Profiles of dental caries and periodontal disease in individuals with or without psoriasis

Direct impact of psoriasis on gingival crevicular fluid levels of VEGF-A in periodontitis patients: a mediation analysis

Introduction

Emerging evidence suggests that psoriasis and periodontitis are linked via systemic inflammation. However, the role of angiogenesis as an additional connecting mechanism between these diseases remains unclear.

Methods

This case control study explored the effect of psoriasis on the gingival crevicular fluid (GCF) levels of vascular endothelial growth factor A (VEGF-A) in patients with different stages of periodontitis. Thirty-one patients with psoriasis (P) and thirty healthy controls (C) underwent physical and intraoral evaluations, with diagnoses confirmed by dermatologists and periodontists. GCF VEGF-A was measured using a multiplex-bead immunoassay. Statistical analyses included Fisher exact tests, Student's T-tests, linear regression models, and mediation analyses.

Results

Psoriasis patients had significantly lower GCF VEGF-A levels compared to controls (p=0.008). Psoriasis was negatively associated with GCF VEGF-A (p=0.006), while severe periodontitis was positively associated with GCF VEGF-A levels, regardless of tobacco use (p=0.027). Further analyses revealed that severe periodontitis significantly increased GCF VEGF-A levels only in the C group (p=0.038), but not in psoriasis patients (p>0.610). Mediation analyses confirmed a significant direct and total effect of psoriasis on GCF VEGF-A (p>0.002), with no significant indirect effect through periodontitis (p=0.699).

Discussion

Psoriasis and severe periodontitis are associated with GCF levels of VEGF-A in opposite and independent ways. In subjects with psoriasis, the impact of the dermatosis is direct with no mediation from periodontitis.

Association of psoriasis and periodontitis in the north Indian population

Background

Psoriasis is a chronic, non-communicable condition of the skin with an immune-mediated etiology. Periodontitis is a chronic inflammatory disease of the tooth-supporting tissues and is now recognized as an established risk factor for various systemic diseases. The present observational study aims to assess the prevalence of periodontitis and its related indices in individuals with psoriasis and to compare them with individuals without psoriasis. A cross-sectional case-control study was performed in a hospital setting, including 200 diagnosed cases of psoriasis and 200 age- and sex-matched healthy controls.

Methods

The case group included patients diagnosed with psoriasis (defined as ICD-10 L40.0-L40.9) by a trained dermatologist. Controls included age- and sex-matched healthy individuals. After history-taking, a detailed dermatological and periodontal examination was done for all the enrolled subjects. The results were statistically analyzed using SPSS software.

Results

The study group had a significantly higher mean GI, PI, PPD and CAL in comparison to the controls. Psoriasis patients had significantly greater scores for GI and PI (1.68 ± 0.61 and 1.57 ± 0.54, respectively) as compared to controls (1.48 ± 0.56 and 1.39 ± 0.60, respectively). Periodontitis was also found to be more prevalent among the cases. Stage II and Stage III periodontitis were found in 41.0 % of cases and 30.5 % of controls, while 12.5 % of cases and 6.0 % of controls had stage IV periodontitis. This difference was statistically significant.

Conclusion

An association between psoriasis and periodontitis was found in the present study, as the individuals with psoriasis had a higher severity and prevalence of periodontitis.

The association between periodontitis and the impact of oral health on the quality of life of individuals with psoriasis and psoriatic arthritis

OBJECTIVE

To evaluate the association between psoriasis (PSO), psoriatic arthritis (PsA) and periodontitis (PE), and the Oral Health-Related Quality of Life (OHRQoL) impacts on individuals with psoriatic disease's daily activities compared to the non-psoriatic ones.

MATERIALS & METHODS

296 individuals with psoriatic disease (PSO n = 210, APS n = 86) (cases) and 359 without these diseases (controls) were included. Complete periodontal examinations and collection of variables of interest were performed. The Brazilian version of the Oral Impacts on Daily Performance (OIDP) instrument was applied.

RESULTS

The prevalence of PE was higher in PsA (57.0%; OR = 2.67 95%CI 1.65-4.32; p<0.001) than in PSO (34.3%; OR = 1.05 95% CI 0.73-1.51; p<0.001) compared to controls (33.1%). Both PsA and PSO groups showed more sites and teeth with 4-6mm probing depth (PD) and had higher OIDP scores than controls (p<0.001), thus indicating worse self-reported quality of life. PE, PSO+PE and consumption of alcohol/anxiolytics significantly influenced OHRQoL (p<0.05). The influence of periodontal parameters on OHRQoL was observed for the presence of PE; PD >6 mm; clinical attachment level >6 mm; higher plaque index, % sites and teeth with bleeding on probing (p<0.05).

