INTRODUCTION: It is a well-known fact that oral and general health are directly related. Numerous systemic and dermatological conditions have oral manifestation and vice versa—the oral microbiome affects the general status. It has been noted recently that dental and particularly periodontal health could be a significant modifying factor in the etiopathogenesis of various mucocutaneous conditions, such as Behçet’s disease, psoriasis, lichen planus, mucous membrane pemphigoid, pemphigus, atopic dermatitis, etc.
AIM: The current review article aims to evaluate the role of oral health in the course of some common dermatological conditions, determine the correlation if there is any, and find the research gaps in the literature.
MATERIALS AND METHODS: The study is based on 88 keyword-matching articles. An electronic search using PubMed, MEDLINE, and Google Scholar databases was conducted until June 2022. We performed a meticulous analysis of the available data and gave some major guidelines for further research.
RESULTS: Oral involvement is a common feature of various mucocutaneous diseases. What is still a subject of interest is whether and how poor oral health influences the course and prognosis of these conditions. It has been suggested that chronic periodontitis could be a significant modifying factor, considering its bacterial etiology. Some authors even claim that adequate periodontal treatment could lead to remission of the skin disease.
CONCLUSION: There is strong evidence that general and oral health are closely related. Further research is still necessary to determine the exact role of periodontal status and oral hygiene in the etiopathogenesis of the above-mentioned dermatological conditions.
Barber HW. The relationship of dental infection to diseases of the skin. Proc R Soc Med. 1927;20(9):1421-30.
Offenbacher S, Heasman PA, Collins JG. Modulation of host PGE2 secretion as a determinant of periodontal disease expression. J Periodontol. 1993 May;64(5 Suppl):432-44. doi: 10.1902/jop.1993.64.5s.432. .
Bansal T, Pandey A, Deepa D, Asthana AK. C-reactive protein (CRP) and its association with periodontal disease: a brief review. J Clin Diagn Res. 2014;8(7):ZE21–4. doi: 10.7860/JCDR/2014/8355.4646.
Okuda K, Ebihara Y. Relationships between chronic oral infectious diseases and systemic diseases. Bull Tokyo Dent Coll. 1998;39(3):165–74.
Yazici H, Seyahi E, Hatemi G, Yazici Y. Behcet syndrome: a contemporary view. Nat Rev Rheumatol. 2018;14(2):107–19. doi: 10.1038/nrrheum.2017.208.
Direskeneli H. Behcet's disease: infectious aetiology, new autoantigens, and HLA-B51. Ann Rheum Dis. 2001;60(11):996–1002. doi: 10.1136/ard.60.11.996.
Gul A. Behcet's disease: an update on the pathogenesis. Clin Exp Rheumatol. 2001;19(5 Suppl. 24):S6–12.
Emmi G, Prisco D. Behcet's syndrome: focus on pathogenetic background, clinical phenotypes and specific treatments. Intern Emerg Med. 2019;14(5):639–43. doi: 10.1007/s11739-019-02154-9.
Leccese P, Ozguler Y, Christensen R, Esatoglu SN, Bang D, Bodaghi B, et al. Management of skin, mucosa and joint involvement of Behcet's syndrome: a systematic review for update of the EULAR recommendations for the management of Behcet's syndrome. Semin Arthritis Rheum. 2019;48(4):752–62. doi: 10.1016/j.semarthrit.2018.05.008.
Isogai E, Isogai H, Ohno S, Kimura K. Role of Streptococcus sanguis and traumatic factors in Behcet's disease. J Appl Res. 2003;3(1):64–75.
Yoshikawa KKS, Sasamoto Y, Ohno S, Matsuda H. Close association of Streptococcus sanguis and Behcet's Disease. Nippon Ganka Gakkai Zasshi. 1991;95(12):1261–7.
Mizushima YMT, Hoshl K, Ohno S. Induction of Behçet's disease symptoms after dental treatment and streptococcal antigen skin test. J Rheumatol. 1988;15(6):1029–30.
