King's College London

In a recent study led by Professor Luigi Nibali and carried out at Great Ormond Street Hospital and the Royal London Hospital, researchers from King’s College London and Queen Mary University of London have found that children with Primary Immunodeficiencies were nearly 10 times more likely to be diagnosed with periodontal (gum) disease, compared with systematically healthy age-matched children.

Primary Immunodeficiencies (PIDS) are disorders in which part of the body’s immune system is missing or does not function normally. With over 300 different conditions, those with PIDS are left with reduced, or no natural defence against germs such as bacteria, fungi, and viruses. Therefore with no defence against germs that cause gum disease, it was found that the same level of dental plaque in the mouth normally compatible with health, leads to gum inflammation in children with PIDS.

Recently published in the Journal of Periodontal Research, the study had both a cross-sectional and cohort design. Twenty-four children aged 4-16 affected by Primary Immunodeficiencies, and 24 age-matched systemically healthy control subjects underwent a dental clinical examination. Basic Periodontal Examination (BPE) was performed, consisting of gentle probing between teeth and gums on index teeth.

Co--author Dr Hiten Halai from the Faculty of Dentistry, Oral & Craniofacial Sciences at King’s College London said: “The prevalence of oral conditions and periodontal diseases has been known to increase in children affected by PIDS as they seem particularly susceptible due to the crucial defensive role of neutrophils against periodonto-pathogenic bacteria.

“Furthermore, their response to periodontal treatment is highly variable, and the presence of periodontitis often leads to early tooth loss. However, most published papers on this so far consisted of case reports, with a lack of good evidence”.

The study also found that children with PIDS also had increased chances of suffering from oral ulcers.

Interestingly, although the children affected by PIDS exhibited a higher prevalence of periodontal disease compared with systemically healthy children, periodontal severity was not very advanced. The researchers theorise that this could be due to early interceptive treatment for both systematic conditions and gingival conditions.

Lead author, Professor Luigi Nibali concludes: “Although the findings are not novel, this is probably the highest level of evidence yet produced on this topic. It is important that future studies should focus on understanding the mechanisms of associations between PIDS and both periodontal disease and oral mucosal lesions, as better prevention and management my improve the quality of life of children affected by PIDS. It may also reduce the systemic inflammatory burden for the children associated with microbial entry into the systemic circulation from inflamed gum tissues.”