Dental Tribune Europe

Children with immune deficiencies more likely to develop periodontal disease

By Iveta Ramonaite, Dental Tribune International
April 23, 2021

LONDON, UK: Primary immunodeficiency (PID) is characterised by a missing or poorly functioning part of the body’s immune system. Inherent from birth or acquired later in life, the disorder inhibits the body’s ability to fight all types of infections. New research has also found that, since children with PID have no natural defence against the oral microbiota that cause periodontal disease, they are more susceptible to developing gingivitis than systemically healthy children.

According to a report published in the Journal of Translational Immunology, 4,758 patients had been entered into the UK Primary Immune Deficiency registry by August 2017. As detailed in an editorial published in Frontiers in Immunology last year, the worldwide incidence of people with PID is one in 10,000, and the disorder is more prevalent in children. Although the incidence rate is comparatively low, researchers have identified more than 300 diseases associated with PID to date, which is why its complications vary greatly, depending on the type of the disorder the patient has.

Since children with PID are more prone to developing frequent, severe infections that compromise their overall health, more research needs to be done to improve understanding of the diagnosis, symptoms and treatment of the disease.

Primary immunodeficiency and oral health

In a recent study, researchers assessed the link between neutrophil-related PIDs and the presence of periodontal and other oral diseases, as well as the response of children with PID to periodontal treatment.

“The motivation came from seeing some very young children with advanced periodontal disease and poor response to treatment. Some of them ended up with dentures from a very young age, hence the need to better understand the mechanisms of the disease,” lead author Dr Luigi Nibali, professor of periodontics at King’s College London, told Dental Tribune International (DTI).

The study was carried out at Great Ormond Street Hospital and the Royal London Hospital by researchers from King’s College London and Queen Mary University of London and included 24 children aged 4–16 with PIDs and 24 age-matched children without PIDs. All children underwent a dental clinical examination which included measuring periodontal pocket depths, clinical attachment loss and bleeding on probing.

The researchers found that a certain level of dental caries in the mouth, which usually does not pose a threat to systemic health, leads to gingivitis in children with PIDS.

“The prevalence of oral conditions and periodontal diseases has been known to increase in children affected by PIDs as they seem particularly susceptible due to the crucial defensive role of neutrophils against periodonto-pathogenic bacteria,” said co-author Dr Hiten Halai, a clinical lecturer in periodontics at King’s College London, in a press release.

“Furthermore, their response to periodontal treatment is highly variable, and the presence of periodontitis often leads to early tooth loss. However, most published papers on this so far consisted of case reports, with a lack of good evidence,” he added.

The study also found that children with PIDS had increased chances of suffering from oral ulcers. When asked to elaborate on the finding, Nibali told DTI that little is known on why children with PIDs often develop oral ulcers but that it might be related to their immune response and explained that it was a coincidental finding.

He also noted that although the findings are not novel, the study offers strong evidence on the topic. Therefore, he thinks it is crucial that future studies delve deeper into understanding the link between PIDs and periodontal disease and oral mucosal lesions. This, in turn, could improve the prevention and management of the disease and improve the quality of life of children with PIDs, he believes. Finally, Nibali thinks that further research could also help find ways to relieve the systemic inflammatory burden resulting from inflamed gingival tissues in children with PID.

“The study shows that children with PIDs have a more severe response to dental caries, which can potentially lead to advanced periodontal disease. However, if the PID is controlled and good oral hygiene and interceptive treatment are achieved early on, the high susceptibility does not necessarily result in tooth loss,” Nibali concluded.

The researcher team is planning to continue working on understanding the genetic–microbial basis of problems related to the periodontal health of children with PIDs.

The study, titled “Periodontal status in children with primary immunodeficiencies”, was published online on 3 April 2021 in the Journal of Periodontal Research, ahead of inclusion in an issue.

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