Go with your gut on oral hygiene

In the UK, 66 people are diagnosed with inflammatory bowel disease (IBD) every day.[i] IBD refers to a group of disorders that inflame the colon and small intestine; ulcerative colitis and Crohn’s disease are the two most common in this category.ⁱ The disease places a notable demand on healthcare resources, prompting the need for a greater awareness of its symptoms and how to manage it.[ii]

For dental practitioners, IBD’s association with oral diseases, such as dental caries and periodontitis, must be taken into consideration. As a patient with IBD is more susceptible to develop an oral disease, and as a patient with an oral disease is more likely to develop IBD, practitioners must help break this link by promoting a consistent oral hygiene routine.

Understanding IBD

The aetiology of IBD is often unknown. However, those with parents or grandparents who have IBD are more likely to develop it,[iii] with white ethnic groups having the highest prevalence of it.[iv] It is a lifelong, debilitating condition with no cure, affecting half a million Brits of varying age groups.^iv

With IBD, the immune system attacks the bowel, causing it to inflame. Patients can greatly struggle, with common symptoms including severe stomach pain and diarrhoea. Other signs and symptoms can present, such as blood or mucus in faeces, feeling constantly tired and losing weight without trying.ⁱⁱⁱ These symptoms can be evident up to 10 years before a diagnosis.[v] IBD can lead to days off work or school, a withdrawal from social environments, and an inability to go about the day or perform simple tasks. As such, anxiety and depression symptoms are associated with it, emphasising the need for a multidisciplinary approach to managing IBD.^v

Oral disease and IBD

For IBD patients, the impacted immune system causes changes in the proinflammatory cytokines and oxidative status markers. This is the same cause that progresses periodontitis, leading to tissue destruction.[vi] Whilst many may associate the gut with being part of the torso, the gastrointestinal tract connects the gut with the oral cavity, increasing the spread of proinflammatory cytokines. The immune system then sends antibodies to reduce the inflammation in the gingivae, damaging the teeth’s supportive structures and increasing the risk of oral disease.[vii] As such, there is a higher prevalence of caries and periodontitis in IBD patients. Caries is notable in ulcerative colitis patients, with its dysbiosis leading to increased levels of streptococcus mutans, the microbe that contributes to enamel demineralisation and tooth decay.^vi IBD patients are therefore at greater risk from oral disease.

A poor diet has been associated with IBD patients. The World Health Organization found that those with IBD ate more sugary foods, such as jam, sweets, and carbonated soft drinks, like lemonade.[viii] Furthermore, 30% of IBD patients had oral lesions.[ix] Advising IBD patients to avoid sugary or processed foods and drinks can play a crucial role in reducing the prevalence of caries and managing IBD symptoms.^vii

IBD can be treated with medication, such as steroids.ⁱⁱⁱ A disadvantage is that these medications can cause xerostomia, stalling saliva secretion and depriving the oral cavity’s natural defence against harmful acids.^vii This exposes the region to a higher chance of infection, such as the recurrent mouth ulcers found in Crohn’s and ulcerative colitis patients.^vii Dental practitioners should recommend solutions for dry mouth, such as chewing sugar-free gum or speaking to a pharmacist.

Wash it away

To help IBD patients repel the threat of oral diseases, recommend using the Cordless Advanced from Waterpik^TM, the leading water flosser brand. Reenergise their oral health with this innovative device that can remove up to 99.99% of plaque.[x] The Cordless Advanced can be customised for optimal compliancy with its four tips, three pressure settings and a full 360-degree tip rotation. This helps the patient find the most comfortable and effective setting for the best results in preventing oral disease infection.

A patient’s quality of life can be reduced by IBD. With overlapping impacts on oral health, physical health and mental health, a multi-disciplinary approach is needed to manage its symptoms. Dental practitioners are a key part of this, and guiding IBD patients towards a reliable oral hygiene routine can play a big role in restoring quality of life.

For more information on Waterpik^TM water flosser products visit www.waterpik.co.uk. Waterpik^TM products are available from Amazon, Costco UK, Argos, Boots and Tesco online and in stores across the UK and Ireland.

Anne Symons is  a Dental Hygienist currently working in a Specialist  Periodontal/implant practice and also a busy NHS surgery. She has previously worked in a Max Fax unit, and also taught Oral Health  care to staff in Nursing and Residential  homes.

[i] Takeaways, K. (n.d.). Epidemiology Summary: Incidence and Prevalence of IBD in the United Kingdom. [online] Available at: https://crohnsandcolitis.org.uk/media/4e5ccomz/epidemiology-summary-final.pdf.

[ii] Freeman, K., Ryan, R., Parsons, N., Taylor-Phillips, S., Willis, B.H. and Clarke, A. (2021). The incidence and prevalence of inflammatory bowel disease in UK primary care: a retrospective cohort study of the IQVIA Medical Research Database. BMC Gastroenterology, [online] 21(1). doi:https://doi.org/10.1186/s12876-021-01716-6.

[iii] NHS (2019). Inflammatory Bowel Disease. [online] NHS. Available at: https://www.nhs.uk/conditions/inflammatory-bowel-disease/.

[iv] Crohn’s & Colitis UK (2022). New research shows over 1 in 123 people in UK living with Crohn’s or Colitis. [online] crohnsandcolitis.org.uk. Available at: https://crohnsandcolitis.org.uk/news-stories/news-items/new-research-shows-over-1-in-123-people-in-uk-living-with-crohn-s-or-colitis.

[v] Written evidence submitted by Crohn’s & Colitis UK (CBP0076). UK Parliament. Accessed via:  https://committees.parliament.uk/writtenevidence/38713/pdf/

[vi] Nijakowski, K., Gruszczyński, D. and Surdacka, A. (2021). Oral Health Status in Patients with Inflammatory Bowel Diseases: A Systematic Review. International Journal of Environmental Research and Public Health, 18(21), p.11521. doi:https://doi.org/10.3390/ijerph182111521.

[vii] Oral Health Foundation. (2022). Crohn’s and Colitis: how can it affect my teeth. [online] Available at: https://www.dentalhealth.org/blog/crohns-and-colitis-how-can-it-affect-my-teeth.

[viii] Google Books. (2024). Oral Health Surveys. [online] Available at: https://books.google.co.uk/books?hl=en&lr=&id=8rEXDAAAQBAJ&oi=fnd&pg=PP1&dq=+World+Health+Organization.+Oral+Health+Surveys.+2013:+125.&ots=fEFMWZwA_x&sig=-cDP5XWrFrsR7PPXrp7w_AM_ei4&redir_esc=y#v=onepage&q=jam&f=false [Accessed 22 Oct. 2024].

[ix] Bertl, K., Johan Burisch, Nikolaos Pandis, Klinge, B. and Stavropoulos, A. (2023). Patients with inflammatory bowel disease have more oral health problems and higher costs of professional dental care than healthy controls: The Periodontitis Prevalence in ulcerative Colitis and Crohn disease (PPCC) case‐control study. Journal of Periodontology. doi:https://doi.org/10.1002/jper.23-0325.

[x] Gorur, A., Lyle, D.M., Schaudinn, C. and Costerton, J.W. (2009). Biofilm removal with a dental water jet. Compendium of Continuing Education in Dentistry (Jamesburg, N.J.: 1995), [online] 30 Spec No 1, pp.1–6. Available at: https://pubmed.ncbi.nlm.nih.gov/19385349/.