Increased risk of periodontal disease and poor oral-related quality of life in fibromyalgia

Authors

  • Katharine Hopkins Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
  • Camilla Ahlgren Department of Research, Development and Education, Public Dental Service, Lund, Sweden
  • Åsa Wahlin Department of Periodontology, Public Dental Service, Lund, Sweden
  • Annarita Antelmi Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
  • Magnus Bruze Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
  • Cecilia Svedman Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden

DOI:

https://doi.org/10.2340/aos.v85.46621

Keywords:

contact allergy, fibromyalgia, OHIP-14, oral symptoms, periodontitis

Abstract

Objective: (1) To survey oral health in fibromyalgia (FM) and compare with population controls and (2) to assess whether patterns of contact allergy are related to oral status in FM.

Materials and methods: Participants: 60 females with FM who had previously received contact allergy testing. Controls: 120 age- and gender-matched individuals. Questionnaire on aspects of oral health and symptoms and Oral Health Impact Profile-14. Clinical and radiological examination regarding oral health status.

Results: The degree of periodontal disease differed significantly between the FM and control groups (p = 0.017), with the difference most marked in younger patients. No difference was seen regarding dental caries and filled surfaces. FM patients had a higher prevalence of oral lesions than control patients (30.0% vs. 10.1%, p < 0.001). Younger FM patients had a poorer oral health-related quality of life than older patients. There was no relationship between oral symptoms or oral lesions and contact allergy.

Conclusions: Patients with FM have a poorer oral status than controls, particularly concerning periodontitis and oral lesions. Further work is required to assess whether contact allergy may play a role in poorer oral status and systemic inflammation in FM.

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References

Hauser W, Brahler E, Ablin J, Wolfe F. Modified 2016 American College of Rheumatology fibromyalgia criteria, the analgesic, anesthetic, and addiction clinical trial translations innovations opportunities and networks-American Pain Society Pain Taxonomy, and the prevalence of fibromyalgia. Arthritis Care Res. 2021;73:617–25. DOI: https://doi.org/10.1002/acr.24202

Sarzi-Puttini P, Giorgi V, Marotto D, Atzeni F. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol. 2020;16:645–60. DOI: https://doi.org/10.1038/s41584-020-00506-w

Rhodus NL, Fricton J, Carlson P, Messner R. Oral symptoms associated with fibromyalgia syndrome. J Rheumatol. 2003;30:1841–5.

De Stefano R, Bruno A, Muscatello MRA, Cedro C, Cicciu A, Rullo R, et al. Oral health and fibromyalgia syndrome: a systemic review. J Funct Morphol Kinesiol. 2020;5:7. DOI: https://doi.org/10.3390/jfmk5010007

Antelmi A, Dahlin J, Hopkins K, Svedman C, Bruze M. Contact allergy to gold simultaneously patch tested in two different chambers. Contact Dermatitis. 2023;89:54–6. DOI: https://doi.org/10.1111/cod.14310

Bruze M, Hopkins K, Dahlin J, Olsson K, Astrand J, Svedman C, et al. Increased rates of fragrance allergy in fibromyalgia individuals tested with the Swedish baseline patch test series. J Eur Acad Dermatol Venereol. 2023;37:104–13. DOI: https://doi.org/10.1111/jdv.18562

Hopkins K, Antelmi A, Dahlin J, Olsson K, Svedman C, Astrand J, et al. Increased rates of gold and acrylate allergy in individuals with fibromyalgia tested with an extended dental patch test series. Acta Derm Venereol. 2023;103:adv22336. DOI: https://doi.org/10.2340/actadv.v103.22336

Hopkins K, Antelmi A, Dahlin J, Olsson K, Svedman C, Astrand J, et al. Clinical relevance of contact allergy to gold sodium thiosulphate in fibromyalgia. Acta Derm Venereol. 2025;105:adv42463. DOI: https://doi.org/10.2340/actadv.v105.42463

Pongpairoj K, Ale I, Andersen KE, Bruze M, Diepgen TL, Elsner PU, et al. Proposed ICDRG classification of the clinical presentation of contact allergy. Dermatitis. 2016;27:248–58. DOI: https://doi.org/10.1097/DER.0000000000000222

Ahnlide I, Ahlgren C, Bjorkner B, Bruze M, Lundh T, Moller H, et al. Gold concentration in blood in relation to the number of gold restorations and contact allergy to gold. Acta Odontol Scand. 2002;60:301–5. DOI: https://doi.org/10.1080/00016350260248283

