Table 4 Evidence on gastrointestinal diseases and caries

Human studies on gastrointestinal diseases and caries

 Inflammatory bowel disease (IBD)

  Koutsochristou et al. [76]

Evaluate dental caries (DMFT/dmft) and periodontal disease experience [gingival, plaque and community periodontal index of treatment needs (CPITN) indices] in pediatric and adolescent IBD patients and compared with controls

Case-control

110 (55 cases and controls)

Greece

Outcomes: IBD group showed significantly higher DMFT/dmft, gingival inflammation and CPITN index (p < 0.001) with non-significant differences in biofilm and oral hygiene habits compared to controls

Conclusions: IBD patients under remission showed significantly higher prevalence of dental caries and gingival inflammation despite similar oral hygiene status

  Zhang et al.  [77]

Evaluate prevalence, severity, and extent of dental caries (DMFT/DMFS) in IBD patients and compare them with healthy controls. Further, questionnaire on demographics, education, smoking, oral hygiene habits, duration of disease and treatment was used to collect information

Case-control

530 (265 cases and controls)

China

Outcomes: DMFS was significantly higher in UC and CD patients compared to controls (p < 0.001). Patients with CD and UC had significantly higher risk of dental caries compared to controls (OR = 4.27 and 2.21 respectively). No significant difference for dental caries was noted between UC and CD patients

Conclusion: IBD patients in this study had higher prevalence, severity and extent of dental caries and are at higher risk for dental caries compared to controls

 Crohn’s Disease (CD)

  Szymanska et al

 [78]

Human case-control study (n = 225, 150 cases: 71 with resective surgery, 79 without surgery and 75 controls) in CD patients to evaluate association with caries prevalence (DMFT/DMFS), salivary parameters, biofilm control and presence of S. mutans and Lactobacilli.

Case-control

225 (150 cases and 75 controls)

Sweden

Outcomes: CD patients who had undergone resective surgery demonstrated significantly higher DMFS score (p = 0.01), significantly higher counts of S.mutans (p = 0.04) and Lactobacilli p = 0.01), significantly higher dental biofilm (p = 0.001) and consumption of sweetened drinks between meals (p = 0.001) compared to controls

Conclusion: CD patients who have undergone resective surgery demonstrate significantly increased risk factors for dental caries when compared to controls

Animal study on gastrointestinal diseases and caries

 Ulcerative Colitis (UC)

  Kojima et al

 [79]

Animal study to investigate effect of S.mutans on dextran sodium sulfate (DSS) induced colitis in a mouse model

Outcomes: A serotype k strain of S.mutans increased severity of colitis in the mouse model, showed evasion of phagocytosis in the peripheral blood (possibly due to variation in surface glucose side chains) and uptake by hepatocytes (potentially mediated by a collagen binding protein); the serotype k of S.mutans also mediated increase in IFN-γ

Conclusion: Serotype k of S.mutans is a potential risk factor for UC. Virulence factors of interest include presence of collagen binding protein and lack of certain surface glucose side chains