Patients with Periodontitis May Be at Increaed risk for Alopecia Areata

Periodontitis and Gingivitis

Periodontitis is a gum disease. It starts with inflammation of the gingiva (gingivitis) but then spreads deeper. This inflammation can then spread to below the gums and along the roots of the teeth. The result is permanent damage to the tissues (or “periodontal ligament”) around the teeth and to the supporting bone. Teeth start to loosen and can eventually be lost.

Therefore, patients with gingivitis can develop periodontitis if they don’t treat their gingivitis. Periodontitis is a much more serious form of gum disease. About 50 % of the population has gingivitis and peridontitis itself is less common.

Gingivitis is an inflammation that is limited to the gum line, while in periodontitis is associated with loss of the jawbone, periodontal ligament, and root cementum. 

Patients may not notice any signs or symptoms whatsoever but may notice swollen and puffy gums, increased bleeding from the gums when they eat or brush their teeth, bad breath, receding gums giving the appearance of longer teeth and painful chewing.

Periodontitis is markedly influenced by oral hygiene and good brushing of the teeth. However, other risk factors are relevant including smoking, genetics, age, diet, type 2 diabetes, stress:

Recent evidence indicates that periodontitis is a type of autoimmune disease. In fact, several studies have demonstrated the involvement of autoimmune responses in this condition.  Bacteria in the dental plaque induce antibody formation. Autoreactive T cells, natural killer cells,  autoantibodies, and genetic factors are reported to have an important role in the autoimmune component of periodontal disease

In addition, periodontitis is associated with immune-mediated cutaneous and systemic inflammatory disorders, such as psoriasis, systemic lupus erythematosus and rheumatoid arthritis

Kim et al 2022

There have been sporadic reports of the literature of associations between dental disease and alopecia areata.

Authors from Korea set out to investigate whether periodontitis increases the risk of AA by using the National Health Insurance Service claims database. They compared 68,000 patients with periodontitis that were matched to 68,000 patients without periodontitis.

There was statistically significant higher AA development in the periodontitis group (a-HR: 1.36 (95% confidence interval [CI]: 1.28–1.44); This was true for all the clinical subtypes of AA including patchy AA, 1.39 [CI: 1.31–1.49]; alopecia totalis/universalis, 1.49 [CI: 1.20–1.85].

Children and Young Adults with Periodontitis at Higher Risk for AA

In further subgroup analysis of the data, children and young adults had a significantly higher risk of AA than older adults (a-HR 2.01 [CI: 1.79–2.25] and 2.06 [CI: 1.92–2.21], respectively).

Patients with Periodontitis Are At Risk Not Only for AA but other Autoimmune Diseases

Authors also showed that the periodontitis group had a significantly higher risk of other autoimmune diseases (known to be AA comorbidities) including systemic lupus erythematosus (a-HR, 2.97 [CI: 1.54–5.74]), rheumatoid arthritis (a-HR, 1.18 [CI: 1.02–1.36]), and atopic dermatitis (a-HR, 1.22 [CI: 1.08–1.38]).

Conclusion

The study showed an association between periodontitis and alopecia areata. Patients with peridontitis may be at risk  to develop alopecia areata. The mechanism by which periodontitis increases the risk of AA is not known and was not the focus of this study. It has been proposed that there is a common underlying autoimmune -inflammatory nature of both conditions and patients with periodonitis had a greater chance of many autoimmune disease.

Although the exact mechanism by which periodontitis acts as a risk factor for AA has not yet been identified, it could be explained by the common autoimmune-inflammatory nature of the two disorders.

REFERENCE

Kim JS et al. Periodontitis and risk of alopecia areata: A nationwide population-based cohort study in Korea. J Eur Acad Dermatol Venereol. 2022 Nov 17.