CONCLUSION

Negative impacts of PE on the OHRQoL were demonstrated. The ones having PSO and especially PsA and PE presented significantly worse indicators.

Increased dental comorbidities in patients with psoriasis: a nationwide population-based cohort study in Korea

BACKGROUND

Limited data are available regarding the association between psoriasis and common dental conditions.

OBJECTIVES

To investigate the risk of potential dental comorbidities in patients with psoriasis.

METHODS

We conducted a nationwide population-based cohort study to analyse the claims data of patients with psoriasis (n = 15 165) and age- and sex-matched controls (n = 75 825). The incidence risk of the following potential dental conditions was analysed: dental caries, pulp and periapical disease, periodontal disease, gingival changes and tooth loss.

RESULTS

After adjusting for potential cofactors, the adjusted hazard ratios (aHRs) of dental caries [1.105; 95% confidence interval (CI) 1.078-1.132], pulp and periapical disease (1.07; 95% CI 1.044-1.096) and periodontal disease (1.108; 95% CI 1.088-1.129) were significantly higher than those in the control cohort (P < 0.001). However, among the subset of patients with psoriasis who received systemic antipsoriatic treatment (n = 4275), the aHR risk of all potential dental comorbidities was not significantly higher from that of the control cohort.

CONCLUSIONS

Patients with psoriasis have an increased risk of dental comorbidities, and systemic antipsoriatic treatment may help mitigate this increased risk.

Periodontal disease does not increase the risk of subsequent psoriasis

Previous studies suggested that chronic periodontitis may be a risk factor for psoriasis. However, no study has confirmed this relationship for all stages of periodontal disease (gingivitis and periodontitis). This nationwide population-based retrospective cohort study aimed to investigate whether periodontal disease is an independent risk factor for the development of subsequent psoriasis. Patients aged ≥ 20 years who underwent both medical and oral checkups from the National Health Screening Program between 2002 and 2007 were selected from a customized database provided by the National Health Insurance Service (NHIS). Then, patients with periodontal disease (n = 3,682,468) and without periodontal disease (control, n = 3,637,128) according to oral examination results were identified. We tracked each patient for subsequent psoriasis diagnosis until the end of 2018 using NHIS database. The incidence rates of psoriasis per 1000 person-years were 0.36 and 0.34 in the periodontal disease group and control groups, respectively. After adjusting for potential cofactors, no significant increase in risk (adjusted hazard ratio, 0.994; 95% confidence interval, 0.974-1.015) was observed. Similar results were observed when analyzing the risk of psoriasis in patients who required scaling or periodontal surgery. In conclusion, periodontal disease is not an independent risk factor of psoriasis.

Psoriasis and oral health in adult United States population: a cross-sectional study

OBJECTIVES

To detect the association between psoriasis as an exposure and oral health conditions as outcomes represented by periodontal and dentition status. This was addressed by analysis of a large number of adults in the United States.

METHODS

By using The National Health and Nutrition Examination Survey datasets from 2009 to 2014, we performed a cross-sectional analysis of 11,726 participants included in our study population. For participants aged ≥ 30 years, the psoriasis status was assessed from the medical questionnaire. We used data from periodontal and oral examinations to assess the oral conditions of our participants. We examined the association between psoriasis as exposure and moderate/severe periodontitis and non-functional dentition as outcomes.

RESULTS

The weighted prevalence of psoriasis was 3%, 44% for moderate/severe periodontitis, and 20.5% for non-functional dentition. The fully adjusted model showed no significant association between psoriasis and moderate/severe periodontitis (Prevalence Ratio 1.02, 95% CI 0.9-1.2, p = 0.8). There was no statistically significant association between psoriasis and non-functional dentition except in the fully adjusted model it became statistically significant (Prevalence Ratio 0.8, 95% CI 0.7-0.9, p = 0.04).

CONCLUSION

Our results showed no association between psoriasis and periodontal or dentition status except in a fully adjusted model for non-functional dentition.

Pathogenetic aspects of the development of psoriatic arthritis in people with generalized chronic periodontitis

The pathogenetic mechanisms of progression of chronic periodontitis and psoriatic arthritis have common components in immune and inflammatory responses.

