Wednesday, May 19, 2010

Behcet's and your gums and teeth

I'm often asked whether people with Behcet's have an unusual amount of dental problems. Some people complain of having cavities along the gum line, while others have teeth that seem to fall apart or require a lot of crowns. And a small number of people give up entirely and have all of their teeth pulled, so that they can have dentures instead (which can lead to a whole host of other problems, like gum ulcers/lesions -- especially if the dentures don't fit well).

Face it, it can be hard to pay attention to your teeth and gums if you have a lot of problems with oral ulcers: Ulcers on your gums, tongue, and anywhere else in your mouth can make it really painful to brush and/or floss. Going to the dentist or periodontist can be a big problem, too, if you're one of the people who gets a flare following any dental work or cleaning.

While I was at the latest American Behcet's Disease Association medical conference at the end of April, a dentist spoke about BD and oral issues. He has a particular interest in the subject because his wife has Behcet's, and has needed an unbelievable number of root canals. Informal surveys that he's performed (including one that he did during his ABDA presentation) has shown that approx. 30% of BD patients have this need for multiple root canal procedures. If any readers have had this issue (or other tooth/cavity-related issues), please feel free to leave a comment at the end of this post. I'll forward relevant comments to the dentist, who is hoping to start formal research on this topic.

In the meantime, here are some summaries of published articles on Behcet's and dental problems:

The close association between dental and periodontal treatments 
and oral ulcer course in Behcet's disease: a prospective clinical study.
J Oral Pathol Med. 2009 May;38(5):410-5. Epub 2009 Mar 5.
Karacayli U, Mumcu G, Simsek I, Pay S, Kose O, Erdem H, Direskeneli H, 
Gunaydin Y, Dinc A.
Department of Oral and Maxillofacial Surgery, Gulhane School of Medicine, 
Ankara, Turkey. 
The aim of the study was to see the effect of dental and periodontal treatments 
on the course of oral ulcers in patients with Behcet's disease (BD). Fifty-eight 
BD patients with oral ulcers were studied. Twenty-nine patients were given 
dental and periodontal cleanings and treatment, while 29 in a control group 
were only given oral hygiene education. 
Results: There was an increase in the number of new oral ulcers within 
2 days of the treatment [period]. However, 6 months after the dental and 
periodontal treatments, the number of oral ulcers was significantly lower 
in the treated group compared with  the control group. 
Conclusion: The results suggest that, in BD patients, dental and 
periodontal therapies could be associated with a flare-up of oral ulcers 
in the short term, but may decrease their number in longer follow-up. 
They also lead to better oral health. 
PMID: 19320802 
Relationship between periodontal parameters and Behcet's 
disease and evaluation of different treatments for oral recurrent 
aphthous stomatitis.
J Periodontal Res. 2009 Dec;44(6):718-25. Epub 2008 Dec 11.
Arabaci T, Kara C, Ciçek Y. 
Department of Periodontology, Faculty of Dentistry, Atatürk University, Erzurum, 

"Since oral aphthous ulcers impair tooth brushing, reducing complaints about 
aphthous ulcers will motivate the patient to maintain better oral hygiene 
performance and will thus reduce plaque accumulation and periodontal scores. 
The purpose of this controlled case study was to evaluate the relationship 
between the severity of periodontal scores and Behcet's disease, and to 
compare the treatment modalities with neodymium-doped yttrium aluminium 
garnet (Nd:YAG) laser and medication on the recurrent aphthous ulcers in 
BD patients by considering the degree of pre- and post-treatment pain, 
discomfort and functional complications. 
Results: BD patients treated with the Nd:YAG laser had less post-treatment 
pain and fewer complications and reported immediate relief of pain and 
faster healing. 
Conclusion: Our results suggest that periodontal status is worse in 
BD patients and is associated with disease severity; also, the Nd:YAG 
laser has better patient acceptance, shorter treatment time and lower 
rates of pain and post-treatment adverse events among BD patients 
with oral recurrent aphthous stomatitis."
PMID: 19076988 [PubMed - indexed for MEDLINE]

Relationship between periodontal findings and the TNF-alpha Gene 
1031T/C polymorphism in Turkish patients with Behcet's disease
J Eur Acad Dermatol Venereol. 2008 Aug;22(8):950-7. Epub 2008 Mar 19. 
Akman A, Sallakci N, Kacaroglu H, Tosun O, Yavuzer U, Alpsoy E, Yegin O.
Department of Dermatology and Venerology, Akdeniz University School of 
Medicine,  Antalya, Turkey.