The Behçet's Disease Research Committee of Japan. Skin hypersensitivity of streptococal antigens and the induction of systemic symptoms by the antigens in Behçet Disease. J Rheumatol. 1989;16(4):506–11.
Kaneko F, Oyama N, Yanagihori H, Isogai E, Yokota K, Oguma K. The role of streptococcal hypersensitivity in the pathogenesis of Behcet's Disease. Eur J Dermatol. 2008;18(5):489–98. doi: 10.1684/ejd.2008.0484.
Isogai E, Ohno S, Kotake S, Isogai H, Tsurumizu T, Fujii N, et al. Chemiluminescence of neutrophils from patients with Behcet's disease and its correlation with an increased proportion of uncommon serotypes of Streptococcus sanguis in the oral flora. Arch Oral Biol. 1990;35(1):43–8. doi: 10.1016/0003-9969(90)90113-O.
Tojo MYH, Zheng X, Noritaka O, Emiko I, Koichi K, Koichiro N, et al. Bes-1 DNA fragment encoding streptococcal antigen in skin lesions from patients with Behcet's disease. J Appl Res. 2003;3(3):232–8.
Miura T, Ishihara K, Kato T, Kimizuka R, Miyabe H, Ando T, et al. Detection of heat shock proteins but not superantigen by isolated oral bacteria from patients with Behcet's disease. Oral Microbiol Immunol. 2005;20(3):167–71. doi: 10.1111/j.1399-302X.2005.00207.x.
Fortune F, Hatemi G. Behçet Syndrome and Microbes. In: Yazici Y, Hatemi G, Seyahi E, Yazici H, editors. Behçet Syndrome. 2nd ed. Springer Nature Switzerland AG; 2020. p. 191–201.
Mumcu G, Direskeneli H. Triggering agents and microbiome as environmental factors on Behcet's syndrome. Intern Emerg Med. 2019;14(5):653–60. doi: 10.1007/s11739-018-2000-1.
Direskeneli H, Mumcu G. A possible decline in the incidence and severity of Behcet's disease: implications for an infectious etiology and oral health. Clin Exp Rheumatol. 2010;28 (4 Suppl. 60):S86–90.
Mumcu G, Alibaz Oner F, Ergun SAT, Direskeneli RH. Decreasing incidence and severity of Behcet's disease is decreasing: a changing trend in epidemiological spectrum possibly associated with oral health. Turk J Med Sci. 2020;50(SI-2):1587–90. doi: 10.3906/sag-2003-147.
Mumcu G. Behcet's disease: a dentist's overview. Clin Exp Rheumatol. 2008;26(4 Suppl. 50):S121–4.
Mumcu G, Inanc N, Yavuz S, Direskeneli H. The role of infectious agents in the pathogenesis, clinical manifestations and treatment strategies in Behcet's disease. Clin Exp Rheumatol. 2007;25(4 Suppl. 45):S27–33.
Coit P, Mumcu G, Ture-Ozdemir F, Unal AU, Alpar U, Bostanci N, et al. Sequencing of 16S rRNA reveals a distinct salivary microbiome signature in Behcet's disease. Clin Immunol. 2016;169:28–35. doi: 10.1016/j.clim.2016.06.002.
Seoudi N, Bergmeier LA, Drobniewski F, Paster B, Fortune F. The oral mucosal and salivary microbial community of Behcet's syndrome and recurrent aphthous stomatitis. J Oral Microbiol. 2015;7:27150. doi: 10.3402/jom.v7.27150.
Fortune F. Can you catch Behcet's disease? J Lab Clin Med. 2003;141(1):5–6. doi: 10.1067/mlc.2003.2.
Tojo M, Zheng X, Yanagihori H, Oyama N, Takahashi K, Nakamura K, et al. Detection of herpes virus genomes in skin lesions from patients with Behcet's disease and other related inflammatory diseases. Acta Derm Venereol. 2003;83(2):124–7. doi: 10.1080/00015550310007472.
Bergmeier L. Oral mucosa in health and disease: A concise handbook. Springer; 2018.