The pathogenesis of chronic periodontitis involves interaction of microbial and immunological components. As a chronic immune-mediated inflammatory disease and a consequence of an infectious trigger that originally affects gingival soft tissue, periodontitis is typically characterized by periodontal destruction and damage to adjacent connective tissues. Neutrophils contribute to the development of periodontitis and participate in its progression by recruiting T helper 17 cells and stimulating synthesis of the receptor activator of the nuclear factor kappa-β ligand (RANKL), contributing to bone resorption.

Macrophages as producers of proinflammatory cytokines (interleukin (IL)-1β, IL-6, IL-22, IL-23, tumor necrosis factor (TNF)), free radicals, and matrix metalloproteinases contribute to the chronic course of the disease. Tissue destruction results in generation of reactive oxygen species by neutrophils, which, against the background of a decrease in the antioxidant potential, leads to development of oxidative stress. These processes together lead to tooth mobility, formation of periodontal pockets, and bone resorption.

The key factors in the formation of psoriatic arthritis against the background of periodontitis are overproduction of proinflammatory cytokines in target tissues (skin, joints, gingival microflora) and development of an excessive systemic immune response to the microbiota inhabiting the epithelial and periodontal tissues. A statistically confirmed correlation of the progression of periodontal destruction with the presence of psoriatic arthritis proves the significance of the effects of inflammation as a background for the progression of a comorbidity. Increased IL-17 synthesis plays a crucial role in the development of immune responses of pathological bone remodeling and bone resorption in periodontitis and psoriatic arthritis.

Periodontal Disease in Patients with Psoriasis: A Systematic Review

Psoriasis is a chronic, inflammatory, and recurrent skin disease. As with periodontitis, the development and progression of lesions depend on immunological, genetic, and environmental factors. This systematic review was designed to answer the question: "Is there a relationship between psoriasis and periodontal disease?". Following the inclusion and exclusion criteria, sixteen studies were included in this systematic review (according to PRISMA statement guidelines). Based on the meta-analysis, psoriasis patients showed a more than two-fold increase in the odds of periodontal disease. Almost one-third of these patients suffered from periodontitis of varying severity. Despite the heterogeneity of the included studies, psoriasis is associated with a higher risk of periodontitis, and especially with advanced progression.

The link between total antioxidant status, total oxidant status, arylesterase activity, and subgingival microbiota in psoriasis patients

BACKGROUND

Studies focusing on the relationship between periodontitis and systemic diseases have suggested a possible association between these two chronic and inflammatory disorders. We aimed to comparatively investigate the salivary oxidative status, biomarker levels, clinical findings, and the microbial load on subgingival biofilm samples in psoriasis patients and controls.

METHODS

Forty participants were allocated into four groups as follows: (1) systemically and periodontally healthy (C group); (2) systemically healthy with periodontitis (P group); (3) psoriasis (Ps) and periodontally healthy (Ps-C group); and (4) Ps with periodontitis (Ps-P group). Subgingival biofilm samples were obtained to detect the periodontopathogenic agents by Real-time PCR (qPCR). The total antioxidant status (TAS) (mmol/l), total oxidant status (TOS) (μmol/l), and arylesterase (ARE) activity (U/L) were analyzed using saliva samples.

RESULTS

The level of TOS and oxidative stress index (OSI) were significantly higher in patients with Ps-P and P compared to controls (P = 0.001, and P ˂ 0.001, respectively). ARE levels were higher in controls compared to Ps and P (P ˂ 0.001). The prevalences of bacteria detected in subgingival biofilm samples were similar between all groups (P > 0.05).

CONCLUSIONS

This study reported that psoriasis may amplify TOS and OSI, and the co-existence of psoriasis and periodontitis may aggravate oxidative stress.

Oral changes in patients with psoriasis

Psoriasis is one of the most frequent skin diseases. The cause of psoriasis is not fully expained as there are many factors (infectious, traumatic, hormonal, and chemical) that may play a role in the manifestation of its symptoms. One of the factors that may contribute to the appearance of psoriatic lesions may be the lesions in the oral cavity. The occurrence of lesions in the oral cavity is defined as rare, what can be explained by their nonspecific clinical image, and also by the possibility of being overlooked. Most characteristic symptoms of psoriasis occurring in the oral cavity are the geographic tongue and fissured tongue. It is also believed that there is a correlation between psoriasis and oral health- the periodontal and teeth condition as well as changes in saliva secretion. The psoriasis arthritis changes can also affect temporomandibular joint and impair the function of stomatognathic system. Because of these reports, cooperation of dermatologists and dentists in psoriasis care seems to be necessary.

