A comparison of Periodontal Disease in

Crohns Disease and matched control patients

A pilot studyby Brittany Le Sueur

Study Introduction

• 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.

CHARACTERISTICSOF 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

Genetic

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 controlsMore dental caries, more periodontal disease and other mouth problems such as mouth ulcersOral Health Prev Dent 2009; 7(3):277-82Rikardsson 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 micro-organisms 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