Isogai E IH, Kotake S, Ohno S, Ishihara M, Aoki K, Tojo M, et al. Antibody cross reactivity from sera of patients with Behçet's disease with synthetic peptides that have homologies with proteins from Streptococcus sanguis. J Appl Res. 2002;2(3):185–91.
Manthiram K, Preite S, Dedeoglu F, Demir S, Ozen S, Edwards KM, et al. Common genetic susceptibility loci link PFAPA syndrome, Behcet's disease, and recurrent aphthous stomatitis. Proc Natl Acad Sci USA. 2020;117(25):14405–11. doi: 10.1073/pnas.2002051117.
Dudding T, Haworth S, Lind PA, Sathirapongsasuti JF, Tung JY, Mitchell R, et al. Genome wide analysis for mouth ulcers identifies associations at immune regulatory loci. Nat Commun. 2019;10(1):1052. doi: 10.1038/s41467-019-08923-6.
Mumcu G, Ergun T, Inanc N, Fresko I, Atalay T, Hayran O, et al. Oral health is impaired in Behcet's disease and is associated with disease severity. Rheumatology (Oxford). 2004;43(8):1028–33. doi: 10.1093/rheumatology/keh236.
Yay M, Celik Z, Aksoy A, Alibaz-Oner F, Inanc N, Ergun T, et al. Oral health is a mediator for disease severity in patients with Behcet's disease: a multiple mediation analysis study. J Oral Rehabil. 2019;46(4):349–54. doi: 10.1111/joor.12750.
Akman A, Ekinci NC, Kacaroglu H, Yavuzer U, Alpsoy E, Yegin O. Relationship between periodontal findings and specific polymorphisms of interleukin-1alpha and−1beta in Turkish patients with Behcet's disease. Arch Dermatol Res. 2008;300(1):19–26. doi: 10.1007/s00403-007-0794-1.
Akman A, Sallakci N, Kacaroglu H, Tosun O, Yavuzer U, Alpsoy E, et al. 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;22(8):950–7. doi: 10.1111/j.1468-3083.2008.02678.x
Kaneko F, Oyama N, Nishibu A. Streptococcal infection in the pathogenesis of Behcet's disease and clinical effects of minocycline on the disease symptoms. Yonsei Med J. 1997;38(6):444–54. doi: 10.3349/ymj.1997.38.6.444.
Kaneko F, Tojo M, Sato M, Isogai E. The role of infectious agents in the pathogenesis of Behcet's disease. Adv Exp Med and Biol. 2003;528:181–3. doi: 10.1007/0-306-48382-3_35.
Narikawa S, Suzuki Y, Takahashi M, Furukawa A, Sakane T, Mizushima Y. Streptococcus oralis previously identified as uncommon ‘Streptococcus sanguis’ in Behcet's disease. Arch Oral Biol. 1995;40(8):685–90. doi: 10.1016/0003-9969(95)00042-N.
Mumcu G, Ergun T, Elbir Y, Eksioglu-Demiralp E, Yavuz S, Atalay T, et al. Clinical and immunological effects of azithromycin in Behcet's disease. J Oral Pathol Med. 2005;34(1):13–6. doi: 10.1111/j.1600-0714.2004.00265.x
Mumcu G, Inanc N, Ozdemir FT, Tulunay A, Eksioglu-Demiralp E, Ergun T, et al. Effects of azithromycin on intracellular cytokine responses and mucocutaneous manifestations in Behcet's disease. Int J Dermatol. 2013;52(12):1561–6. doi: 10.1111/ijd.12144.
Mumcu G, Inanc N, Aydin SZ, Ergun T, Direskeneli H. Association of salivary S. mutans colonisation and mannose-binding lectin deficiency with gender in Behcet's disease. Clin Exp Rheumatol. 2009;27(2 Suppl. 53):S32–6.
