Autoimmune Diseases and Oral Health

Abstract

Paper 1: Background and Aims: Prior studies have suggested an association between periodontitis and rheumatoid arthritis (RA). To better understand the strength and nature of a potential association between these two common conditions, we undertook a cross-sectional analysis of a large number of patients in the United States. Methods: A cross-sectional analysis was performed of 8941 U.S. adults aged ≥30 years who participated in one of three NHANES cycles 2009-2014. Based on self-reporting, patients were categorized as being “with” or “without” RA. Periodontal status was assigned based on clinical attachment level (CAL) and periodontal pocket depth (PPD), and individuals were categorized into two groups, “moderate/ severe” (MSP) or “no/ mild” periodontitis (NMP). Dentition status was also assessed by oral examination and reported as the number of permanent teeth observed, and participants were stratified as having “functional” (≥20 teeth; FD) or “non-functional” dentition (≤19 teeth; NFD). We examined the association between RA and moderate/ severe periodontitis and the association between RA and non-functional dentition. We progressively adjusted our models for different sets of potential confounders. Results: The weighted prevalence of RA, MSP and NFD was 5.4%, 42%, and 17% respectively. MSP was more prevalent in participants reporting RA vs without RA (53% vs. 41.5%, p= 0.0003). Also, NFD was more prevalent in participants with RA vs without RA (41% vs. 15.5%, p= 0.0001). After adjusting for demographics, lifestyle and comorbidities, participants with RA had higher odds of having a NFD (Odds Ratio 1.8, 95% CI 1.3-2.3, p= 0.0001), whereas the fully adjusted model showed no association between RA and MSP (Prevalence Ratio 1.01, 95% CI 0.9-1.1, p= 0.9). Conclusion: RA was associated with higher likelihood of having a NFD but was not associated with higher prevalence of MSP after adjustments of the risk factors; to control their confounding effects on the association. RA patients over forty more likely to have oral health deterioration. Paper 2: Background and Aims: Although the previous literature tried to address association between psoriasis and oral conditions, the results were inconsistence between showing significant or unsignificant results. We aimed to determine this association by using large real-world data of adults United States population. Methods: By using NHANES datasets and appending 3 cycles of NHANES from 2009 to 2014, we used a cross-sectional analysis of 11726 U.S. adults aged ≥30 years. Those adults were categorized into two groups either “with” or “without” psoriasis according to their answers to medical condition questionnaire. We used data from periodontal and oral examinations to assess the oral conditions of our participants. The periodontal status of the participants was categorized into two groups either having no/mild (NMP) or moderate/severe (MSP) periodontitis. The dentition status of the participants was categorized into two groups either having functional dentition (FD) or non-functional dentition (NFD). We progressively adjusted models for different sets of potential confounders, to examine the association between the psoriasis and moderate/severe periodontitis and non-functional dentition Results: The weighted prevalence of psoriasis was 3%. For MSP and NFD, the weighted prevalence was 44% and 20.5% respectively. By comparing participants with and without psoriasis the prevalence of MSP and NFD was not significantly different. The regression models showed no significance association between psoriasis and MSP, so in the fully adjusted model of demographics, lifestyle, and comorbidities (Prevalence Ratio 1.03, 95% CI 0.9-1.2, p= 0.7). There was no statistically significant association between psoriasis and NFD except in the fully adjusted model it became statistically significant (Prevalence Ratio 0.8, 95% CI 0.7-0.9, p= 0.04). Conclusion: Psoriasis was associated with the lower prevalence of NFD after adjustment of potential confounders but was not associated with the higher prevalence of MSP.