We are using cookies to implement functions like login, shopping cart or language selection for this website. Furthermore we use Google Analytics to create anonymized statistical reports of the usage which creates Cookies too. You will find more information in our privacy policy.
OK, I agree I do not want Google Analytics-Cookies
International Poster Journal of Dentistry and Oral Medicine
Login:
username:

password:

Plattform:

Forgotten password?

Registration

Int Poster J Dent Oral Med 11 (2009), No. 1     15. Mar. 2009

Int Poster J Dent Oral Med 2009, Vol 11 No 1, Poster 439

Periodontal status of patients with Crohn's Disease

Language: English
 

Authors:
Dr. Jamal M. Stein, Prof. Dr. Georg Conrads, Marie Sooriyakumaran, Prof. Dr. Friedrich Lampert,
Department of Operative Dentistry and Periodontology, University Hospital RWTH Aachen
Dr. Dr. Ralf Smeets,
Department of Oral and Maxillofacial Surgery, University Hospital Aachen
Dr. Claudia Weiss,
Institute of Medical Statistics, University Hospital RWTH Aachen
Prof. Dr. Frank Lammert,
Department of Internal Medicine I, University Hospital Bonn

Date/Event/Venue:
28.06.2006-01.07.2006
Europerio 5
Madrid, Spain
 

Introduction

Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that can affect any segment of the gastrointestinal tract including oral cavity and has extra-intestinal manifestations as well (1, 2). There exist several similar features in the pathophysiology of CD and periodontitis (Fig. 1).

 
Fig 1: Possible relationship between Crohn's disease and periodontitis  

CD has been reported to have periodontal manifestations. However, most of the knowledge is based on case reports (3, 4) and one cohort study with a limited number of patients (5). Data on periodontal parameters and microbiology is rare (6). Besides, recent studies showed an association of single nucleotide polymorphisms (SNPs) in the NOD2(CARD15) gene with CD (7, 8). These SNPs (SNP8,12,13) are involved in recognition towards peptidoglycans of bacterial lipopolysaccharides (9) and might therefore affect interactions between CD and periodontitis.
 

Objectives

The aim of our study was to investigate the clinical periodontal status of patients with CD taking into account periodontal pathogens and the NOD2(CARD15) SNPs 8, 12 and 13.
 

Material and Methods

The periodontal status of 147 Caucasian patients with CD (age range: 18-59) was assessed. Plaque index (PI, Silness & Löe [10]), gingiva index (GI, Löe & Silness [11]), periodontal probing depth (PD) and clinical attachment loss (CAL) were measured in each patient. Smoking status and intake of immunosuppressive medicaments has been recorded.
Subgingival plaque samples were obtained from all individuals. Paper-point samples were taken from the deepest subgingival site in each quadrant of the dentition (12, 13). Detection of periodontopathic bacteria Actinobacillus actinomycetemcomitans (A.a.), Tannerella forsythia (T.f.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.) and Campylobacter rectus (C.r.) were established by dot blot hybridization with 16S rRNA directed DNA-probes. Patients were considered positive for a bacterium, if its number was > 103.
NOD2(CARD15) genotyping was done with allele specific multiplex PCR using the Taqman assay (7). 3 SNPs were differentiated: SNP8 (rs2066844 C2023T); SNP12 (rs2066845 G2641C); SNP13 (rs2066847 2936insC). For each SNP 2 alleles could be discriminated (allele 1 = mutant, allele 2 = wild type).
The unpaired t-test was used for comparison of the values of continuous variables between the mutant and the wild type subgroup. Investigation of associations between allele type (mutant or wild type) and various categorical variables was done with Fishers Exact Text. Statistical comparison of the 3 NOD2(CARD15) SNP subgroups with the wild type regarding bacterial scores was done with Chi2 Test with Yates correction or Fishers Exact Test if appropriate. Moreover, multivariate statistical analyses were used in order to determine the effect of the variables sex, age, smoking, immunosuppression, PI, GI, bacterial scores and the NOD2(CARD15) SNP subtypes on different PD and CAL variables. Multiple logistic regression analyses were used for binary PD/CAL scores, while covariance analyses were conducted in cases of continuous PD/CAL variables. All p values were corrected according to Bonferroni adjustment.
 