Celenligil-Nazliel H, Kansu E, Ebersole JL. Periodontal findings and systemic antibody responses to oral microorganisms in Behcet's disease. J Periodontol. 1999;70(12):1449–56. doi: 10.1902/jop.1999.70.12.1449.
Karacayli U, Mumcu G, Simsek I, Pay S, Kose O, Erdem H, et al. 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;38(5):410-5. doi: 10.1111/j.1600-0714.2009.00765.x
Mumcu G, Fortune F. Oral health and its aetiological role in Behçet's disease. Front Med (Lausanne). 2021;8:613419. doi: 10.3389/fmed.2021.613419.
Antal M, Braunitzer G, Mattheos N, Gyulai R, Nagy K. Smoking as a permissive factor of periodontal disease in psoriasis. PLoS One. 2014;9(3):e92333. doi: 10.1371/journal.pone.0092333. Erratum in: PLoS One. 2014;9(10):e110975.
Lazaridou E, Tsikrikoni A, Fotiadou C, Kyrmanidou E, Vakirlis E, Giannopoulou C, et al. Association of chronic plaque psoriasis and severe periodontitis: a hospital based case-control study. J Eur Acad Dermatol Venereol. 2013;27(8):967-72. doi: 10.1111/j.1468-3083.2012.04615.x..
Nakib S, Han J, Li T, Joshipura K, Qureshi AA. Periodontal disease and risk of psoriasis among nurses in the United States. Acta Odontol Scand. 2013;71(6):1423-9. doi: 10.3109/00016357.2013.766360.
Skudutyte-Rysstad R, Slevolden EM, Hansen BF, Sandvik L, Preus HR. Association between moderate to severe psoriasis and periodontitis in a Scandinavian population. BMC Oral Health. 2014;14:139. doi: 10.1186/1472-6831-14-139.
Sharma A, Raman A, Pradeep AR. Association of chronic periodontitis and psoriasis: periodontal status with severity of psoriasis. Oral Dis. 2015;21(3):314-9. doi: 10.1111/odi.12271.
Woeste S, Graetz C, Gerdes S, Mrowietz U. Oral health in patients with psoriasis-a prospective study. J Invest Dermatol. 2019;139(6):1237-44. doi: 10.1016/j.jid.2018.12.014.
Keller JJ, Lin HC. The effects of chronic periodontitis and its treatment on the subsequent risk of psoriasis. Br J Dermatol. 2012;167(6):1338-44. doi: 10.1111/j.1365-2133.2012.11126.x.
Telfer NR, Chalmers RJ, Whale K, Colman G. The role of streptococcal infection in the initiation of guttate psoriasis. Arch Dermatol. 1992;128(1):39–42.
Thorleifsdottir RH, Eysteinsdóttir JH, Olafsson JH, Sigurdsson MI, Johnston A, Valdimarsson H, et al. Throat Infections are Associated with Exacerbation in a Substantial Proportion of Patients with Chronic Plaque Psoriasis. Acta Derm Venereol. 2016;96(6):788-91. doi: 10.2340/00015555-2408.
Wu W, Debbaneh M, Moslehi H, Koo J, Liao W. Tonsillectomy as a treatment for psoriasis: a review. J Dermatolog Treat. 2014;25(6):482-6. doi: 10.3109/09546634.2013.848258.
Thorleifsdottir RH, Sigurdardottir SL, Sigurgeirsson B, Olafsson JH, Petersen H, Sigurdsson MI, et al. HLA-Cw6 homozygosity in plaque psoriasis is associated with streptococcal throat infections and pronounced improvement after tonsillectomy: A prospective case series. J Am Acad Dermatol. 2016;75(5):889-96. doi: 10.1016/j.jaad.2016.06.061.
Johnston A, Gudjonsson JE, Sigmundsdottir H, Love TJ, Valdimarsson H. Peripheral blood T cell responses to keratin peptides that share sequences with streptococcal M proteins are largely restricted to skin-homing CD8(+) T cells. Clin Exp Immunol. 2004;138(1):83-93. doi: 10.1111/j.1365-2249.2004.00600.x.
