Multiple autoimmune diseases, including pernicious anemia, a condition that can lead to nerve damage if left untreated, appeared to show significant associations with oral health problems, according to a study that was published on August 5 in BMC Oral Health.
Oral health problems, like bleeding gums and toothaches, may act as clinically relevant markers of an individual's risk of autoimmune diseases, the authors wrote.
“By evaluating a broad spectrum of autoimmune conditions, this study provides comprehensive population-level evidence on the association between self-reported oral health issues and autoimmune disease risk, including a novel association with pernicious anemia,” wrote the authors, led by Dongwon Yoon of the laboratory of epidemiology and population sciences at the U.S. National Institutes of Health in Baltimore.
To investigate a potential link between self-reported oral health issues, painful or bleeding gums, mouth ulcers, toothache, dentures, or loose teeth, and the risk of developing an autoimmune disease, researchers used data from the U.K. Biobank. The biobank is a database of information, including physical exams and self-reported data, of about 500,000 middle- and older adults in the U.K. Health outcomes were gathered from self-reported information and electronic health records, according to the study.
Hazard ratios (HRs) and 95% confidence intervals (CIs) for any autoimmune diseases and 39 types of autoimmune diseases were calculated using Cox regression models with Bonferroni correction to explore associations.
Of the 451,404 patients, 177,198 (39%) self-reported oral health issues that were linked to a heightened risk of any autoimmune disease (HR: 1.11, 95% CI: 1.09 to 1.14). The strongest correlation was painful gums (HR: 1.39, 95% CI: 1.31 to 1.47) followed by mouth ulcers (HR: 1.23, CI: 1.18 to 1.27) and toothache (HR: 1.21, CI: 1.15 to 1.27), the authors wrote.
Additionally, the risk rose as the number of self-reported oral health issues increased (per one-issue increase: HR: 1.09, 95% CI: 1.08 to 1.11, P-trend < 0.001).
Finally, different autoimmune diseases showed varying risk levels. Primary biliary cholangitis, a chronic autoimmune disease that gradually destroys the liver’s small bile ducts, (HR: 1.65, 95% CI: 1.24 to 2.19), rheumatism, chronic joint and muscle pain and stiffness, (HR: 1.48, CI: 1.23 to 1.77), lichen planus (HR: 1.35, CI: 1.15 to 1.57), Sjögren’s disease (HR: 1.30, CI: 1.11 to 1.52), pernicious anemia (HR: 1.28, CI: 1.12 to 1.46), rheumatoid arthritis (HR: 1.18, CI: 1.12 to 1.26), and psoriasis (HR: 1.16, CI: 1.07 to 1.26) were identified as diseases that had the highest correlation with oral health problems.
However, the study had limitations. Oral health problems may introduce recall bias, the authors wrote.
“Self-reported oral health issues were associated with an increased risk of incident autoimmune diseases, suggesting that oral health indicators may serve as clinically relevant markers of autoimmune disease risk,” Yoon and team wrote.