The impact of external factors on psoriasis

Psoriasis is one of the most common chronic inflammatory skin diseases, constituting a significant health and socioeconomic problem. Despite numerous therapeutic options, the results of treatment very often remain insufficient. It is extremely important to remember that many external factors impact the effectiveness of therapy. This article discusses the importance of emollients in therapy and the influence of infectious agents and injuries on the course of psoriasis. Understanding the above-mentioned factors in the treatment of psoriasis is critical to achieve satisfactory therapeutic effects.

Saliva Proteomics as Fluid Signature of Inflammatory and Immune-Mediated Skin Diseases

Saliva is easy to access, non-invasive and a useful source of information useful for the diagnosis of serval inflammatory and immune-mediated diseases. Following the advent of genomic technologies and -omic research, studies based on saliva testing have rapidly increased and human salivary proteome has been partially characterized. As a proteomic protocol to analyze the whole saliva proteome is not currently available, the most common aim of the proteomic analysis is to discriminate between physiological and pathological conditions. The salivary proteome has been initially investigated in several diseases: oral squamous cell carcinoma and oral leukoplakia, chronic graft-versus-host disease, and Sjögren's syndrome. Otherwise, salivary proteomics studies in the dermatological field are still in the initial phase, thus the aim of this review is to collect the best research evidence on the role of saliva proteomics analysis in immune-mediated skin diseases to understand the direction of research in this field. The results of PRISMA analysis reported herein suggest that human saliva analysis could provide significant data for the diagnosis and prognosis of several immune-mediated and inflammatory skin diseases in the next future.

Oral health status and dental treatment needs of psoriatic patients with different therapy regimes

The aim of the study was to investigate the dental treatment requirements and oral health status of psoriatic patients with different severities of the disease, managed by different methods, including biological therapies.

METHODS

One hundred and twenty-seven patients diagnosed with psoriasis were enrolled in this study. All subjects completed a general medical history and a Dermatology Life Quality Index (DLQI) questionnaire. The severity of the disease was assessed using the Psoriasis Area and Severity Index (PASI) scale and a DLQI questionnaire. In order to evaluate the oral health status, the following techniques were used: Approximal Plaque Index (API), the Community Periodontal Index (CPI) and the Decayed, Missing and Filled Teeth (DMFT) index.

RESULTS

Patients treated with biologicals presented a significantly lower mean CPI index and required no surgical interventions. Subjects managed with topical therapy had significantly more decayed teeth and higher treatment needs. Only 11.3% of patients did not require dental intervention.

CONCLUSIONS

The study revealed a high need for dental interventions in patients with psoriasis. The type of treatment used may affect the oral health status of patients. However, further investigations are required to explain the significantly lower CPI value in the group treated with biologicals.

Periodontitis and the impact of oral health on the quality of life of psoriatic individuals: a case-control study

AIM

To evaluate the periodontal condition and the impact of oral health on the quality of life (OHRQL) among individuals with and without psoriasis.

METHODS

This case-control study comprised 295 individuals with psoriasis and 359 controls. A full mouth examination was performed for all periodontal clinical parameters. To evaluate OHRQL, the Oral Impact on Daily Performance (OIDP) questionnaire was applied. Data was analyzed using the chi-square, Fischer, Kruskal-Wallis, Mann-Whitney, and Bootstrap intervals tests to determine different profiles in relation to the OIDP.

RESULTS

Individuals with psoriasis had a 1.40 greater chance of having periodontitis than controls (OR = 1.40 95%CI: 1.01-1.93; p = 0.019). Individuals with psoriasis with periodontitis (+P) had greater impacts on OHRQL (13.76 ± 15.58), when compared with those without periodontitis (-P) (4.83 ± 8.25; p < 0.001). Additionally, psoriasis +P stage III/IV patients (13.94 ± 15.68) had worse indicators than controls -P (9.49 ± 22.54; p = 0.001). The final multivariate model demonstrated higher OIDP scores related to the following variables: diabetes, anxiolytics use, periodontitis, and psoriasis, showing worse OHRQoL.

CONCLUSIONS

This study demonstrated an important risk association between psoriasis and periodontitis, as both diseases demonstrated worse OHRQL indicators. Moreover, the severity of periodontitis and psoriasis significantly increased these negative impacts.

CLINICAL RELEVANCE

Practical implications: Multidisciplinary interaction is desirable to improve the impact of these diseases on the QoL of individuals with psoriasis and periodontitis.

Periodontitis in patients with psoriasis: A systematic review and meta-analysis

Objective

The present study aimed to summarize and update the evidence regarding the association between periodontitis and psoriasis.

