Download The relationship between intestinal Crohns and Oral Crohns Disease

A comparison of
Periodontal Disease in
Crohns Disease and
matched control patients
A pilot study
by Brittany Le Sueur
Study Introduction
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Summer Research Studentship
GUT Health Network
Colgate
Auckland University of Technology (AUT)
Aim
• To understand how the gingiva relates to intestinal Crohns
disease.
• Studies suggest there may be a link between oral health and
the development of Crohns Disease
• Compare and establish what is normal between Crohns and
non-Crohns patients
INFLAMMATORY BOWEL DISEASE
(IBD)
A range of chronic, immune
mediated inflammatory diseases of
the gastrointestinal tract (includes
Crohns disease)
47% of people with IBD may suffer
from extra-intestinal manifestations
of IBD
Crohns Disease
• A chronic, incurable bowel disorder that affects all age
groups and causes pain, illness and disruption to life.
• It may affect any part of the GIT, including the mouth &
often in a discontinuous fashion
• New Zealand has the 2nd highest incidence of disease in
the world.
CHARACTERISTICS
OF CHRONIC
PERIODONTITIS
• Most Common Form Of Periodontitis
• Can Affect The Primary & Permanent Dentition
• Usually Has A Slow To Moderate Progression
• It May Also Have Periods Of Rapid Progression
• Can Be Localised or Generalised
• Can be modified by systemic factors
Systemic Risk Factors for Periodontal
Disease
Behavioural/life Style
Environmental
Metabolic/Autoimmune Diseases
Haematological
PERCEIVED ORAL HEALTH IN
PATIENTS WITH CROHNS DISEASE
1943 patients with CD in Sweden. Given
questionnaires and allowed for variables
Reported significantly greater need for
dental treatment compared with
controls
More dental caries, more periodontal
disease and other mouth problems such
as mouth ulcers
Oral Health Prev Dent 2009; 7(3):277-82
Rikardsson S et al
Study (Grossner-Schreiber B
2006)
• Patients with IBD had slightly greater Probing pocket depth
(PPD) and Clinical Attachment Loss (CAL) compared with
controls.
• Unsure re micro-organisms and if this further exacerbates IBD
as in other diseases
• Need for studies on the impact of oral disease and microorganisms on IBD
Research Hypothesis
• Crohns disease patients are more susceptible to
periodontal disease either as a result of the
disease itself or as a result of
immunosuppressant treatment
Methodology
• Study commenced beginning of December 2013
with full ethical approval
• Patients were sourced from gastrointerologist
clinics
• Control patients were matched where possible
to existing Crohns study patients
• Age 18 and upwards
• Aimed for an equal spread of M/F
Methodology
• Completion of the required informed consents
and questionnaires
• A plaque index is recorded
• Periodontal pocket depths are recorded
• Bleeding on probing – noted as PPD are recorded
• Mobility scores recorded
• A plaque sample is taken and frozen in 1ml of
PBS
Plaque Sample
• Mature biofilm was sampled from each patients
mouth, where ever the plaque was most
abundant
• Plaque was frozen in PBS and stored
• It is to be sent to Canada for DNA sequencing,
where the bacteria in the biofilm samples will be
identified and quantified
• Then I will compare the bacteria of CD and
Controls, looking to see if there is any correlation
between the two study groups
Limitations/Observations
• Small study group to work with
• CD patients were motivated, mobile and not
seriously ill
• Preliminary observations show that controls
were less frequent dental attenders
• There was marginally more bleeding on probing
in the control group
Where the Study stands now
• Awaiting sample analysis of plaque samples, continue with
statisticians analysis
• Important to raise awareness of the periodontal disease in
patients, particularly those with autoimmune diseases such as
crohns
Thank You