P051 Proton Pump Inhibitors are Associated with Less Severe Periodontal Disease: Considerations for IBD Patients

P051 Proton Pump Inhibitors are Associated with Less Severe Periodontal Disease: Considerations for IBD Patients
 

Yerke Lisa1, Cohen Robert1
1 University at Buffalo, Buffalo, United States

BACKGROUND: Proton pump inhibitors (PPI) are frequently used for treatment of gastroesophageal (GI) reflux disease, but patients with Crohn's disease and ulcerative colitis (IBD) might experience an increased risk of disease complications with use of PPI. GI and oral microbiota, as well as bone metabolism, also are affected by use of PPI. IBD has been associated with an inflammatory host response to bacterial infection that shares many characteristics of periodontal disease (PD). We previously reported that patients referred to a university-based postgraduate periodontics training program during 2010-2017, who were taking PPI, exhibited less severe PD and had fewer teeth with periodontal pocket depths than those not taking PPI. Consequently, the objective of this study was to further assess the effect of PPI on PD utilizing an alternative, large, independent patient population.

METHODS: Following IRB approval, medical and dental history records were reviewed from patients ≥ 18 years old who were referred from 1996-2015 to a university-based private periodontics faculty practice (N=1,093). Smokers and diabetics were excluded; the effects of systemic factors such as IBD, use of systemic steroids, peri-menopausal hormone replacement therapy, and autoimmune disease, were considered as modifying risk factors. PD severity was measured by calculating the percentage of teeth with elevated periodontal pocket depths. Significance was measured via independent sample t-tests, adjusting for equal or unequal variance as indicated, using IBM SPSS Statistics v26.

RESULTS: We found that there was an inverse relationship between use of PPI and severity of PD. After adjusting for smoking and diabetes, the prevalence of pocket depths ≥ 6 mm was 13.9% in PD patients taking PPI, vs. 24.1% for PD patients not taking PPI (mean difference= 10.2%, 42.3% decrease, 95% confidence interval= 1.7%-18.6%, P=0.005). After adjusting for medical conditions as noted above, the prevalence of pocket depths ≥6 mm was 14.0% in PD patients taking PPI, vs. 23.6% for PD patients not taking PPI (mean difference= 9.6%, 40.7% decrease, 95% confidence interval= 0.9%-18.5%, P=0.03). Similarly, the prevalence of pocket depths ≥5 mm (to assess less severe PD) was 27.8% in PD patients taking PPI, vs. 40.6% for PD patients not taking PPI (mean difference= 12.8%, 31.5% decrease, 95% confidence interval= 1.1%-24.5%, P=0.03). After adjusting for those medical conditions noted above, the prevalence of pocket depths ≥5 mm was 27.2% in PD patients taking PPI, vs. 40.1% for PD patients not taking PPI (mean difference= 12.9%, 31.7% decrease, 95% confidence interval= 0.6%-25.0%, P=0.04). There were no differences in oral hygiene efficacy among any of the groups examined (P>.05).
 

CONCLUSION(S): Our results suggest that use of PPI medications is associated with less severe PD. These results have now been demonstrated in two distinct patient populations, in different clinical settings, at different time periods, using different examiners. Consequently, we propose that more conservative periodontal therapy might initially be considered for IBD patients with advanced periodontal disease for whom PPI are prescribed as a component of their IBD treatment. This study was supported in part by the Department of Periodontics and Endodontics, University at Buffalo, SUNY.