Results

1. Clinical and demographic parameters

  Total SNP 8 SNP 12 SNP 13 Mutant
(SNP 8, 12, 13)
Wild Type Mutant vs. Wild Type
Significance
  N = 147 N = 34 N = 15 N = 29 N = 66 N = 81  
  Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) p
age (years) 36.6 (9.9) 34.9 (11.0) 32.7 (10.5) 36.2 (8.8) 35.5 (9.8) 37.5 (9.8) 0.304 (n.s.)
females % 52.4 47.1 60.0 62.1 50.0 54.3 0.869 (n.s.)
smokers % 37.4 44.1 26.7 44.8 43.9 32.1 0.168
immuno-
suppression %
47.6 38.2 46.7 44.8 42.4 51.9 0.411 (n.s.)
PI (0-3) 1.2 (0.6) 1.1 (0.6) 1.2 (0.7) 1.2 (0.6) 1.2 (0.6) 1.2 (0.6) 0.553 (n.s.)
GI (0-3) 1.2 (0.6) 1.2 (0.6) 1.2 (0.7) 1.2 (0.7) 1.3 (0.6) 1.1 (0.5) 0.140 (n.s.)
PD (mm) 3.6 (0.8) 3.4 (0.7) 3.3 (1.0) 3.4 (0.8) 3.5 (0.7) 3.6 (1.0) 1.000 (n.s.)
% teeth with              
PD > 3.5 53.1 55.9 53.3 55.2 59.1 48.1 0.189 (n.s.)
PD > 5.5 2.7 0.0 0.0 0.0 0.0 4.9 0.133 (n.s.)
CAL (mm) 3.8 (1.0) 3.6 (0.9) 3.6 (1.1) 3.6 (1.0) 3.7 (0.8) 3.8 (1.2) 0.987 (n.s.)
% teeth with              
CAL > 3.5 59.9 61.8 60.0 58.6 65.2 55.6 0.242 (n.s.)
CAL > 5.5 4.8 2.9 6.7 3.4 3.0 6.2 0.699 (n.s.)
missing teeth 6.1 (3.7) 4.6 (2.7) 6.4 (4.3) 6.2 (2.7) 5.8 (3.4) 6.3 (3.9) 0.752 (n.s.)
Tab 1: Clinical and demographic characterization of different NOD2(CARD15) subgroups. mutant = at least one allele 1 (mutant allele) for SNP 8, 12 or 13 present. Wild Type = only wild type allele 2 present.

Among all 147 patients with CD, 34 (23.13%) were carriers of the mutant allele 1 of NOD2(CARD15) SNP8, 15 (10.20%) had allele 1 for SNP12 and 29 (19.73%) had allele 1 for SNP13. 66 patients (44.9%) had at least one allele 1 for SNP8, 12 or 13 ("mutant" group). In 81 patients (55.1%) there was none of the allele 1 ("wild type" group). Table 1 shows all demographic values in the total group of all SNP subgroups. In all groups, there was a similar distribution of the gender, number of smo-kers and intake of immunosuppressive medicaments. There were no clinical differences between the "mutant group" and the "wild type" group regarding PI, GI, PD and CAL.

2. Microbiologic results

Fig 2a: Distribution of periodontopathic bacteria in all SNP subgroups Fig 2b: Presence of periodontopathic bacteria in patients with "mutant" and "wild type" NOD2(CARD15).

Figures 2a and 2b show the distribution of the periodontopathic bacteria in all NOD2(CARD15) SNP subgroups. All investigated species were detected in more than 60% of all patients. C.r. had the highest frequency (94.56%). Comparing the "mutant" group with the "wild type" group there was a trend for a lower frequency of all bacteria and, in particular, a significantly decreased frequency of P.i. in the "mutant" group (46/66, 69.7% vs.71/81, 78.65%; p = 0.007, pBf = 0.035).
When the results of the present study were compared to cohorts with and without periodontitis published by other authors, CD associated bacteria reached a similar (or even higher) frequency as (than) patients with chronic or aggressive periodontitis (Table 2).