Background: "Genetic factors predispose individuals to Behcet's 
disease (BD)  and periodontal disease. Tumour necrosis factor-alpha 
(TNF-alpha) has been implicated in the pathogenesis [development] of 
both BD and periodontal disease. The relationship with periodontitis 
and the pathogenesis of BD has not yet been determined. 
Methods: Eighty-two unrelated patients with BD, 42 RAS [recurrent 
aphthous stomatitis] patients and 77 HC [healthy controls] were enrolled 
in the study. Periodontal status of all subjects was evaluated according 
to the World Health Organization community periodontal index of treatment 
needs (CPITN). 
Conclusions: Our data indicate that the TNF-alpha-1031T/C gene 
polymorphism (CC genotype) is a risk factor for periodontitis, RAS and 
BD patients and also suggests that long-term periodontal follow-up and 
education of oral hygiene in patients with BD may help to prevent the 
development and/or progression of the disease."
PMID: 18355201 

Relationship between periodontal findings and Behcet's disease: 
a controlled study.
J Clin Periodontol. 2007 Jun;34(6):485-91. Epub 2007 Apr 23. 
Akman A, Kacaroglu H, Donmez L, Bacanli A, Alpsoy E. 
Department of Dermatology and Venerology, Akdeniz University School 
of Medicine, Antalya, Turkey. 

BACKGROUND: "Behcet's disease (BD) is a chronic, relapsing, systemic vasculitis of
unknown aetiology. The involvement of oral mucosal surfaces represents the onset 
feature of the disease in the majority of patients. 
OBJECTIVE: The aim of this study was to evaluate the periodontal status of BD patients 
and then compare with recurrent aphthous stomatitis (RAS) patients and healthy controls. 
We also determined the relationship between the periodontal condition and the clinical
severity of the disease in BD patients. 
METHODS: Eighty-six patients with BD, 63 patients with RAS and 82 healthy subjects 
were included in the study. The periodontal status of all subjects was evaluated
according to the community periodontal index of treatment needs (CPITN). BD 
patients were also assessed for  clinical severity score (CSS) as described previously. 
were observed to be higher in BD patients (1.79 +/- 0.96) compared with RAS
patients (1.22 +/- 0.87) and healthy controls (1.18 +/- 0.98) (p<0.001). There
was a positive association between CSS and CPITN (p=0.017) in BD patients.
CONCLUSION: Our results showed that periodondal status is worse in BD patients
and associated with disease severity. We can speculate that periodontitis may
induce a systemic inflammatory process that may contribute to the development
and/or progression of BD. "
PMID: 17451414 

Periodontal findings and systemic antibody responses to oral microorganisms in
Behcet's disease.
J Periodontol. 1999 Dec;70(12):1449-56. 
Celenligil-Nazliel H, Kansu E, Ebersole JL. 
Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara,

BACKGROUND: "Behcet's disease is a multisystem disorder of unknown etiology,
affecting predominantly the oral mucosa, skin, and eyes. Recurrent and painful
episodes of oral ulcerations interfere with regular oral hygiene leading to rapid
bacterial plaque accumulation. The aims of this study were to evaluate the
periodontal status of patients with Behcet's disease and determine serum antibody
responses to selected oral microorganisms, including major periodontopathogens in
these patients. 
METHODS: Thirty-three patients with Behcet's disease and 15
healthy subjects were included in the study. Plaque, sulcular bleeding,
periodontal index scores, probing depths, and total number of teeth were
recorded. Serum IgG antibody levels to a panel of 13 oral microorganisms were
RESULTS: Significantly higher values for each of the clinical
measures were observed in patients with Behcet's disease compared to healthy
subjects (P <0.0001). Antibody levels to selected members of plaque, including
Actinomyces viscosus, Streptococcus mutans, Streptococcus sanguis, Streptococcus 
oralis, Eikenella corrodens, Campylobacter rectus, and Prevotella intermedia were
significantly lower in patients with Behcet's disease than in controls (P
<0.001-0.05). In contrast, these patients exhibited significantly elevated
antibody levels to Actinobacillus actinomycetemcomitans Y4 compared to controls
(P <0.01). 
CONCLUSIONS: Our data indicate that the patients with Behcet's disease
generally exhibit clinical findings of established periodontal disease. Decreased
antibody responses to early colonizers of both supra- and subgingival plaque were
observed along with the elevation in antibody levels to A. actinomycetemcomitans.
These results suggest that the bacterial plaque ecology and/or immune responses
to these microorganisms may be affected in Behcet's disease which could lead to
changes in the expression of periodontal disease. "
PMID: 10632520