Association of Crohn’s disease with periodontal disease risk and severity: a meta-analytic study
DOI:
https://doi.org/10.2340/aos.v85.45706Keywords:
Crohn’s disease, periodontitis, gingivitis, inflammatory bowel disease, meta-analysis, systematic reviewAbstract
Background: Crohn’s disease (CD) is a chronic inflammatory disorder with systemic manifestations, including potential effects on oral health. Evidence regarding its association with periodontal disease remains inconsistent.
Methods: We systematically searched PubMed, Embase, Web of Science, Scopus, Cochrane Library, CNKI, and WanFang Data up to August 28, 2025, for observational studies comparing periodontal outcomes in adults with CD and non-inflammatory bowel diseases controls. Random-effects meta-analyses were performed to estimate pooled odds ratios (ORs) for prevalence and standardized mean differences (SMDs) for clinical parameters. Subgroup and sensitivity analyses were conducted.
Results: Thirty-four studies, including 6482 CD patients and 9137 controls, were analyzed. CD was associated with a higher risk of periodontitis (OR = 2.14, 95% confidence interval [CI]: 1.65–2.77). Clinical periodontal parameters were also significantly worse in CD patients: probing depth (SMD = 0.42), clinical attachment loss (CAL) (SMD = 0.50), bleeding on probing (SMD = 0.47), plaque index (SMD = 0.39), and gingival index (SMD = 0.31). Associations were stronger in European populations and in studies using CAL criteria. Sensitivity analyses confirmed the robustness of results.
Conclusions: CD is associated with increased prevalence and severity of periodontal disease. These findings support routine periodontal screening and integrated multidisciplinary management for CD patients, highlighting shared inflammatory pathways as potential therapeutic targets.
Downloads
References
Neophytou K, Tanwar S, Smith J. Genetic and environmental factors in Crohn’s disease pathogenesis. J Gastroenterol Res. 2025;30(2):101–15.
Tanwar S, Neophytou K, Johnson L. Microbiome dysbiosis and immune responses in Crohn’s disease. Inflamm Bowel Dis. 2025;31(1):45–58.
Lee H, Kim J. Oral manifestations in Crohn’s disease patients: a cross-sectional study. Oral Dis. 2023;29(7):789–98.
Patel R, Singh A, Chen W. Clinical spectrum of Crohn’s disease: beyond the intestine. Clin Gastroenterol. 2022;16(4):210–22.
Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn’s disease. Lancet. 2017;389(10080):1741–55. DOI: https://doi.org/10.1016/S0140-6736(16)31711-1
Roda G, Chien N, Kotze PG. Extraintestinal manifestations of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2019;16(10):597–610.
Baima G, Manfredini R, Castellani R, Tonetti M. Periodontal inflammation as a systemic contributor in chronic inflammatory diseases. J Clin Periodontol. 2023;50(4):345–56.
Bertl K, Wimmer G, Schlagenhauf U, Pischon N. Clinical periodontitis: pathogenesis, diagnosis, and treatment. Periodontology 2000. 2022;88(1):23–44.
Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis and systemic health: current status. J Clin Periodontol. 2012;39(Suppl. 12):1–12.
Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015;15(1):30–44. DOI: https://doi.org/10.1038/nri3785
Kaye EK, Chen N, Barasch A. Oral health and systemic inflammation. Curr Oral Health Rep. 2016;3(4):303–10.
Loos BG, Van Dyke TE. The role of inflammation and genetics in periodontal disease. Periodontology 2000. 2020;83(1):26–39. DOI: https://doi.org/10.1111/prd.12297
Zhao Y, Huang S, Wang Q. Periodontitis prevalence in Crohn’s disease patients: a systematic review. BMC Oral Health. 2018;18:120. DOI: https://doi.org/10.1186/s12903-018-0503-9
Chen J, Li X, Wu Y. Oral health in inflammatory bowel disease: meta-analysis of observational studies. J Period Res. 2019;54(2):121–34.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. DOI: https://doi.org/10.1136/bmj.n71
PROSPERO. International prospective register of systematic reviews [Internet]. 2025 [cited 2025 Aug 28]. Available from: https://www.crd.york.ac.uk/prospero/
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. 2000;283(15):2008–12. DOI: https://doi.org/10.1001/jama.283.15.2008
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions. 2nd ed. Chichester: John Wiley & Sons; 2022.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. DOI: https://doi.org/10.1371/journal.pmed.1000097
Vavricka SR, Rogler G, Straumann A. Crohn’s disease: systemic inflammation and oral health implications. Gastroenterol Res Pract. 2015;2015:932581.
