Skin cells grow and flake off from the human body, allowing new cells to move to the surface and continue protecting the body. This cycle takes four weeks, but for patients with psoriasis, it takes a few days.[i] In the UK, this rapid growth affects 2% of people and, whilst able to start at any age, often develops in those aged 20-30 and 50-60.[ii] Psoriasis’s effect on the skin can have many adverse health impacts.
Dental practitioners should be aware that psoriasis has a notable association with oral health: patients presenting with psoriasis may be at a greater risk of oral disease, particularly periodontitis.i Between practitioner and patient, a stronger understanding of this connection is essential to promote the importance of a consistent oral hygiene routine.
Background
The exact cause of psoriasis is unknown, but can be genetic.[iii] Defined as an immune-mediated inflammatory disease, psoriasis sees inflammatory cells accumulate in the dermis, leading to the faster growth of the cells in the epidermis and subsequent scaly patches.i These are most commonly found on the knees, elbows, scalp and lower back, but can appear anywhere, causing discomfort, pain and discoloration. Psoriasis scales can be temperamental in frequency; a period of inactivity may then be followed by more severe symptoms.ii
The flaking skin or visible scales can make people feel self-conscious, impacting social situations and inhibiting their quality of life. This can create a vicious circle as, for up to 88% of afflicted patients, stress is one of the factors that can exacerbate a flare-up.iii Other risk factors for severe symptoms include obesity, poor diet, alcohol consumption, and smoking; these issues are also associated with periodontitis.i When chronic, psoriasis can affect the entire body and increases the risk of heart disease, cancer, inflammatory bowel disease and psoriatic arthritis, making it a key condition to manage.i
Oral health impacts
Oral health impactsAmong psoriasis patients, it has been observed that the risk of periodontal disease doubles, with one-third of psoriasis patients suffering from periodontitis.[iv] What connects the two conditions is a similar inflammatory process, as well as how periodontal infections are also considered a source of superantigen, a molecule that may initiate and worsen psoriasis patches.iv The relationship between the two is stronger when either disease is in its severe form, with the inflammation from both having major impacts on the oral cavity.[v]
Psoriasis can also present on the lips, tongue and other surfaces of the oral cavity. Whilst this is less common, oral psoriasis can cause problems, such as pain and discomfort when swallowing, an enhanced risk of tooth decay, loosening of the teeth, and reduction in the alveolar bone.[vi] Combined with the inflammation and weakening of the tooth-supporting structures from periodontitis, this leads to a higher rate of tooth loss for psoriasis patients.
The correlation between obesity and severe psoriasis is also crucial, as oral diseases are more prevalent among patients with a poor diet.[vii] Research has shown that overweight or obese psoriasis patients experienced a 50-75% drop in severity when they lost 12% of their body weight over a 10-week period, promoting the need for dietary guidelines among at-risk patients.i Certain foods found in unhealthy diets, such as carbonated soft drinks and ultra-processed foods, are inflammatory, intensifying a psoriasis flare-up. To lower the risk of this, practitioners should recommend a diet rich in antioxidants: fruit, vegetables, fish, and unprocessed alternatives.i Following this guidance, such as with a Mediterranean diet, can help vulnerable patients reduce the risk of diseases like caries, periodontitis, obesity and cardiovascular disease, leading to a healthier and happier lifestyle.[viii]
A daily solution
As psoriasis patients are more likely to experience oral health complications, practitioners must identify them early and encourage regular check-ups, as well as conducting examinations for periodontitis. Along with an anti-inflammatory diet, it is paramount that at-risk patients are shown the importance of interdental cleaning to reduce the threat of periodontitis.
To achieve optimal oral hygiene results, recommend the CPS interdental brush range from Curaprox. Available in five different sizes and utilising an eco-friendly click-system to minimise waste, each CPS interdental brush creates an umbrella effect with its ultrafine bristles. This ensures that any food particles or bacteria trapped in the interdental spaces can be removed with ease, reducing the risk of periodontitis and caries.
Psoriasis symptoms can have detrimental effects on a patient’s quality of life. Due to its strong association with periodontitis and other health complications, practitioners must increase awareness about how diet and a consistent oral hygiene routine can combat the symptoms of psoriasis, leading to excellent, long-term health outcomes.
To arrange a Practice Educational Meeting with your Curaden Development Manager please email us on sales@curaden.co.uk
For more information, please visit www.curaprox.co.uk and www.curaden.co.uk
Author: Andrew Turner Curaden UK Head of Marketing UK & Ireland
[i] www.medicalnewstoday.com. (2023). Psoriasis and chronic inflammation: What is the link? [online] Available at: https://www.medicalnewstoday.com/articles/psoriasis-and-chronic-inflammation#lifestyle-tips.
[ii] NHS Choices (2020). Overview – Psoriasis. [online] NHS. Available at: https://www.nhs.uk/conditions/psoriasis/.
[iii] Esra Pancar Yuksel, Dilek Durmus and Gokhan Sarisoy (2019). Perceived stress, life events, fatigue and temperament in patients with psoriasis. Journal of international medical research, 47(9), pp.4284–4291. doi:https://doi.org/10.1177/0300060519862658.
[iv] Nijakowski, K., Gruszczyński, D., Kolasińska, J., Kopała, D. and Surdacka, A. (2022). Periodontal Disease in Patients with Psoriasis: A Systematic Review. International Journal of Environmental Research and Public Health, 19(18), p.11302. doi:https://doi.org/10.3390/ijerph191811302.
[v] Meissner, M. (2021). Is Psoriasis Linked to Dental Health? [online] Healthline. Available at: https://www.healthline.com/health/psoriasis/psoriasis-dental-health.
[vi] Healthline. (2021). Psoriasis and Your Teeth: Problems, Tips, and More. [online] Available at: https://www.healthline.com/health/psoriasis/psoriasis-dental-health#psoriasis-and-your-teeth.
[vii] www.medicalnewstoday.com. (2023). How dental health and psoriasis are related. [online] Available at: https://www.medicalnewstoday.com/articles/dental-health-and-psoriasis.
[viii] Martinon, P., Fraticelli, L., Giboreau, A., Dussart, C., Bourgeois, D. and Carrouel, F. (2021). Nutrition as a Key Modifiable Factor for Periodontitis and Main Chronic Diseases. Journal of Clinical Medicine, [online] 10(2), p.E197. doi:https://doi.org/10.3390/jcm10020197.