  CD
(present study,
N = 147)
Healthy Patients without periodontitis
(Boutaga et al. 2006,
N = 111)
Chronic periodontitis
(Boutaga et al. 2006,
N = 259)
Aggressive Periodontitis
(Darby et al. 2000,
N = 96)
Presence of
A.a. (%)
76.9 18.0 27.4 20.8
Presence of
P.g. (%)
62.6 9.9 45.5 62.5
Presence of
P.i. (%)
79.6 23.2 83.0 79.2
Presence of
T.f. (%)
64.6 33.2 89.2 91.7
  CD
(present study, N = 147)
Healthy Patients without periodontitis
(Saygun et al. 2004,
N = 16)
Chronic periodontitis
(Colombo et al. 2006*, N = 49)
Aggressive Periodontitis
(Albandar et al. 1997, N = 148)
Presence of
C.r. (%)
94.6 18.8 35.0 71.0
Tab 2: Frequency of periodontopathic bacteria among patients with CD with different study populations published in the literature. (* = detection of C.r. in crevicular epithelial cells)
 

3. Multivariate analyses
Multivariate analyses were done to determine different variables on PD and CAL as well as on periodontopathic bacteria (Table 3a, b).
Logistic regression and covariance analyses resulted in a significant impact of age (> 35 years) and gingiva index on PD and CAL values more than 3.5 mm. Since C.r. was the most frequent bacterium in all CP patients, we tested the influence of different detection levels (103, 104 and 105). High levels of C.r. (105) were associated with increased PD and a higher frequency of sites with CAL > 5.5 mm. Regarding the presence of the investigated bacteria, only age and GI were risk factors for the presence of P.g. (age) and T.f. (GI).

parameter intercept immuno-
suppression
age
(> 35)
GI smoking C.r. ≥ 103 C.r. ≥ 105 NOD2(CARD15) mutation
PD > 3.5 0.0025 --- 0.0019 0.6413 0.2637 0.7669 0.0109 0.0529
PD > 5.5 0.0180 --- 0.0196 --- 0.8639 0.9140 0.0005 0.3478
CAL > 3.5 0.0292 --- <0.0001 0.0035 0.0150 0.6419 --- 0.0899
CAL > 5.5 0.9304 --- 0.9005 0.4214 0.2655 0.9853 0.0229 ---
% sites
PD > 3.5
--- --- <0.0001 0.0005 0.5725 0.7173 0.0947 ---
% sites
PD > 5.5
--- --- 0.0070 0.0784 0.7643 0.8741 0.0029 0.0977
% sites
CAL > 3.5
--- --- <0.0001 <0.0001 0.0436 0.6868 0.0125 ---
% sites
CAL > 5.5
--- --- 0.0643 0.0272 0.4626 0.7048 <0.0001 0.0603
Tab 3a: Logistic regression and covariance analyses for PD and CAL values. Significant p-values according to Bonferroni correction (p < 0.0024) are marked.
parameter intercept gender (female) age
(> 35)
GI smoking immuno-
suppression
NOD2(CARD15) mutation
A.a. ≥ 103 0.2028 --- 0.2158 0.3102 --- --- ---
P.g. ≥ 103 0.9292 --- 0.0010 0.2339 --- --- ---
P.i. ≥ 103 0.4204 --- 0.0095 --- --- --- 0.9855
T.f. ≥ 103 0.0930 --- 0.1213 0.0023 0.0146 --- ---
C.r. ≥ 103 0.0009 --- 0.2825 --- --- --- ---
Tab 3b: Logistic regression and covariance analyses for periodontopathic bacteria. Significant p-values according to Bonferroni correction (p < 0.0024) are marked.

Conclusions

The results of our study suggest that patients with Crohn's disease have an increased prevalence but only moderate severity of periodontal disease. Our data do not support a role of NOD2(CARD15) on periodontal status in CD. However, in all patients there was a high frequency of periodontopathic bacteria A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythia and C. rectus with highest scores in the NOD2(CARD15) wild type. C. rectus, which has already been reported to impair neutrophils in patients with CD (6), might be of particular value for the periodontal manifestation of CD. Trigger effects for autoimmune responses or cross tolerance referred to this bacterium might be possible mechanisms. Further studies are necessary to confirm the role of periodontopathic bacteria and its possible value for diagnostics and therapy of CD.
 

