Oral Aspects Identified in Atopic Dermatitis Patients: A Literature Review

Abstract

Introduction:Atopic dermatitis is a chronic inflammatory skin condition that is more prevalent in children (10-20% of the world's population) than in adults. As its etiology is multifactorial, it is important to know the most frequent oral manifestations in atopic dermatitis patients.Methodology:In the last decades, the correlation between atopic dermatitis and conditions and/or changes in the oral cavity has been demonstrated by several studies. The objective of this paper was to describe, through a review of the literature, the oral health conditions and/or oral aspects identified in patients with atopic dermatitis.Search Strategy:A descriptive literature review was carried out through a bibliographical survey based on the last 10 years, in order to answer the study questions.Results:As a result, we found six studies with different sample sizes, ranging from 43 to 468 patients, and the majority of them were of cross-sectional study design.Discussion:Two studies performed their analysis through dental exams and reported that patients with atopic dermatitis tend to have a greater frequency of carious lesions, and two studies correlated Candida with atopic dermatitis through mycological analyzes.Conclusion:There are a few studies in the literature that identify the oral aspects of atopic dermatitis. More investigations are needed in order to contribute to the knowledge of such oral aspects and the approach to treat these patients regarding oral health.

Oral mycobiome identification in atopic dermatitis, leukemia, and HIV patients – a systematic review

“…Fungal microbiota in AD can be affected by therapy modalities. Outpatients that present moderate and severe forms of AD are in general treated with immunomodulators and corticosteroids, the latter being related to oral candidiasis and favoring cariogenic activity [34].…”

“…Candida albicans was cultured from the nasopharynx of 59% of AD patients and its IgE-production stimulation was positively correlated to the severity of the disease [ 33 ]. Although the major studies in atopic dermatitis concern fungal characterization in the skin, the oral cavity presents a similar architecture but is rarely investigated [ 34 , 35 ]. In a sectional study, AD patients presented greater colonization by Candida albicans in the mouth when compared to healthy controls [ 36 ].…”

Identification of oral symptoms associated with atopic dermatitis in adolescents: Results from the Korea national representative survey 2009–2017

“…Decreased saliva resulting from mouth breathing or antihistamines could increase susceptibility to oral infection because saliva plays an important role in host defense against oral pathogens 36 . In addition, Candida albicans, which is a commensal yeast normally present in the oral cavity, may be transformed to a pathogenic form, resulting in the developing of oral lesions, because AD patients are often treated with immunosuppressants or antibiotics and may also have xerostomia 19,37 . A decrease in IgA levels has been also found in gingival tissue of asthma patients, which plays an important role in immune defense at mucosal levels, thus this may be involved with susceptibility to oral infection in allergic patients 38 .…”

“…Previous studies regarding oral manifestations in AD, most of which have been cross-sectional studies, have suggested that the following oral manifestations may be associated with AD: increased susceptibility to cariogenic activity, odontogenic focal infection, and reactivation of herpes simplex virus (HSV) type 1 followed by release into the oral cavity 16 – 19 . According to a study based on a national survey that enrolled 91,642 children aged 0–17 years in the United States, eczema was associated with toothache ( P < 0.0001), broken teeth ( P = 0.01) and bleeding gums ( P < 0.0001) but not with dental caries 20 .…”

“…A decrease in IgA levels has been also found in gingival tissue of asthma patients, which plays an important role in immune defense at mucosal levels, thus this may be involved with susceptibility to oral infection in allergic patients 38 . Furthermore, as observed in the FLG-defective skin, oral mucosa with defective FLG may also be susceptible to dryness and infection leading to dental caries 19 , 39 .…”