Methods

The present systematic review was conducted under the guidelines of Transparent Reporting of Systematic Reviews and Meta‐Analyses (PRISMA) and was recorded in the PROSPERO database, under registration number CRD42017063799. Three databases (MEDLINE, Embase, and Cochrane Library) were searched up to March 2020. Case–control or cohort studies assessing the association between periodontitis and psoriasis were identified. Quantitative synthesis was conducted with meta‐analysis.

Results

A total of 13 studies (11 case–control and two cohort studies) assessing the association between periodontitis and psoriasis were included. Of these 13 articles, 9 showed the prevalence of periodontitis or psoriasis. Therefore, meta‐analyses were conducted with data retrieved from the nine studies included. Pooled effect estimate for nine studies showed that patients with periodontitis associated with a higher risk of psoriasis with a pooled OR of 2.87 (95% CI, 1.75–4.69).

Conclusions

This systematic review demonstrated a positive association between periodontitis and psoriasis; however, a causal relationship cannot be established. Due to the weak evidence, caution should be taken when interpreting the results regarding periodontal parameters. Well‐designed prospective studies are necessary to evaluate interactions between both diseases.

Higher Prevalence of Periodontitis and Decayed, Missing and Filled Teeth in Patients with Psoriasis

OBJECTIVE

 The aim of this study is to describe the prevalence and severity of periodontitis and decayed, missing and filled teeth (DMFT) index in patients with psoriasis. As a secondary aim, verify if periodontitis was a risk indicator for psoriasis.

MATERIALS AND METHODS

 A total of 69 patients diagnosed with psoriasis (48.7 ± 14.6 years) and 74 healthy controls (40.3 ± 12.9 years) participated in the study. Probing pocket depth, clinical attachment loss (CAL), bleeding on probing, plaque index, and DMFT index were measured in all subjects. Periodontitis was defined as the presence of at least three interproximal sites with CAL ≥3 mm in different teeth and severe periodontitis should involve at least two interproximal sites in different teeth with CAL ≥5 mm.

STATISTICAL ANALYSIS

 The Mann-Whitney test was used to analyze the demographics and the clinical data. The significance level was 5%. A multivariate logistic regression was conducted, and the odds ratio were calculated to express the risk to develop psoriasis.

RESULTS

 Patients with psoriasis had significantly more sites with CAL ≥3 mm (p < 0.03) and CAL ≥5 mm (p < 0.0001), less sites with plaque (p < 0.0001), fewer teeth (p < 0.0001), and a high DMFT index (p < 0.02) as compared with controls. Severe periodontitis was significantly more frequent (87.1% × 58.1%) and was a risk indicator for psoriasis after adjusting for sex, age, race, and smoking habits (odds ratio: 3.7, 95% confidence interval: 1.5-9.0, p < 0.003).

CONCLUSION

 Patients with psoriasis have higher prevalence of severe periodontitis and higher DMFT than control patients. Severe periodontitis may be a risk indicator for psoriasis.

Effects of non-surgical periodontal therapy on inflammatory markers of psoriasis: A randomized controlled trial

AIM

The purpose of this randomized controlled clinical study was to evaluate the effect of non-surgical mechanical periodontal therapy on the inflammatory status and severity of psoriasis in subjects with psoriasis.

MATERIAL AND METHODS

The study population consisted of 92 periodontitis patients with psoriasis vulgaris suffering from an untreated periodontal disease. Two randomized groups were formed from these patients: immediate periodontal therapy (test group, n = 46) and delayed periodontal therapy (control group, n = 46). Periodontal clinical measures, on salivary interleukin 2, interleukin 6 and secretory immunoglobulin A levels and the Psoriasis Area and Severity Index (PASI) scores were evaluated at baseline and on the 8th week in control and test groups.

RESULTS

Eight weeks after completion of non-surgical periodontal therapy (test group) or initial examination (control group), a significant decrease was observed in interleukin 2, interleukin 6 level and in PASI score, whereas a significant increase was observed in secretory immunoglobulin A levels in the test group (p < .05).

CONCLUSION

Within the limits of this study, the results suggest that effective periodontal therapy improves the psoriasis condition in patients afflicted by both diseases.

