Background Periodontal disease (PD) is a chronic bacterial infection of the supporting structures of the teeth. Behçet's Disease (BD) is a chronic multi-systemic inflammatory vasculitis. PD and BD have strong similarities in the underlying pathological processes; chronic inflammation and immune dysfunction are central to both diseases and both are modulated by cytokines which are mediators of inflammation.
Objectives The present study was designed to assess the association between PD and BD and to determine the effects of periodontal disease on disease severity and activity in patients with BD.
Methods Forty BD patients (36 males; 4 females) of mean age 33.5 years and mean disease duration 6.0 years fulfilling the criteria of the International Study Group for Behçet's disease and 30 age-sex-socioeconomic-dental hygiene-matched controls were assessed for PD. Exclusion criteria included smoking, diabetes mellitus, cancer and other inflammatory conditions. All subjects underwent a clinical, dental, laboratory and radiological evaluation. Clinical activity was assessed at the time of entry into the study on the basis of active symptoms and signs- oral ulcers, genital ulcers, eye lesions (retinal vasculitis, anterior or posterior uveitis), thrombophlebitis, active arthritis, positive pathergy test and laboratory findings (high ESR, elevated hsCRP and raised neutrophil count). Patients having at least 2 of the active signs and symptoms and both elevated ESR and hs-CRP were considered to have active disease. All 40 patients had oral ulcerations, 38 had skin lesions, 35 had genital ulcers, 20 had ocular lesions, 15 had arthritis, 20 had vascular lesions and 3 had central nervous system manifestations. BD patients were also assessed for clinical severity score (CSS). Physicians assessed the global improvement (PGA) in ulcer count and pain using a visual analogue scale (VAS) 0-10. The dental exam included a full-mouth periodontal exam for assessment of PD by gingival bleeding, recession, calculus, attachment levels and loss of teeth as well as pantomography X-ray evaluation. Blood samples were obtained and the hs-CRP, ESR and TNF alpha were assayed.
Results The findings of this study showed an association between PD and BD. Of the 40 BD patients studied, 29 (73%) had PD. Active BD patients (23/40) had significantly more PD and higher serum levels of ESR, hsCRP and TNF alpha when compared to inactive (17/40) BD patients. The severity of PD correlated to BD disease duration (r =0.528, p<0.001), VAS for pain (r =0.424, p<0.001), CCS (r =0.554, p<0.001), PGA (r =0.478, p<0.001), TNF- alpha (r =0.557, p<0.001), ESR (r =0.385, p<0.005) and hs-CRP (r =0.583, p<0.003) respectively.
Conclusions It can be concluded that there is an association between periodontitis and BD. Our results showed that PD is prevalent in BD patients and associated with disease severity. PD creates a “systemic inflammation” milieu which further adds to the inflammation burden of BD aiding the progression of the disease. A better understanding of the biological processes common to both diseases may help in finding new ways to treat them with medications that modify the body's response to inflammation. Oral health thus becomes an important parameter of medical health and quality of life in BD sufferers.
Disclosure of Interest None declared