Literature

  1. Podolsky DK. Inflammatory bowel disease N Engl J Med. 1991; 325:928-937.
  2. Glickman JN. Ulcerative colitis surveillance: activity does matter. Inflamm Bowel Dis. 2008; 14:1453-1454.
  3. Engel LD, Pasquinelli KL, Leone SA, Moncla BJ, Nielson KD, Rabinovitch PS: Abnormal lymphocyte profiles and leukotriene B4 status in a patient with Crohn\'s disease and severe periodontitis. J Periodontol 1988; 59:841-847.
  4. Rhodes JM, Potter BJ, Brown DJ, Jewell DP. Serum inhibitors of leukocyte chemotaxis in Crohn\'s disease and ulcerative colitis. Gastroenterology 1982; 82:1327-1334.
  5. Flemmig TF, Shanahan F, Miyasaki KT: Prevalence and severity of periodontal disease in patients with inflammatory bowel disease. J Clin Periodontol 1991;18:690-697.
  6. Van Dyke TE, Dowell VR Jr, Offenbacher S, Snyder W, Hersh T: Potential role of microorganisms isolated from periodontal lesions in the pathogenesis of inflammatory bowel disease. Infect Immun 1986;53:671-677.
  7. Hampe J, Grebe J, Nikolaus et al.: Association of NOD2 genotype with clinical course of Crohn's disease: a cohort study. Lancet 2002;11:1661-1665.
  8. Hugot JP, Chamaillard M, Zouali H, Lesage S, Cézard JP, Belaiche J, Almer S, Tysk C, O\'Morain CA, Gassull M, Binder V, Finkel Y, Cortot A, Modigliani R, Laurent-Puig P, Gower-Rousseau C, Macry J, Colombel JF, Sahbatou M, Thomas G. Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn\'s disease. Nature 2001; 411:599-603.
  9. Girardin SE, Boneca IG, Viala J, Chamaillard M, Labigne A, Thomas G, Philpott DJ, Sansonetti PJ. Nod2 is a general sensor of peptidoglycan through muramyl dipeptide (MDP) detection. J Biol Chem 2003;278:8869-8872.
  10. Silness J, Loe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22:121-135.
  11. Loe H, Silness J Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand. 1963;21:533-551.
  12. Mombelli A, McNabb H, Lang NP. Black-pigmenting gram-negative bacteria in periodontal disease. II. Screening strategies for detection of P. gingivalis. J Periodontal Res. 1991;26:308-313.
  13. Mombelli A, Gmür R, Gobbi C, Lang NP. Actinobacillus actinomycetemcomitans in adult periodontitis. I. Topographic distribution before and after treatment. J Periodontol. 1994;65:820-826.
  14. Boutaga K, van Winkelhoff AJ, Vandenbroucke-Grauls CM, Savelkoul PH. The additional value of real-time PCR in the quantitative detection of periodontal pathogens. J Clin Periodontol. 2006;33:427-33.
  15. Darby IB, Hodge PJ, Riggio MP, Kinane DF. Microbial comparison of smoker and non-smoker adult and early-onset periodontitis patients by polymerase chain reaction. J Clin Periodontol. 2000;27:417-424.
  16. Saygun I, Kubar A, Ozdemir A, Yapar M, Slots J. Herpesviral-bacterial interrelationships in aggressive periodontitis. J Periodontal Res. 2004;39:207-212.
  17. Colombo AV, Silva CM, Haffajee A, Colombo AP. Identification of oral bacteria associated with crevicular epithelial cells from chronic periodontitis lesions. J Med Microbiol. 2006;55:609-615.
  18. Albandar JM, Brown LJ, Löe H. Putative periodontal pathogens in subgingival plaque of young adults with and without early-onset periodontitis. J Periodontol. 1997;68:973-981.

Abbreviations

CD: Crohn\'s diseases
NOD: Nukleotide-Oligodimerisation-Domain
CARD: Caspase Recruitment Domain
A.a.: Actinobacillus actinomycetemcomitans
P.g.: Porphyromonas gingivalis
P.i.: Prevotella intermedia
T.f.: Tannerella forsythia
C.r.: Campylobacter rectus
PI: Plaque Index (Silness & Loe)
GI: Gingiva Index (Loe & Silness)
PD: Probing depth
CAL: Clinical attachment level
 

This Poster was submitted by Dr. Jamal M. Stein.
 

Correspondence address:
Dr. Jamal M. Stein
University Hospital RWTH Aachen
Department of Operative Dentistry and Periodontology
Pauwelsstrasse 30
52074 Aachen
Germany