A review of the influence of periodontal treatment in systemic diseases

The effects and consequences of periodontal diseases might not be confined to the oral cavity. A great body of evidence has arisen supporting the claim demonstrating an association with several systemic conditions and diseases. With different levels of evidence, an association between periodontal disease and cardiovascular disease, diabetes, psoriasis, rheumatoid arthritis, pregnancy outcomes and respiratory diseases has been established. However, the true nature of this association, if it is causal, still remains elusive. For a better understanding of the complex relationships linking different conditions, interventional studies now begin to focus on the possible outcomes of periodontal treatment in relation to the events, symptoms and biomarkers of several systemic disorders, assessing if periodontal treatment has any impact on them, hopefully reducing their severity or prevalence. Therefore, we proceeded to review the recent literature on the subject, attempting to present a brief explanation of the systemic condition or disease, what proposed mechanisms might give biological plausibility to its association with periodontal disease, and finally and more importantly, what data are currently available pertaining to the effects periodontal treatment may have. Raising awareness and discussing the possible benefits of periodontal treatment on overall systemic health is important, in order to change the perception that periodontal diseases are only limited to the oral cavity, and ultimately providing better and comprehensive care to patients.

Psoriasis Patients Suffer From Worse Periodontal Status-A Meta-Analysis

Background and Objective: Patients with psoriasis have a significantly elevated risk of periodontitis compared with the nonpsoriasis controls. However, the data regarding the difference in the periodontal health status of the psoriasis patients and the nonpsoriasis controls are limited and inconsistent; hence, a specialized meta-analysis that quantitatively compared the periodontal status between the psoriasis and nonpsoriasis subjects by evaluating the related clinical periodontal indexes was needed. The aim of this meta-analysis was to quantitatively evaluate whether the periodontal status of psoriasis patients is worse than that of nonpsoriasis subjects.

Methods: We searched PubMed and EMBASE for all eligible studies that compared the periodontal status between psoriasis patients and nonpsoriasis subjects. The studies were screened based on pre-established inclusion criteria. After extracting the available periodontal indexes from the included studies, the weighted mean difference (WMD) with 95% confidence intervals (CIs) was calculated by pooling the mean and standard deviations (SD) of each index.

Results: In total, 8 studies, including 812 psoriasis patients and 772 nonpsoriasis subjects, were included in our meta-analysis, and the publication dates ranged from 2013 to 2019; eight periodontal indexes were analyzed. The WMD (95% CIs) for each index were: bleeding on probing (%), 9.188 (4.046–14.330, P < 0.001); probing depth (mm), 0.524 (0.183–0.865, P = 0.003); clinical attachment loss (mm), 0.408 (0.051–0.765, P = 0.025); plaque index, 0.186 (−0.170 to 0.543, P = 0.306); gingival index, 0.458 (−0.413 to 1.328, P = 0.303), remaining teeth, −1.709 (−2.106 to −1.312, P < 0.001); missing teeth, 1.130 (0.275–1.985, P = 0.010); the level of alveolar bone loss (mm), 0.400 (0.102–0.698, P = 0.008).

Conclusion: In summary, our meta-analysis revealed that psoriasis patients suffer from worse periodontal health than do nonpsoriasis subjects, mainly characterized by worse gingival inflammation, more alveolar bone loss, fewer remaining teeth and more missing teeth. Considering the limitations of this meta-analysis, more high-quality and well-designed studies are needed to validate our conclusions in the future.

Association of geographic tongue and fissured tongue with ABO blood group among adult psoriasis patients: a novel study from a tertiary care hospital in Saudi Arabia

OBJECTIVE

We aimed to determine if there was any association between geographic tongue (GT) and fissured tongue with ABO blood group among adult psoriasis patients in Saudi Arabia.

STUDY DESIGN

This hospital-based cross-sectional study included 100 consecutive new adult patients diagnosed with psoriasis and 100 case-matched participants in the control group (nonpsoriatic). Sociodemographic and dermatologic parameters, intraoral lesions (GT and fissured tongue), and ABO blood grouping and immunoglobulins were recorded and evaluated using χ² or Fisher's exact test.

RESULTS

A total of 74% of patients had an early age of onset, and 48% of them reported this disease in their parents. A total of 76% of those with generalized psoriasis had plaque type, whereas 78% with the localized type had pustular lesions. A total of 70% of psoriatic patients had O Rh-positive blood; 63% of tongue lesions seen in these patients were GT, and it was most prominent in O Rh-positive (64.28%) and O Rh-negative (62.50%) blood types. GT was prevalent among women (75.6%).

CONCLUSIONS

This study found a positive association of both GT and fissured tongue in this population of adult patients with psoriasis compared with a case-matched control population without psoriasis.

Periodontitis as another comorbidity associated with psoriasis: A case-control study

BACKGROUND

The association between periodontitis and immuno-mediated inflammatory diseases has been widely studied and recognized each more over the past few years. The aim of this study was to evaluate the potential association between psoriasis and periodontitis, as well as the influence of risk variables in this association.