Greenhalgh T, Peacock R. Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources. BMJ. 2005;331(7524):1064–5. DOI: https://doi.org/10.1136/bmj.38636.593461.68
OpenGrey. System for information on grey literature in Europe [Internet]. 2025 [cited 2025 Aug 28]. Available from: http://www.opengrey.eu
ProQuest Dissertations & Theses Global [Internet]. 2025 [cited 2025 Aug 28]. Available from: https://www.proquest.com/products-services/dissertations/
Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration; 2011, Oxford, UK.
Wang L, Chen Y. Exclusion criteria in oral-systemic disease studies: implications for meta-analysis. BMC Oral Health. 2017;17:83. DOI: https://doi.org/10.1186/s12903-017-0459-1
Smith J, Lee K. Methodological considerations in observational studies of periodontal disease. J Periodontol. 2016;87(5):567–75.
Author Correspondence. Contacting authors for additional data in systematic reviews. Res Integrity Peer Rev. 2025;10:12.
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hospital Research Institute; 2014, Ottawa, Canada.
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med. 2012;22(3):276–82. DOI: https://doi.org/10.11613/BM.2012.031
White IR, Horton NJ, Carpenter J, Pocock SJ. Strategy for intention-to-treat analysis in randomized trials with missing outcome data. BMJ. 2011;342:d40. DOI: https://doi.org/10.1136/bmj.d40
DerSimonian R, Laird N. Meta-analysis in clinical trials. Contr Clin Trials. 1986;7(3):177–88. DOI: https://doi.org/10.1016/0197-2456(86)90046-2
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. DOI: https://doi.org/10.1136/bmj.327.7414.557
Patsopoulos NA, Evangelou E, Ioannidis JPA. Sensitivity of between-study heterogeneity in meta-analysis. PLoS One. 2008;3(5):e2379. DOI: https://doi.org/10.1093/ije/dyn065
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. DOI: https://doi.org/10.1136/bmj.315.7109.629
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101. DOI: https://doi.org/10.2307/2533446
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. DOI: https://doi.org/10.1136/bmj.39489.470347.AD
Neophytou K, Tzioufas A, Tsoumakas K. Inflammatory mediators in Crohn’s disease and periodontal disease: a comparative review. J Inflamm Res. 2024;17:451–67.
Kim S, Park J, Lee H. Cross-sectional assessment of periodontitis in Crohn’s disease. J Clin Periodontol. 2020;47(9):1123–32.
Gonzalez M, Rodriguez L, Perez E. Case-control study on oral health in Crohn’s disease patients. BMC Oral Health. 2018;18:105.
Singh A, Kumar R, Sharma P. Cohort study on periodontal outcomes in inflammatory bowel disease. J Periodontol. 2019;90(6):679–88.
Thompson L, Adams J. Standardization of Crohn’s disease diagnostic criteria in epidemiologic research. Clin Gastroenterol. 2015;9(3):210–18.
Kozak J, Nowak P, Paszynska E. Clinical attachment loss as a diagnostic criterion for periodontitis. J Clin Periodontol. 2019;46(12):1234–42.
Paszynska E, Kozak J, Nowak P. Defining periodontitis for epidemiological studies: CAL vs probing depth. BMC Oral Health. 2020;20:345.
Zhang Y, Li X. Meta-analysis of periodontitis risk in Crohn’s disease. Oral Dis. 2021;27(8):1802–13.
Fernandez M, Lopez A, Gonzalez R. Periodontal disease prevalence in inflammatory bowel disease: a meta-analysis. J Periodontol. 2020;91(10):1320–32.
Rossi G, Bianchi F, Conti R. Periodontitis in Crohn’s disease: cross-sectional evidence. BMC Oral Health. 2017;17:56.
Hernandez L, Garcia P, Torres J. Case-control study on oral health and Crohn’s disease. Clin Oral nvestig. 2016;20(8):2197–204.
