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

Abstract

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.