METHODS

This case-control study included 756 individuals, 397 with psoriasis, and 359 controls. A full-mouth periodontal examination was performed, recording therefore plaque index, probing depth, clinical attachment level, and bleeding on probing. The influence of risk variables was tested by univariate analysis and multivariate logistic regression.

RESULTS

A high prevalence of periodontitis was observed among cases (46.1%) when compared to controls (33.1%). Individuals with psoriasis presented a 1.72 higher chance of having periodontitis than controls (OR = 1.72; 95% CI 1.28-2.32; p < 0.001) in the univariate analysis, but with no significance in the multivariate model. The prevalence of periodontitis increased significantly according to the severity of psoriasis [mild form (44.4%); moderate (46.3%); and advanced (47.1%)] when compared to the control group (33.1%). The final multivariate logistic model showed that the number of teeth (OR = 1.08; 95% CI 1.01-1.14; p = 0.018), smoking (OR = 1.91; 95% CI 1.19-3.07; p = 0.008), and body mass index (OR = 1.13; 95% CI 1.11-1.16; p < 0.001) remained significantly associated with the occurrence of periodontitis.

CONCLUSIONS

The prevalence of periodontitis was higher in individuals with psoriasis than in controls. Severity of psoriasis also presented a strong relationship with all periodontal clinical parameters.

Saliva as a Future Field in Psoriasis Research

Psoriasis is a skin inflammatory disease characterized by an increased body of comorbidities, including parodontopathy. Despite the visibility of skin lesions, prognostic biomarkers, related to disease monitoring and therapeutic effectiveness, are still missing. Although several markers have been studied, none of them has been identified as an independent prognostic factor. This concise review aims to summarize the current knowledge and results in saliva research applied to psoriasis. Combination of different markers could improve the prognostic prediction in patients with psoriasis. Future studies are needed to implement research on salivary biomarkers and their prognostic/therapeutic effects in the management of patients with psoriasis.

Increased risk of periodontitis in patients with psoriatic disease: a nationwide population-based retrospective cohort study

Aims

Periodontitis and psoriatic disease, including psoriasis (PS) and psoriatic arthritis (PsA), share the common risk factors and co-morbidities. However, the risk of periodontitis in patients with psoriatic disease still needs further investigation. This study was a nationwide population-based retrospective cohort study assessing the risk of periodontitis from psoriatic disease exposure.

Materials and Methods

Patients with newly diagnosed psoriatic disease from 2003 to 2012 were identified from the Taiwanese National Health Insurance Research Database. The 1:4 ratio propensity score matched controls were selected from no psoriatic disease participations. The subsequent risk of periodontitis was evaluated in exposure and comparison groups. Multiple Cox proportional hazard models were used for the estimation.

Results

A total of 3,487 psoriatic disease patients and 13,948 controls were identified. Incidence rate of periodontitis was higher in patients with PsA. The adjusted hazard ratio (aHRs) for moderate/severe periodontitis were 0.85 (95% CI [0.65-1.11]) in PS group and 1.66 (95% CI [0.99-2.78]) in PsA group. The aHRs of PsA were increased over time, aHRs was changed from 0.65 (0-11 months from index date) to 1.34 (≥12 months from index date) in all types of periodontitis and from 1.09 to 1.79 in moderate/severe periodontitis group, respectively.

Conclusions

The increased risk of periodontitis was observed, especially the association between PsA and moderate/severe periodontitis. The patients with psoriatic disease should receive regular periodontal evaluation.

Risk of periodontitis in patients with psoriasis and psoriatic arthritis

BACKGROUND

Psoriasis and periodontitis are chronic inflammatory disorders with overlapping inflammatory pathways, but data on risk of periodontitis in psoriasis are scarce and a possible pathogenic link is poorly understood.

OBJECTIVE

We investigated the association between psoriasis and periodontitis in a nationwide cohort study.

METHODS

All Danish individuals aged ≥18 years between 1 January 1997 and 31 December 2011 (n = 5,470,428), including 54 210 and 6988 patients with mild and severe psoriasis, and 6428 with psoriatic arthritis, were linked through administrative registers. Incidence rate ratios (IRRs) were estimated by Poisson regression.

RESULTS

Incidence rates of periodontitis per 10 000 person-years were 3.07 (3.03-3.12), 5.89 (1.07-6.84), 8.27 (5.50-12.45) and 11.12 (7.87-15.73) for the reference population, mild psoriasis, severe psoriasis and psoriatic arthritis respectively. Adjusted IRRs were (1.66; 1.43-1.94) for mild psoriasis, (2.24; 1.46-3.44) for severe psoriasis and (3.48; 2.46-4.92) for psoriatic arthritis. Similar results were found when a case-control design was applied.

