By Dr. Joseph D. Lim
People with acute intermittent porphyria (AIP) are more likely to have issues with oral health.
That is, those with kidney failure or liver scarring have worse dental health, with a greater number of filled or missing teeth, compared to those without the genetic disorder, according to a study published in the journal Life.
It is the first study to systematically examine dental health among patients with AIP, a genetic disease caused by one or more genes that are not working properly.
AIP is caused by low levels of porphobilinogen deaminase (PBGD), an enzyme often called hydroxymethylbilane synthase, according to the Mayo Clinic.
The low levels of PBGD are generally not sufficient to cause symptoms. However, activating factors such as hormones, drugs and dietary changes may trigger symptoms. Individuals with symptoms typically experience abdominal pain with nausea.
The study included 47 adults with AIP, as well as 47 individuals without the genetic disorder. Their oral health was examined extensively. Because AIP patients are often advised to eat a relatively high proportion of carbohydrates, their dietary habits were also recorded.
The study found that the rates of periodontitis or gum disease were not significantly different between AIP patients and those without the disorder. Researchers noted that AIP patients with periodontitis were generally older, by about a decade on average, than those without gum disease.
Although overall sugar consumption was not different between the two groups of patients, researchers noted that carbohydrate consumption was markedly increased among AIP patients with periodontitis. It suggests that diet plays a role in the development of gum disease among AIP patients.
A measure of kidney function was significantly associated with the number of decayed, missing or filled teeth (DMFT) in study participants. DMFT correlated with measures of liver scarring in both patients with and without AIP. The study demonstrated that AIP patients with complications such as kidney failure had worse dental health as determined by DMFT.
Smoking cigarettes was associated with worse DMFT outcomes among patients. Smoking was linked to inflammation and periodontitis that were more pronounced among AIP patients.
The study observed a strong “link” between smoking and inflammation in the AIP cases, suggesting that smoking has a greater effect on dental health in the AIP patients. The study speculates that the combination of smoking and AIP might lead to more inflammation and organ damage than just smoking.
“AIP-associated organ complications and chronic low-grade inflammation may worsen dental health,” the study observes, noting however that the findings are not conclusive given the small number of study participants.
The study was also limited by a lack of data on participants’ oral hygiene habits or dental treatment histories, which might have influenced the study results.
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Dr. Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De La Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com./WDJ