Dentist examining teeth of person with psoriasis

Psoriasis and the Risk of Periodontal Disease

Plaque psoriasis can exist along with several other chronic health conditions (what is called co-morbidity), and it can also increase the risk of developing others, such as cardiovascular complications.  These ideas aren’t new to anyone with plaque psoriasis, however, there may be one more unexpected condition to add to the list of things to watch out for–periodontal disease (a growing and frustrating list!).

What is Periodontal Disease?

Periodontal disease, or gum disease, can be comprised of a variety of different conditions.  Some of these conditions are reversible and easily treatable, such as gingivitis, while others, like periodontitis, can permanently damage the gums and jaw bone and lead to tooth loss, exposure to invading bacteria, or connective tissue loss.  When the body responds to bacteria that cause gingivitis, it initiates a similar immune system pathway that is present in plaque psoriasis flare-ups.  While the body should respond this way in response to bad, invading bacteria, there is evidence that the same type of inflammation response that is seen with psoriasis can be initiated by oral lesions.  These lesions are hard to distinguish from normal gum and mouth inflammation and are often diagnosed as oral psoriasis only when a person is presenting with psoriatic skin lesions at the same time.  Any inflammation within the mouth can lead to weakening or destruction of the gums, worsening the risk of periodontal disease.

The Partnership of Psoriasis and Periodontal Disease

It makes sense that inflammation from psoriasis, on top of normal bodily bacterial responses, could exacerbate and increase the incidence of periodontal disease.  Several studies have been done over the years that compare the rate of periodontal disease markers in healthy individuals to those with psoriasis.1 A staggering correlation has been found that suggests that people with psoriasis are nearly 4.4 times more likely to develop periodontal disease, especially in its more severe forms, than their healthy counterparts.  While many of these studies have been small, and the types of periodontal disease—ranging from gingivitis to mild, moderate, or severe periodontitis with accompanying permanent gum or tooth loss—have been varied, it has become apparent that psoriasis plays a part in the start and progression of gum disease.  Even after adjustments for other potential confounding variables, the link between psoriasis on its own, and gum disease has remained strong in these studies.

Smoking Can Play a Huge Role

Another layer to this puzzle has recently been analyzed. Specifically, the role smoking plays in this relationship.  Smoking on its own is a risk factor for periodontal disease, increasing the risk of developing gum disease to a significant degree.  However, one study investigated how smoking affects the rate of gum disease development in people with psoriasis and found a staggering result.2 Those who had psoriasis, and who also smoked cigarettes, were 24.3 times more likely to develop periodontal disease!  That’s a nearly 6-fold increase in the risk of developing gum disease!  While the mechanism for this result isn’t completely understood, there is some speculation that it is a result of cigarette smoke causing your body to respond by increasing the usage of several immune-cell receptors, that are already over-used in psoriasis.  This can lead to an incredible up-usage of these receptors, leading to the immune or inflammatory response responsible for psoriatic lesions, as well as periodontal disease.

While more research needs to be done to determine how these two conditions are actually related through inflammatory pathways, or just correlated through the increase in risk, this is still an interesting relationship to consider and to keep an eye out for as you are managing your psoriasis.

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