CONCLUSIONS

We found a significant psoriasis-associated increased risk of periodontitis, which was highest in patients with severe psoriasis and psoriatic arthritis.

Association between moderate to severe psoriasis and periodontitis in a Scandinavian population

Background

The aim of the present study was to compare the prevalence of periodontitis and alveolar bone loss among individuals with psoriasis and a group of randomly selected controls.

Methods

Fifty individuals with psoriasis and 121 controls completed a structured questionnaire, and were examined clinically and radiographically. Oral examination included numbers of missing teeth, probing pocket depth (PPD), clinical attachment level (CAL), presence of dental plaque and bleeding on probing, as well as alveolar bone loss from radiographs. Questionnaires requested information on age, gender, education, dental care, smoking habits, general diseases and medicament use. For adjustment for baseline differences between psoriasis individuals and controls the propensity score based on gender, age and education was computed using multivariate logistic regression. A subsample analysis for propensity score matched psoriasis individuals (n = 50) and controls (n = 50) was performed.

Results

When compared with controls, psoriasis individuals had significantly more missing teeth and more sites with plaque and bleeding on probing. The prevalence of moderate and severe periodontitis was significantly higher among psoriasis individuals (24%) compared to healthy controls (10%). Similarly, 36% of psoriasis cases had one or more sites with radiographic bone loss ≥3 mm, compared to 13% of controls. Logistic regression analysis showed that the association between moderate/severe periodontitis and psoriasis remained statistically significant when adjusted for propensity score, but was attenuated when smoking was entered into the model. The association between psoriasis and one or more sites with bone loss ≥3 mm remained statistically significant when adjusted for propensity score and smoking and regularity of dental visits. In the propensity score (age, gender and education) matched sample (n = 100) psoriasis remained significantly associated with moderate/severe periodontitis and radiographic bone loss.

Conclusions

Within the limits of the present study, periodontitis and radiographic bone loss is more common among patients with moderate/severe psoriasis compared with the general population. This association remained significant after controlling for confounders.

Dynamic changes in saliva after acute mental stress

Stress-related variations of fluoride concentration in supernatant saliva and salivary sediment, salivary cortisol, total protein and pH after acute mental stress were assessed. The hypothesis was that stress reactions have no influence on these parameters. Thirty-four male students were distributed into two groups: first received the stress exposure followed by the same protocol two weeks later but without stress exposure, second underwent the protocol without stress exposure followed by the stress exposure two weeks later. The stressor was a public speech followed by tooth brushing. Saliva was collected before, immediately after stress induction and immediately, at 10, 30 and 120 min. after tooth brushing. Cortisol concentrations, total protein, intraoral pH, and fluoride content in saliva were measured. The data were analyzed statistically. Salivary sediment was ca 4.33% by weight of whole unstimulated saliva. Fluoride bioavailability was higher in salivary sediment than in supernatant saliva. The weight and fluoride concentration was not altered during 2 hours after stress exposure. After a public speech, the salivary cortisol concentration significantly increased after 20 minutes compared to the baseline. The salivary protein concentration and pH also increased. Public speaking influences protein concentration and salivary pH but does not alter the fluoride concentration of saliva.

Periodontal disease and risk of psoriasis among nurses in the United States

OBJECTIVE

Periodontal disease has been associated with systemic inflammation and may be a risk factor for autoimmune diseases. This study evaluated the association between periodontal disease and the risk of incident psoriasis in a large prospective cohort study.

MATERIAL AND METHODS

Self-reported history of periodontal bone loss, from 1998-2008, was evaluated as a risk factor for incident psoriasis among 60,457 women in the Nurses' Health Study. Secondary analyses examined associations between history of tooth loss and number of natural teeth and psoriasis risk. Cox proportional hazards models were used to assess multivariate estimates, adjusting for age, cigarette smoking, body mass index, alcohol intake and physical activity.

RESULTS

An increased multivariate risk of psoriasis was observed for those with mild periodontal bone loss (RR = 1.35, 95% CI = 1.03-1.75) and moderate-to-severe periodontal bone loss (RR = 1.49, 95% CI = 1.08-2.05), as compared to those without periodontal bone loss, after adjusting for age, cigarette smoking, body mass index, alcohol intake, physical activity and tooth loss. Number of natural teeth and tooth loss were not associated with risk of psoriasis in this study.

CONCLUSION

This study shows that a history of periodontal bone loss may increase risk of subsequent psoriasis. A limitation of this study is that it is based on self-reported measures.