Evaluating the association of oral health with quality of life in Ankylosing Spondylitis patients: A case control study

Articles in Press

Document Type : Original Article

Authors

1 Department of Oral Medicine, School of Dentistry, Isf.C., Islamic Azad University, Isfahan, Iran

2 Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Community Oral Health, School of Dentistry, Isf.C., Islamic Azad University, Isfahan

Abstract

Background: Periodontitis is a chronic inflammatory disease that affects the tissues surrounding the teeth, leading to the destruction of the bone and connective tissue supporting them. The relationship between Ankylosing spondylitis (AS) and periodontitis has been an area of debate in recent studies.
 
Objectives: According to the recent conflicting studies that have been conducted on the periodontal indicators of patients bearing AS, some have reported the existence of a relationship, and others have reported the absence of a relationship. Considering that there are few studies related to oral and dental health and its relationship with quality of life in AS patients, and the results of the existing studies are controversial, we investigated this issue in the present study.
 
Methods: This study employed a case-control design. The study participants consisted of 108 individuals, 54 of whom were in the patient group and 54 in the control group, which comprised healthy individuals. The patients were divided into three groups based on the severity of the disease (mild, moderate, severe). The patients were selected from among people referring to dental clinics in Isfahan (Iran) in 2022. Oral health behaviors, clinical attachment loss (CAL), periodontal pocket depth, gingival bleeding on probing, and DMFT index were measured in the studied individuals.
 
Results: The value of the CPI index was significantly higher in people with severe disease compared to those with mild disease (p = 0.030) and healthy cases (p < 0.001). The CAL index in individuals with severe disease was significantly higher than in patients with mild disease (p = 0.011), moderate disease (p = 0.047), and healthy participants (p < 0.001). A significant difference was observed in the comparison of the DMFT index between healthy individuals (16.78 ± 4.03) and case groups with mild (16.17 ± 5.61), moderate (12.94 ± 5.72), and severe (17.67 ± 6.45) disease (p = 0.021).
 
Conclusion: AS patients had more serious periodontal conditions than the control group; based on the results, it seems that this serious condition is more tangible in patients with severe disease activity.
 

Keywords

Acknowledgements: We wish to thank all our colleagues at Isfahan University of Medical Sciences.

 

Availability of data and materials: Data availability is the corresponding author's responsibility.

 

Conflicts of interests: The authors declare that they have no conflict of interest.

 

Consent for publication: Not applicable.

 

Ethics approval and consent to participate: All procedures performed in the studies involving human participants were in accordance with the ethical standards of the local ethics committee of Isfahan University of Medical Sciences (IR.IAU.KHUISF.REC.1401.038) and the 1964 Helsinki Declaration.

 

Financial disclosure: No financial support was received for this study.

 

Author contributions: M.S. designed the study. E.M and N.S. write the manuscript. F.R.M. revised the manuscript. H.Sh analysis data.

 

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

1. Zochling J, Smith EU. Seronegative spondyloarthritis. Best practice & research Clinical rheumatology. 2010;24(6):747-56.
https://doi.org/10.1016/j.berh.2011.02.002
PMid:21665123
 
2. Strand V, Singh JA. Patient burden of axial spondyloarthritis. Journal of Clinical Rheumatology. 2017;23(7):383.
https://doi.org/10.1097/RHU.0000000000000589
PMid:28937474 PMCid:PMC5617559  
 
3. Collantes E, Zarco P, Muñoz E, Juanola X, Mulero J, Fernández-Sueiro J, et al. Disease pattern of spondyloarthropathies in Spain: description of the first national registry (REGISPONSER). Rheumatology. 2007;46(8):1309-15.
https://doi.org/10.1093/rheumatology/kem084
PMid:17526930  
 
4. Linden GJ, McClean K, Young I, Evans A, Kee F. Persistently raised C‐reactive protein levels are associated with advanced periodontal disease. Journal of clinical periodontology. 2008;35(9):741-7.
https://doi.org/10.1111/j.1600-051X.2008.01288.x
PMid:18647204  
 
5. Reveille JD, Eder L, Ziade N, Sampaio-Barros PD, Kim T-H, Akkoç N, et al. Global epidemiology of spondyloarthritis. Nature Reviews Rheumatology. 2025;21(10):580-98.
https://doi.org/10.1038/s41584-025-01286-x
PMid:40954333  
 
6. Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS‐G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ‐S). Arthritis care & research. 2011;63(S11):S47-S58.
https://doi.org/10.1002/acr.20575
PMid:22588768  
 
7. Bal A, Unlu E, Bahar G, Aydog E, Eksioglu E, Yorgancioglu R. Comparison of serum IL-1β, sIL-2R, IL-6, and TNF-α levels with disease activity parameters in ankylosing spondylitis. Clinical rheumatology. 2007;26(2):211-5.
https://doi.org/10.1007/s10067-006-0283-5
PMid:16583185  
 
8. Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. International journal of health sciences. 2017;11(2):72.  
 
