Pathogenic associations between oral and gastrointestinal diseases

Abstract

Both periodontitis and inflammatory bowel disease (IBD) are complex chronic conditions characterized by aberrant host immune response and dysregulated microbiota. Emerging data show an association between periodontitis and IBD, including direct and indirect mechanistic links between oral and intestinal inflammation. Direct pathways include translocation of proinflammatory microbes from the oral cavity to the gut and immune priming. Indirect pathways involve systemic immune activation with possible nonspecific effects on the gut. There are limited data on the effects of periodontal disease treatment on IBD course and vice versa, but early reports suggest that treatment of periodontitis decreases systemic immune activation and that treatment of IBD is associated with periodontitis healing, underscoring the importance of recognizing and treating both conditions.

Keywords: immunology; inflammatory bowel disease; microbiome; oral–gut axis; pathobiont; periodontal disease.

Figure 1.. Mechanisms of periodontal and intestinal inflammation.

In the setting of host factors that increase susceptibility periodontal disease with altered microbial communities and activation of inflammatory T cells through dendritic cell signaling can lead to intestinal inflammation. This occurs through enteric transmission of inflammatory microbes that lead to in situ T cell activation and through hematogenous and lymphatic migration of activated T-cells to the gut. Abbreviations: DC=dendritic cell, IFN=interferon, IL=interleukin, MMP=matrix metalloprotease, Mφ=macrophage, Th=T-helper, TNF=tumor necrosis factor.