A new study reveals that Inflammatory Bowel Disease (IBD), which included Crohn's Disease and Ulcerative Colitis can be made worse by poor oral health.
Poor oral health has previously been proven to be associated with diabetes, cardio-vascular health and many other systemic diseases.
The study was carried out in collaboration by U-M Medical and Dental Schools. The disease is estimated to affect almost 3 million adults in the US alone.
Nobuhiko Kamada, PhD is an assistant professor of internal medicine in the division of gastroenterology, he has been studying the microflora of gut for years. Dr Kamada noted that there can be an emerging link in research literature between an overgrowth of foreign bacterial species in the guts of people with IBD and bacteria that are normally found in the mouth.
"I decided to approach the dental school to ask the question, does oral disease affect the severity of gastrointestinal diseases?" says Kamada.
The Prosposed Pathways!
There are two pathways by which the bacteria in the oral cavity appear to worsen the inflammation in the gut.
In the first pathway, periodontitis, leads to an imbalance in the normal healthy microbiome found in the oral cavity. This is due to increase in number of bacteria that causes periodontitis. Now these disease causing pathogens are proposed to travel from the oral cavity to the stomach. This alone may not be enough to set off gut inflammation but can aggravate the existing inflammation. "The normal gut microbiome resists colonisation by exogenous, or foreign, bacteria," says Kamada. "However, in mice with IBD, the healthy gut bacteria are disrupted, weakening their ability to resist disease-causing bacteria from the mouth”.
The second pathway proposed is that periodontitis activates the immune system’s T cells in the oral cavity. These T cells now travel to the stomach where they, too, exacerbate the inflammation. In normal circumstances the actions of inflammatory and regulatory T cells are balanced to tolerate the resident gut microflora. The inflammation in the oral cavity generates inflammatory T cells majorly. As they migrate from oral cavity to stomach, their normal environment is changed. Thus they trigger the immune response in the stomach, worsening the inflammation.
"This exacerbation of gut inflammation driven by oral organisms that migrate to the gut has important ramifications in emphasising to patients the critical need to promote oral health as a part of total body health and wellbeing", says co-author William Giannobile DDS, the William K and Mary Anne Najjar professor of dentistry and chair of the department of periodontics and oral medicine at the U-M School of Dentistry.
The study has implications for novel treatments for IBD because "far too many patients still fail medications, leading to reduced quality of life and eventual surgery”, says study co-author Shrinivas Bishu MD, assistant professor of gastroenterology. "This study importantly implies that clinical outcomes in IBD may be improved by monitoring oral inflammation — an intriguing concept."