9. Savage A, Eaton KA, Moles DR, Needleman I. A systematic review of definitions of periodontitis and methods that have been used to identify this disease. Journal of clinical periodontology. 2009;36(6):458-67.
https://doi.org/10.1111/j.1600-051X.2009.01408.x
PMid:19508246  
 
10. Leroy R, Eaton KA, Savage A. Methodological issues in epidemiological studies of periodontitis-how can it be improved? BMC oral health. 2010;10:1-7.
https://doi.org/10.1186/1472-6831-10-8
PMid:20409298 PMCid:PMC2874507  
 
11. Brook PH, Shaw WC. The development of an index of orthodontic treatment priority. The European Journal of Orthodontics. 1989;11(3):309-20.
https://doi.org/10.1093/oxfordjournals.ejo.a035999
PMid:2792220  
 
12. Fejerskov O, Nyvad B, Kidd E. Dental caries: the disease and its clinical management: John Wiley & Sons; 2015.  
 
13. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. The Journal of rheumatology. 1994;21(12):2286-91.  
 
14. Ainamo J. Development of the World Health Organization community periodontal index of treatment needs. Int dent J. 1982;32:281-91.  
 
15. Barmes D. CPITN--a WHO initiative. International dental journal. 1994;44(5 Suppl 1):523-5.  
 
16. Benigeri M, Brodeur JM, Payette M, Charbonneau A, Ismaïl AI. Community periodontal index of treatment needs and prevalence of periodontal conditions. Journal of clinical periodontology. 2000;27(5):308-12.
https://doi.org/10.1034/j.1600-051x.2000.027005308.x
PMid:10847533  
 
17. Ziebolz D, Douglas D, Douglas D, Schmickler J, Patschan D, Müller GA, et al. Periodontal condition is associated with disease duration and motoric disabilities in patients with ankylosing spondylitis: results of a cross-sectional study. Rheumatology International. 2018;38:855-63.
https://doi.org/10.1007/s00296-018-4012-6
PMid:29557489  
 
18. Helenius LMJ, Meurman JH, Helenius I, Kari K, Hietanen J, Suuronen R, et al. Oral and salivary parameters in patients with rheumatic diseases. Acta Odontologica Scandinavica. 2005;63(5):284-93.
https://doi.org/10.1080/00016350510020043
PMid:16419434  
 
19. Bisanz JE, Suppiah P, Thomson WM, Milne T, Yeoh N, Nolan A, et al. The oral microbiome of patients with axial spondyloarthritis compared to healthy individuals. PeerJ. 2016;4:e2095.
https://doi.org/10.7717/peerj.2095
PMid:27330858 PMCid:PMC4906644  
 
20. Sezer U, Erciyas K, Pehlivan Y, Üstün K, Tarakçıoğlu M, Şenyurt S, et al. Serum cytokine levels and periodontal parameters in ankylosing spondylitis. Journal of periodontal research. 2012;47(3):396-401.
https://doi.org/10.1111/j.1600-0765.2011.01448.x
PMid:22126620  
 
21. Pischon N, Pischon T, Gülmez E, Kröger J, Purucker P, Kleber B-M, et al. Periodontal disease in patients with ankylosing spondylitis. Annals of the rheumatic diseases. 2010;69(01):34-8.
https://doi.org/10.1136/ard.2008.097212
PMid:19126560  
 
22. Kang EH, Lee JT, Lee HJ, Lee JY, Chang SH, Cho HJ, et al. Chronic periodontitis is associated with spinal dysmobility in patients with ankylosing spondylitis. Journal of periodontology. 2015;86(12):1303-13.
https://doi.org/10.1902/jop.2015.150202
PMid:26291296  
 
23. Schmalz G, Douglas D, Douglas D, Patschan S, Patschan D, Müller GA, et al. Oral health-related quality of life is associated with disease specific parameters in patients with ankylosing spondylitis. Clinical Oral Investigations. 2018;22:2889-96.
https://doi.org/10.1007/s00784-018-2375-4
PMid:29541915  
 
24. Suppiah P, Cullinan M, Nolan A, Thompson W, Stebbings S, editors. An association between periodontal disease, oral health related quality of life and disease activity in patients with ankylosing spondylitis. Rheumatology; 2013: OXFORD UNIV PRESS GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND.  
 
25. Bautista-Molano W, van der Heijde D, Landewé R, Lafaurie GI, de Ávila J, Valle-Oñate R, et al. Is there a relationship between spondyloarthritis and periodontitis? A case-control study. RMD open. 2017;3(2):e000547.
https://doi.org/10.1136/rmdopen-2017-000547
PMid:29299339 PMCid:PMC5729302  
 
Razavi Journal of Medicine

Articles in Press, Accepted Manuscript
Available Online from 07 October 2025

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