Valdimarsson H, Sigmundsdóttir H, Jónsdóttir I. Is psoriasis induced by streptococcal superantigens and maintained by M-protein-specific T cells that cross-react with keratin? Clin Exp Immunol. 1997;107(Suppl 1):21–4.
Egeberg A, Mallbris L, Gislason G, Hansen PR, Mrowietz U. Risk of periodontitis in patients with psoriasis and psoriatic arthritis. J Eur Acad Dermatol Venereol. 2017;31(2):288-93. doi: 10.1111/jdv.13814.
Fadel HT, Flytström I, Calander AM, Bergbrant IM, Heijl L, Birkhed D. Profiles of dental caries and periodontal disease in individuals with or without psoriasis. J Periodontol. 2013;84(4):477-85. doi: 10.1902/jop.2012.120119..
Ganzetti G, Campanati A, Santarelli A, Pozzi V, Molinelli E, Minnetti I, et al. Involvement of the oral cavity in psoriasis: results of a clinical study. Br J Dermatol. 2015;172(1):282-5. doi: 10.1111/bjd.13201.
Preus HR, Khanifam P, Kolltveit K, Mørk C, Gjermo P. Periodontitis in psoriasis patients: a blinded, case-controlled study. Acta Odontol Scand. 2010;68(3):165-70. doi: 10.3109/00016350903583678.
Su NY, Huang JY, Hu CJ, Yu HC, Chang YC. Increased risk of periodontitis in patients with psoriatic disease: a nationwide population-based retrospective cohort study. PeerJ. 2017;5:e4064. doi: 10.7717/peerj.4064.
Ungprasert P, Wijarnpreecha K, Wetter DA. Periodontitis and risk of psoriasis: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2017;31(5):857-62. doi: 10.1111/jdv.14051.
Alani A, Seymour R. Systemic medication and the inflammatory cascade. Periodontol 2000. 2014;64(1):198-210. doi: 10.1111/j.1600-0757.2012.00454.x.
Hijazi K, Lowe T, Meharg C, Berry SH, Foley J, Hold GL. Mucosal microbiome in patients with recurrent aphthous stomatitis. J Dent Res. 2015;94(3 Suppl):87S-94S. doi: 10.1177/0022034514565458.
Cekić Arambašin A, Sistig S, Vučićević Boras V. Connection between the course of neurodermitis and oral focus finding. Acta Stomatol Croat. 2000;1(34):89–94.
Satoh T, Takayama K, Sawada Y, Yokozeki H, Nishioka K. Chronic nodular prurigo associated with nummular eczema: possible involvement of odontogenic infection. Acta Derm Venereol. 2003;83(5):376-7. doi: 10.1080/00015550310003728.
Satoh T, Yokozeki H, Nishioka K. Chronic pigmented purpura associated with odontogenic infection. JAAD. 2002;6(46):942–4.
Schaub B, Lauener R, von Mutius E. The many faces of the hygiene hypothesis. J Allergy Clin Immunol. 2006 May;117(5):969-77; quiz 978. doi: 10.1016/j.jaci.2006.03.003.
Azizi A, Rezaee M. Comparison of periodontal status in gingival oral lichen planus patients and healthy subjects. Dermatol Res Pract. 2012;2012:561232. doi: 10.1155/2012/561232.
Rai NP, Kumar P, Mustafa SM, Divakar DD, Kheraif AA, Ramakrishnaiah R, et al. Relation between periodontal status and pre-cancerous condition (oral lichen planus): A pilot study. Adv Clin Exp Med. 2016;25(4):763-6. doi: 10.17219/acem/59014.
Ertugrul AS, Arslan U, Dursun R, Hakki SS. Periodontopathogen profile of healthy and oral lichen planus patients with gingivitis or periodontitis. Int J Oral Sci. 2013;5(2):92–7. doi: 10.1038/ijos.2013.30.
Ramón-Fluixá C, Bagán-Sebastián J, Milián-Masanet M, Scully C. Periodontal status in patients with oral lichen planus: a study of 90 cases. Oral Dis. 1999;5(4):303–6. doi: 10.1111/j.1601-0825.1999.tb00094.x.