Ahlgren C, Ahnlide I, Bjorkner B, Bruze M, Liedholm R, Moller H, et al. Contact allergy to gold is correlated to dental gold. Acta Derm Venereol. 2002;82:41–4. DOI: https://doi.org/10.1080/000155502753600876

Malinauskiene L, Isaksson M, Bruze M. Systemic contact dermatitis in a gold-allergic patient after treatment with an oral homeopathic drug. J Am Acad Dermatol. 2013;68:e58. DOI: https://doi.org/10.1016/j.jaad.2012.09.013

Möller H, Björkner B, Bruze M. Clinical reactions to systemic provocation with gold sodium thiomalate in patients with contact allergy to gold. Br J Dermatol. 1996;135:423–7. DOI: https://doi.org/10.1111/j.1365-2133.1996.tb01507.x

Norderyd O, Kochi G, Papias A, Köhler AA, Helkimo AN, Brahm CO, et al. Oral health of individuals aged 3–80 years in Jönköping, Sweden, during 40 years (1973–2013). I. Review of findings on oral care habits and knowledge of oral health. Swed Dent J. 2015;39:57–68.

Norderyd O, Kochi G, Papias A, Köhler AA, Helkimo AN, Brahm CO, et al. Oral health of individuals aged 3–80 years in Jönköping, Sweden during 40 years (1973–2013). II. Review of clinical and radiographic findings. Swed Dent J. 2015;39:69–86.

Hugoson A, Koch G. Oral health in 1000 individuals aged 3–70 years in the community of Jönköping, Sweden. A review. Swed Dent J. 1979;3:69–87.

Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol. 1997;25:284–90. DOI: https://doi.org/10.1111/j.1600-0528.1997.tb00941.x

Larsson P, John MT, Hakeberg M, Nilner K, List T. General population norms of the Swedish short forms of oral health impact profile. J Oral Rehabil. 2014;41:275–81. DOI: https://doi.org/10.1111/joor.12137

World Health Organization. Oral health surveys: basic methods. 5th ed. Geneva: World Health Organization; 2013.

Koch G. Effect of sodium fluoride in dentifrice and mouth wash on incidence of dental caries in schoolchildren. Odontol Revy. 1967;18:72–6.

Hugoson A, Jordan T. Frequency distribution of individuals aged 20–70 years according to severity of periodontal disease. Community Dent Oral Epidemiol. 1982;10:187–92. DOI: https://doi.org/10.1111/j.1600-0528.1982.tb00377.x

Rodriguez-Pinto I, Agmon-Levin N, Howard A, Shoenfeld Y. Fibromyalgia and cytokines. Immunol Lett. 2014;161:200–3. DOI: https://doi.org/10.1016/j.imlet.2014.01.009

Christidis N, Ghafouri B, Larsson A, Palstam A, Mannerkorpi K, Bileviciute-Ljungar I, et al. Comparison of the levels of pro-inflammatory cytokines released in the vastus lateralis muscle of patients with fibromyalgia and healthy controls during contractions of the quadriceps muscle – a microdialysis study. PLoS One. 2015;10:e0143856. DOI: https://doi.org/10.1371/journal.pone.0143856

O’Mahony LF, Srivastava A, Mehta P, Ciurtin C. Is fibromyalgia associated with a unique cytokine profile? A systematic review and meta-analysis. Rheumatology (Oxford). 2021;60:2602–14. DOI: https://doi.org/10.1093/rheumatology/keab146

Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012;55:21–31. DOI: https://doi.org/10.1007/s00125-011-2342-y

Sanz M, Marco Del Castillo A, Jepsen S, Gonzalez-Juanatey JR, D’Aiuto F, Bouchard P, et al. Periodontitis and cardiovascular diseases: consensus report. J Clin Periodontol. 2020;47:268–88. DOI: https://doi.org/10.1111/jcpe.13189

Pischon N, Pischon T, Kroger J, Gulmez E, Kleber BM, Bernimoulin JP, et al. Association among rheumatoid arthritis, oral hygiene, and periodontitis. J Periodontol. 2008;79:979–86. DOI: https://doi.org/10.1902/jop.2008.070501

Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;45(Suppl. 20):S219–29.

