Abstract Background Patients with inflammatory bowel disease (IBD) have an increased prevalence of periodontitis, a multifactorial disease in which both the immune system and the oral microbiota play pivotal roles (Madsen, G. et al., Inflammatory bowel diseases 2022). Poor oral hygiene is a major contributor to periodontitis through its impact on microbial composition. TNF-α inhibitors modulate systemic immune activity and may also influence the oral microbiota and consequently periodontitis. This study investigated whether TNF-α therapy alters the association between oral hygiene and the severity of periodontitis in patients with IBD. Methods In this monocentric, retrospective study, 20 patients with ulcerative colitis and 48 patients with Crohn’s disease receiving TNF-α therapy were matched to 53 IBD patients without advanced therapy (AT) based on sex, age, and disease severity between 2012 and 2020. Periodontitis stage and Approximal Plaque Index (API; 0% = excellent hygiene, 100% = poor hygiene) were assessed to determine whether moderate to poor oral hygiene (API 25%) differentially affected periodontitis severity depending on TNF-α treatment status. Associations between API, periodontitis stage and AT were analyzed using an ordinal multivariate logistic regression model. Data were obtained from chart review and medical documentation. Results All patients were in clinical remission, as indicated by normal stool frequency, absence of abdominal pain, and unremarkable laboratory markers (leukocytes and CRP). API scores were comparable between groups: 63% in the control IBD group and 65% in the TNF-α–treated group (UC: 63%; CD: 66%). The interaction between TNF-α therapy and API was not statistically significant (p = 0.243), indicating that TNF-α therapy did not modify the association between oral hygiene and periodontitis severity. TNF-α therapy itself had no significant effect on periodontitis stage in the overall IBD cohort or within UC and CD subgroups. In contrast, the API was a significant predictor of periodontitis stage (estimator = 0.031; p = 0.005), with higher API values associated with more severe periodontitis across all groups. Conclusion TNF-α therapy does not appear to influence periodontitis severity in patients with IBD. Oral hygiene, as measured by the API, was the only significant determinant of disease severity. These findings underscore the importance of maintaining adequate oral hygiene in patients with IBD, regardless of TNF-α treatment status. Conflict of interest: Dr. Kaps, Leonard: No conflict of interest Gund, Madline: No conflict of interest
Kaps et al. (Thu,) studied this question.