The connection between oral health and psoriasis
In recent years, there has been growing evidence suggesting a connection between the severity of psoriasis and oral health issues. While direct studies focused on this relationship may be limited, the shared underlying immune-inflammatory mechanisms point towards a potential link.
- Psoriasis, Inflammation, and Systemic Health
Psoriasis, especially moderate to severe forms, is a chronic inflammatory disease that involves dysregulation of the immune system, notably the IL-23/IL-17 pathway. Treatments targeting these pathways have shown effectiveness in controlling skin symptoms, implying that systemic inflammation is a key factor in disease expression[1][4].
- Oral Manifestations and Dental Health Issues
Oral manifestations of psoriasis can include erythematous, scaly lesions in the mouth, although these are less common and less well characterized than skin lesions. Chronic systemic inflammation seen in psoriasis may contribute to oral mucosal changes and could exacerbate dental health issues[3].
- Probiotics and Oral Health in Psoriasis Patients
Research highlights the role of probiotics in modulating systemic and mucosal inflammation, potentially improving both psoriasis severity and oral health. In clinical trials, probiotics combined with standard therapy have reduced psoriasis severity and systemic inflammatory markers like TNF-α and IL-17, which are also implicated in periodontal disease and oral mucosal inflammation[2].
- Assessing Psoriasis Severity and Oral Health Risks
The Psoriasis Area and Severity Index (PASI) score is commonly used to assess disease severity. Higher PASI scores (indicating more severe disease) correlate with systemic inflammation levels, which likely impacts extra-cutaneous manifestations including oral health[3].
- The Importance of Dental Health Monitoring for Psoriasis Patients
Another 2019 study found that psoriasis severity correlated with higher scores on Bleeding on Probe and Community Periodontal Index, which help assess a person's overall oral health and risk for developing oral health complications[5]. People with psoriasis are advised to consider adding a dentist to their care team to help address potential oral health concerns.
- Common Symptoms of Oral Psoriasis
Trouble swallowing food, burning, difficulty chewing, bleeding, and redness are common symptoms when psoriasis appears in the mouth. If a person experiences excessive or regular bleeding when brushing teeth, unexpected loss of one or more teeth, moderate to severe pain or chronic pain that does not go away, or other oral symptoms or issues that may indicate an underlying issue, they should see a dentist[6].
- Preventive Measures for Maintaining Good Oral Health
The American Dental Association recommends receiving regular dental cleanings and exams, using fluoride toothpaste, brushing at least two times a day, flossing daily, eating a healthy diet, limiting sugary foods and drinks, avoiding oral piercings and tobacco products[7].
- The Impact of Smoking and Diet on Psoriasis and Oral Health
Smoking increased the risk of developing psoriasis in people with periodontitis even further[8]. Conversely, people who reported eating at least one piece of fruit a day reported better overall dental health[9]. People with periodontitis had a much greater chance of developing psoriasis compared with others[10].
- Oral Lesions in Psoriasis Patients
Psoriasis lesions can, on rare occasions, cause lesions in the mouth, appearing as geographic tongue and fissured tongue[11]. A 2019 study at Ohio State University examined the relationship between psoriasis and patient-reported oral health[12].
Further targeted clinical research is warranted to clarify the precise nature and extent of these relationships and to establish guidelines for oral health monitoring and management in psoriasis patients. By addressing both skin and oral health concerns, individuals with psoriasis can potentially improve their overall quality of life. Close cooperation between people living with psoriasis and dental healthcare workers can play an important role in their overall care.
- Beyond the skin: Some autoimmune disorders, such as psoriasis, can affect various parts of the body, including oral health.
- Mouth Problems Linked to Skin: Oral health conditions might be a concern for individuals suffering from chronic skin conditions like psoriasis, as shared underlying inflammatory mechanisms between the two may imply a potential connection.
- Role of Nutrition: Adopting a balanced diet rich in fruits could benefit overall dental health and potentially alleviate symptoms of psoriasis.
- Healthy Habits: In addition to taking care of their skin, individuals with psoriasis should prioritize oral health by adhering to regular dental check-ups, brushing, flossing, and healthy eating habits.
- Smoking Risks: Smokers with periodontitis are at a higher risk of developing psoriasis, emphasizing the importance of avoiding tobacco products for maintaining both oral health and preventing psoriasis flare-ups.
- Skin and Skin-related Disorders: Apart from geographic tongue and fissured tongue, other skin conditions may lead to oral lesions in some rare cases, especially in people with psoriasis.
- Mind Over Matter: The connection between mental health and skin conditions like psoriasis is increasingly being recognized, and understanding this relationship could help manage symptoms, potentially improving not only skin health but also overall well-being.
