Oral health characteristics and oral-health-related quality of life in ankylosing spondylitis patients

In the past few decades, there has been a growing body of evidence indicating an association between periodontitis and certain systemic medical conditions. Intervention studies have further elucidated this association by demonstrating improvements in the systemic conditions, as a result from treating periodontal disease. Recent evidence suggests that there is a significant association between rheumatoid arthritis and chronic periodontitis. However, there is currently insufficient evidence as to whether this association is generalized to all forms of rheumatic diseases. Ankylosing spondylitis (AS) is another form of debilitating rheumatic disease. Few studies have looked at the periodontal status of individuals with AS and some, have reported the coexistence of Sjögren’s syndrome in association with AS. Hence, the oral health and quality of life could be compromised further in this group. The aim of this study was to compare the periodontal disease occurrence, the overall oral health status, and the impact of these on AS patients and healthy controls. A total of 41 AS patients and 49 healthy controls individually matched for age, sex and ethnicity participated in this case-control study. The case group participants were recruited from the Rheumatology Department, Dunedin Public Hospital and the School of Dentistry. The healthy controls were recruited from the South Dunedin Electoral Roll. The study involved a single chair-side dental visit to obtain clinical data that included probing pocket depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index, oral mucosal conditions, dentition caries status (DMFT), and salivary flow rate (SFR). The sociodemographic characteristics, medical history, and the oral-health-related quality of life (OHRQoL) (OHIP-14) were assessed through questionnaires. The case group had a higher occurrence of periodontitis (≥2 sites with 4+mm CAL) than the control group (87.8% and 71.4% respectively), however the difference failed to reach statistical significance (P= 0.06). Although the extent of periodontitis was significantly higher in the case group (mean percentage of sites with 5+mm PD), the severity of periodontitis was similar in both the groups. The conditional logistic regression modelling showed that there was no significant association between periodontitis and AS. However, a positive gradient was observed between the mean AS disease activity score (BASDAI) and periodontal disease severity. The mean BOP and plaque score were significantly higher in the case group than the control group (P< 0.05 and P< 0.001 respectively). The cases had a higher DMFT score and more oral mucosal lesions than the controls but the differences were not statistically significant. The mean SFR in both the groups was similar (0.5ml/minute). AS patients OHRQoL was significantly more compromised than healthy individuals with a higher mean OHIP-14 score (10.8 and 6.8 respectively; P< 0.05). Within the limitations of this study, the findings suggest that AS patients may have a higher extent of periodontal disease but the association between periodontitis and AS was not significant. AS patients overall oral-health appeared to be more compromised than their healthy counterparts and this had a detectable impact on their OHRQoL. The findings are clinically relevant and indicate that AS patients may have higher oral health treatment needs than healthy individuals

Adhesion of three Lactobacillus strains to human urinary and intestinal epithelial cells.

There is a growing understanding of the mechanisms by which the influence of the microbiota projects beyond sites of primary mucosal occupation to other human body systems. Bacteria present in the intestinal tract exert a profound effect on the host immune system, both locally and at distant sites. The oral cavity has its own characteristic microbiota, which concentrates in periodontal tissues and is in close association with a permeable epithelium. In this review we examine evidence which supports a role for the microbiome in the aetiology of rheumatic disease. We also discuss how changes in the composition of the microbiota, particularly within the gastrointestinal tract, may be affected by genetics, diet, and use of antimicrobial agents. Evidence is presented to support the theory that an altered microbiota is a factor in the initiation and perpetuation of inflammatory diseases, including rheumatoid arthritis (RA), spondyloarthritis (SpA), and inflammatory bowel disease (IBD). Mechanisms through which the microbiota may be involved in the pathogenesis of these diseases include altered epithelial and mucosal permeability, loss of immune tolerance to components of the indigenous microbiota, and trafficking of both activated immune cells and antigenic material to the joints. The potential to manipulate the microbiome, by application of probiotics and faecal microbial transplant (FMT), is now being investigated. Both approaches are in their infancy with regard to management of rheumatic disease but their potential is worthy of consideration, given the need for novel therapeutic approaches, and the emerging recognition of the importance of microbial interactions with human hosts. © Springer Science+Business Media New York 2013

The oral microbiome of patients with axial spondyloarthritis compared to healthy individuals

Background. A loss of mucosal tolerance to the resident microbiome has been postulated in the aetiopathogenesis of spondyloarthritis, thus the purpose of these studies was to investigate microbial communities that colonise the oral cavity of patients with axial spondyloarthritis (AxSpA) and to compare these with microbial profiles of a matched healthy population. Methods. Thirty-nine participants, 17 patients with AxSpA and 22 age and gender- matched disease-free controls were recruited to the study. For patients with AxSpA, disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants underwent a detailed dental examination to assess oral health, including the presence of periodontal disease assessed using probing pocket depth (PPD). Plaque samples were obtained and their bacterial populations were profiled using Ion Torrent sequencing of the V6 region of the 16S rRNA gene. Results. Patients with AxSpA had active disease (BASDAI 4.1±2.1 [mean±SD]), and a significantly greater prevalence of periodontitis (PPD ≥ 4 mm at ≥ 4 sites) than controls. Bacterial communities did not differ between the two groups with multiple metrics of α and β diversity considered. Analysis of operational taxonomic units (OTUs) and higher levels of taxonomic assignment did not provide strong evidence of any single taxa associated with AxSpA in the subgingival plaque. Discussion. Although 16S rRNA gene sequencing did not identify specific bacterial profiles associated with AxSpA, there remains the potential for the microbiota to exert functional and metabolic influences in the oral cavity which could be involved in the pathogenesis of AxSpA