IBD – a cure inside the mouth?

Posted by watchmen
November 2, 2020
Posted in OPINION

Poor oral health may cause or worsen heart disease and diabetes conditions. 

Now another disease has been linked to poor oral health – Inflammatory Bowel Disease (IBD).

IBD is a chronic inflammation of the digestive tract. One example is ulcerative colitis which causes inflammation and sores or ulcers in the innermost lining of the large intestine (colon) and rectum.

Another IBD is Crohn’s disease caused by the inflammation of the lining of the digestive tract.

The causes are not yet known although diet, a compromised immune system and genetic factors are among the suspected factors.

Many IBD cases are diagnosed among those younger than 30 years old although IBD can occur among those in their 50s and 60s as well.

We don’t have numbers for the Philippines but in the United States, some 3 million adults are affected.

Depending on the severity of inflammation and where it occurs, the symptoms may be mild, severe or even life-threatening complications. Symptoms include severe diarrhea, abdominal pain, fever, fatigue, reduce appetite and weight loss and blood in the stool.

Complications include colon cancer; joint inflammation; arthritis, skin lesions and eye inflammation. Chronic inflammation can lead to open sores (ulcers) anywhere in the digestive tract, including the mouth.

Which brings us to a new study on mice conducted by the University of Michigan Medical and Dental Schools.

The mouse study, published in the scientific journal Cell, shows two pathways by which oral bacteria appear to worsen gut inflammation.

In the first pathway, periodontitis leads to an imbalance in the normal healthy microbiome found in the mouth. Periodontitis is the scientific name for gum disease.

The imbalance causes an increase of bacteria that cause inflammation, according to a news release provided by University of Michigan. These disease-causing bacteria then travel to the gut.

The study, “The intermucosal connection between the mouth and gut in commensal pathobiont-driven colitis,” also found that oral bacteria may aggravate gut inflammation.

“The normal gut microbiome resists colonization by exogenous, or foreign, bacteria,” says Nobuhiko Kamada, Ph.D., Assistant Professor of Internal Medicine in the Division of Gastroenterology.

“However, in mice with IBD, the healthy gut bacteria are disrupted, weakening their ability to resist disease-causing bacteria from the mouth.”

The study found that mice with both oral and gut inflammation had significantly increased weight loss and more disease activity.

In the second proposed pathway, gum disease activates the immune system’s T cells in the mouth. The oral T cells travel to the gut where they may worsen inflammation.

The gut’s normal microbiome is held in balance by the action of inflammatory and regulatory T cells that are fine-tuned to tolerate the resident bacteria.

However, according to Dr. Kamada, oral inflammation generates mostly inflammatory T cells that migrate to the gut. Removed from their normal environment, they trigger the gut’s immune response and worsen the disease.

“This exacerbation of gut inflammation driven by oral organisms that migrate to the gut has important ramifications in emphasizing to patients the critical need to promote oral health as a part of total body health and wellbeing,” says Dr. William Giannobile, a dentist and co-author of the study.

He is also the William K and Mary Anne Najjar Professor of Dentistry and Chair of the Department of Periodontics and Oral medicine at the University of Michigan School of Dentistry.

The study has implications for novel treatments for IBD, necessary because “far too many patients still fail medications, leading to reduced quality of life and eventual surgery,” says another study co-author, Dr. Shrinivas Bishu, a medical doctor and Assistant Professor of Gastroenterology.

“This study importantly implies that clinical outcomes in IBD may be improved by monitoring oral inflammation – an intriguing concept.”



Dr. Joseph D. Lim is a former Associate Dean of the UE College of Dentistry, former Dean of the College of Dentistry, National University, past president and honorary fellow of the Asian Oral Implant Academy, and honorary fellow of the Japan College of Oral Implantologists. Honorary Life Member of Thai Association of Dental Implantology. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515./WDJ

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