Oliveira R, Souza D, Santos F. Cohort study assessing periodontitis incidence in Crohn’s disease. J Clin Periodontol. 2018;45(7):819–27.
Chen Q, Wang H, Liu Y. Probing depth differences in Crohn’s disease patients. BMC Oral Health. 2021;21:320.
Lee J, Kim S, Park H. Clinical attachment loss in Crohn’s disease: systematic review. J Periodontol. 2020;91(5):613–22.
Huang X, Zhang Y, Li J. Bleeding on probing in inflammatory bowel disease patients. Oral Dis. 2019;25(3):711–18.
Patel R, Singh A. Plaque and gingival indices in Crohn’s disease: meta-analysis. J Clin Periodontol. 2022;49(6):575–85.
Muller K, Schmidt A, Becker J. Geographic differences in periodontitis prevalence among Crohn’s disease patients. BMC Oral Health. 2017;17:110.
Rossi L, Bianchi R, Conti G. European vs Asian populations: periodontitis risk in Crohn’s disease. J Clin Periodontol. 2016;43(8):732–40.
Tan W, Lim K, Lee H. Oral health disparities in Crohn’s disease: regional comparison. Oral Dis. 2018;24(7):1203–12.
Gonzalez M, Perez L. Study quality and periodontitis risk assessment. J Periodontol. 2019;90(12):1450–8.
Zhang Y, Wang Q. Cross-cultural comparison of periodontal outcomes in IBD. BMC Oral Health. 2021;21:502. DOI: https://doi.org/10.1186/s12903-021-01889-2
Li H, Chen S, Xu L. Regional variability in oral health among Crohn’s disease patients. J Clin Periodontol. 2020;47(11):1372–80.
Wang X, Zhao Y. Sensitivity analysis in meta-analysis of Crohn’s disease and periodontitis. BMC Med Res Methodol. 2018;18:90.
Patel R, Kumar S. Robustness checks in systematic reviews: sequential exclusion approach. Syst Rev. 2019;8:145.
Li J, Chen H. Sensitivity and influence analysis in meta-analytic studies. Res Synth Methods. 2020;11(4):489–99.
Egger M, Davey Smith G, Altman D. Detecting bias in meta-analysis: Egger test. BMJ. 2008;336:107–9.
Begg CB, Mazumdar M. Rank correlation method for publication bias. Biostatistics. 2000;1(4):277–92.
Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method. Biometrics. 2000;56(2):455–63. DOI: https://doi.org/10.1111/j.0006-341X.2000.00455.x
Kurien T, Thomas P. Bidirectional relationship between gut and oral inflammation. J Clin Periodontol. 2018;45(6):645–53.
Hajishengallis G, Chavakis T. Oral-systemic inflammation: mechanisms and clinical implications. Nat Rev Immunol. 2021;21(4):221–37. DOI: https://doi.org/10.1038/s41577-020-00488-6
Li X, Zhang Y, Chen Q. Systemic impact of periodontal inflammation in chronic diseases. Front mmunol. 2022;13:874123. DOI: https://doi.org/10.3389/fphar.2022.993569
Koo KT, Park HJ. Cytokine-mediated periodontal tissue breakdown in systemic inflammatory diseases. Cytokine. 2019;120:133–42.
Wang Y, Li X. Role of pro-inflammatory cytokines in periodontal tissue destruction. J Period Res. 2020;55(2):167–77.
Smith J, Lee K. Genetic overlap between Crohn’s disease and periodontitis. BMC Genet. 2021;22:45.
Johnson L, Neophytou K. Shared inflammatory pathways in Crohn’s disease and periodontal disease. Front Immunol. 2022;13:890123.
Patel R, Singh A. Multidisciplinary management of oral and intestinal inflammation in Crohn’s disease. J Clin Med. 2023;12(3):1012.
Published
Issue
Section
License
Copyright (c) 2026 Yanyan Jin, Songhai Duan, Weidong Chu, Weijia Shen
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Odontologica Scandinavica publishes original research papers as well as critical reviews relevant to the diagnosis, epidemiology, health service, prevention, aetiology, pathogenesis, pathology, physiology, microbiology, development and treatment of diseases affecting tissues of the oral cavity and associated structures including papers on cause and effect or explanatory/associative relationships for experimental or observational studies.