Macklis P, Adams K, Kaffenberger J, Kumar P, Krispinsky A, Kaffenberger B. The association between oral health and skin disease. J Clin Aesthet Dermatol. 2020;13(6):48-53.
Xue JL, Fan MW, Wang SZ, Chen XM, Li Y, Wang L. A clinical study of 674 patients with oral lichen planus in China. J Oral Pathol Med. 2005;34(8):467-72. doi: 10.1111/j.1600-0714.2005.00341.x.
Bajaj DR, Khoso NA, Devrajani BR, Matlani BL, Lohana P. Oral lichen planus: a clinical study. J Coll Physicians Surg Pak. 2010;20(3):154-7.
Holmstrup P, Schiøtz AW, Westergaard J. Effect of dental plaque control on gingival lichen planus. Oral Surg Oral Med Oral Pathol. 1990;69(5):585–90. doi: 10.1016/0030-4220(90)90241-j.
Tricamo MB, Rees TD, Hallmon WW, Wright JM, Cueva MA, Plemons JM. Periodontal status in patients with gingival mucous membrane pemphigoid. J Periodontol. 2006;77(3):398-405. doi: 10.1902/jop.2006.050113.
Arduino PG, Farci V, D'Aiuto F, Carcieri P, Carbone M, Tanteri C, et al. Periodontal status in oral mucous membrane pemphigoid: initial results of a case-control study. Oral Dis. 2011;17(1):90-4. doi: 10.1111/j.1601-0825.2010.01709.x.
Scully C, Carrozzo M, Gandolfo S, Puiatti P, Monteil R. Update on mucous membrane pemphigoid: a heterogeneous immune-mediated subepithelial blistering entity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88(1):56-68. doi: 10.1016/s1079-2104(99)70194-0.
Schellinck AE, Rees TD, Plemons JM, Kessler HP, Rivera-Hidalgo F, Solomon ES. A comparison of the periodontal status in patients with mucous membrane pemphigoid: a 5-year follow-up. J Periodontol. 2009;80(11):1765-73. doi: 10.1902/jop.2009.090244.
Thorat MS, Raju A, Pradeep AR. Pemphigus vulgaris: effects on periodontal health. J Oral Sci. 2010;52(3):449-54. doi: 10.2334/josnusd.52.449.
Akman A, Kacaroglu H, Yilmaz E, Alpsoy E. Periodontal status in patients with pemphigus vulgaris. Oral Dis. 2008;14(7):640–3. doi: 10.1111/j.1601-0825.2008.01445.x.
Arduino PG, Broccoletti R, Sciannameo V, Scully C. A practical clinical recording system for cases with desquamative gingivitis. Br J Dermatol. 2017;177(1):299–301. doi: 10.1111/bjd.15075.
Gambino A, Carbone M, Arduino PG, Carcieri P, Carbone L, Broccoletti R. Conservative approach in patients with pemphigus gingival vulgaris: a pilot study of five cases. Int J Dent. 2014;2014:747506. doi: 10.1155/2014/747506.
Jascholt I, Lai O, Zillikens D, Kasperkiewicz M. Periodontitis in oral pemphigus and pemphigoid: A systematic review of published studies. J Am Acad Dermatol. 2017;76(5):975–978. e3. doi: 10.1016/j.jaad.2016.10.028.
Choi HA, Ahn SO, Lim HD, Kim GJ. Growth Suppression of a Gingivitis and Skin Pathogen Cutibacterium (Propionibacterium) acnes by Medicinal Plant Extracts. Antibiotics (Basel). 2021;10(9):1092. doi: 10.3390/antibiotics10091092.
Monib KME, El-Fallah AA, Salem RM. Inflammatory markers in acne vulgaris: Saliva as a novel diagnostic fluid. J Cosmet Dermatol. 2022;21(3):1280-5. doi: 10.1111/jocd.14236.
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