IL 17 inflammatory cytokine is elevated both in the psoriatic skin and in the inflammatory periodontium.
- The CRP rises in cases of periodontitis and psoriasis.
Thus, it is possible to think that an association between periodontitis and psoriasis does exist, but we must remain cautious as there are few studies available. Multidisciplinary care of the patient with psoriasis is desired.
The author:
Ons Zouiten
Doctor of Dental Surgery, Paris University
Bibliography
1 - Yamada J, Amar S, Petrungaro P. Psoriasis-Associated Periodontitis: A case report. J Periodontal 1992;63:854-857
2 - Preus HR, Khanifam P, Kolltveit K, Mork C, Gjermo P. Periodontitis in psoriasis patients. A blinded, case-controlled study. Acta Odontol Scand 2010;68:165-170.
3 - Lazaridou E1, Tsikrikoni A, Fotiadou C, Kyrmanidou E, Vakirlis E, Giannopoulou C, Apalla Z, Ioannides D. Association of chronic plaque psoriasis and severe periodontitis: a hospital based case-control study. J Eur Acad Dermatol Venereol. 2013 Aug;27(8):967-72.
4 - Sharma A, Raman A, Pradeep AR. Association of chronic periodontitis and psoriasis: periodontal status with severity of psoriasis. Oral Dis. 2015 Apr;21(3):314-319.
5 - Skudutyte-Rysstad R, Slevolden EM, Hansen BF, Sandvik L, Preus HR. Association between moderate to severe psoriasis and periodontitis in a Scandinavian population. BMC Oral Health. 2014 Nov 26;14:139.
6 - Keller JJ1, Lin HC. The effects of chronic periodontitis and its treatment on the subsequent risk of psoriasis. Br J Dermatol. 2012 Dec;167(6):1338-44
7 - Nakib S1, Han J, Li T, Joshipura K, Qureshi AA. Periodontal disease and risk of psoriasis among nurses in the United States. Acta Odontol Scand. 2013 Nov;71(6):1423-9.
8 - Fadel HT1, Flytström I, Calander AM, Bergbrant IM, Heijl L, Birkhed D. Profiles of dental caries and periodontal disease in individuals with or without psoriasis. J Periodontol. 2013 Apr;84(4):477-85.
9 - Zouiten O, Gosset M. Existe-t-il une association entre le psoriasis et les parodontites? Une revue de la littérature. AOS 2014;269:32-36