Nijakowski K, Gruszczynski D, Kolasinska J, Kopala D, Surdacka A. Periodontal disease in patients with psoriasis: a systematic review. Int J Environ Res Public Health. 2022;19:11302. DOI: https://doi.org/10.3390/ijerph191811302

Ma KS, Lai JN, Veeravalli JJ, Chiu LT, Van Dyke TE, Wei JC. Fibromyalgia and periodontitis: bidirectional associations in population-based 15-year retrospective cohorts. J Periodontol. 2022;93:877–87. DOI: https://doi.org/10.1002/JPER.21-0256

da Silva LA, Kazyiama HH, de Siqueira JT, Teixeira MJ, de Siqueira SR. High prevalence of orofacial complaints in patients with fibromyalgia: a case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:e29–34. DOI: https://doi.org/10.1016/j.oooo.2012.04.001

Esteve M, Rosales-Leal JI. Analysis of temporomandibular disorders, bruxism and well-being in patients with fibromyalgia syndrome: a case-control study. J Oral Rehabil. 2025;52:350–6. DOI: https://doi.org/10.1111/joor.13908

Hadler-Olsen E, Petrenya N, Jonsson B, Steingrimsdottir OA, Stubhaug A, Nielsen CS. Periodontitis is associated with decreased experimental pressure pain tolerance: the Tromso Study 2015–2016. J Clin Periodontol. 2024;51:874–83. DOI: https://doi.org/10.1111/jcpe.13968

De Porras-Carrique T, Ramos-Garcia P, Aguilar-Diosdado M, Warnakulasuriya S, Gonzalez-Moles MA. Autoimmune disorders in oral lichen planus: a systematic review and meta-analysis. Oral Dis. 2023;29:1382–94. DOI: https://doi.org/10.1111/odi.14127

Dave A, Shariff J, Philipone E. Association between oral lichen planus and systemic conditions and medications: case-control study. Oral Dis. 2021;27:515–24. DOI: https://doi.org/10.1111/odi.13572

Jansson H, Wahlin A, Johansson V, Akerman S, Lundegren N, Isberg PE, et al. Impact of periodontal disease experience on oral health-related quality of life. J Periodontol. 2014;85:438–45. DOI: https://doi.org/10.1902/jop.2013.130188

Diepgen TL, Ofenloch RF, Bruze M, Bertuccio P, Cazzaniga S, Coenraads PJ, et al. Prevalence of contact allergy in the general population in different European regions. Br J Dermatol. 2016;174:319–29. DOI: https://doi.org/10.1111/bjd.14167

Uter W, Wilkinson SM, Aerts O, Bauer A, Borrego L, Brans R, et al. Patch test results with the European baseline series, 2019/20-Joint European results of the ESSCA and the EBS working groups of the ESCD, and the GEIDAC. Contact Dermatitis. 2022;87:343–55. DOI: https://doi.org/10.1111/cod.14170

Kucharczyk M, Slowik-Rylska M, Cyran-Stemplewska S, Gieron M, Nowak-Starz G, Krecisz B. Acrylates as a significant cause of allergic contact dermatitis: new sources of exposure. Postepy Dermatol Alergol. 2021;38:555–60. DOI: https://doi.org/10.5114/ada.2020.95848

Raap U, Stiesch M, Reh H, Kapp A, Werfel T. Investigation of contact allergy to dental metals in 206 patients. Contact Dermatitis. 2009;60:339–43. DOI: https://doi.org/10.1111/j.1600-0536.2009.01524.x

Forkel S, Schubert S, Corvin L, Heine G, Lang CCV, Oppel E, et al. Contact allergies to dental materials in patients. Br J Dermatol. 2024;190:895–903. DOI: https://doi.org/10.1093/bjd/ljad525

Marcusson JA. Contact allergies to nickel sulfate, gold sodium thiosulfate and palladium chloride in patients claiming side-effects from dental alloy components. Contact Dermatitis. 1996;34:320–3. DOI: https://doi.org/10.1111/j.1600-0536.1996.tb02215.x

Ahlgren C, Isaksson M, Moller H, Axell T, Liedholm R, Bruze M. The necessity of a test reading after 1 week to detect late positive patch test reactions in patients with oral lichen lesions. Clin Oral Investig. 2014;18:1525–31. DOI: https://doi.org/10.1007/s00784-013-1122-0

Ahlgren C, Bruze M, Moller H, Gruvberger B, Axell T, Liedholm R, et al. Contact allergy to gold in patients with oral lichen lesions. Acta Derm Venereol. 2012;92:138–43. DOI: https://doi.org/10.2340/00015555-1247

Ahlgren C, Axell T, Moller H, Isaksson M, Liedholm R, Bruze M. Contact allergies to potential allergens in patients with oral lichen lesions. Clin Oral Investig. 2014;18:227–37. DOI: https://doi.org/10.1007/s00784-013-0950-2

Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, et al. Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89(Suppl. 1):S173–82.

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Published

2026-07-31