Periodontal status of children with primary immunodeficiencies: a systematic review

Abstract

Objective The aim of this systematic review was to appraise the existing literature on periodontal disease in children affected by different types of neutrophil-associated primary immunodeficiencies (PIDs). Methods A PRESS-validated search strategy was developed to search through databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, Google Scholar and Open Grey. All included studies were assessed for methodological quality and risk of bias. Results One hundred eighteen articles reporting on 160 PID patients were included for qualitative analysis. The majority (70%) were individual case reports. Clinical and radiographic manifestations of the periodontal disease included poor oral hygiene, generalised alveolar bone loss, severe gingival inflammation, increased pocket depths, tooth mobility and gingival recession. For most studies, the primary intervention was periodontal treatment in the form of scaling and root planing or dental extractions. Stabilisation of the periodontal condition varied between different PIDs. In severe congenital neutropenia (SCN), 61% of cases reported stabilisation of the periodontal condition, while for all other PIDs, ‘stability’ was reported in less than 43% of cases. Conclusion The published literature suggests that patients with PIDs can present with severe periodontitis and that conventional treatment approaches have limited benefits.

Periodontal status in children with primary immunodeficiencies

“…Thirty-eight per cent of the test children and 13% of the control children had a BPE of 3 or higher in the present study, compared with 3% of male and 5% of female 15-year-old children in the Children's Dental Health Survey 21. However, periodontal disease prevalence and severity observed in this group of children with PIDs (mean approximately 3 sites with PPD >4 mm per patient) are somewhat less than what was reported in PID patients in previous studies11,22,23 and summarised in a recent Clinical photograph and radiograph of neutropenic test patient diagnosed with periodontitis Clinical photographs and radiographs of systemically healthy control patient diagnosed with gingivitis (A,B) and periodontal health (C,D) systematic review from our group 4. A reason for this difference may be the good standard medical and dental management of patients included in the present study.…”

“…3,4 Children with defects in neutrophil activity seem particularly susceptible to develop severe periodontitis in both primary and permanent dentitions, due to the crucial defensive role of neutrophils against periodontopathogenic bacteria. 5,6 Furthermore, their response to periodontal treatment is highly variable, and the presence of periodontitis often leads to early tooth loss, 4,7 with a devastating effect on mastication, aesthetics and quality of life. Furthermore, oral diseases (in particular periodontitis) may also provide an additional systemic inflammatory burden for these subjects, due to microbial entry into the systemic circulation from inflamed gum tissues.…”

“…7,8 Incorporation of periodontal screening has been advocated for early diagnosis and treatment of periodontal diseases in all children and especially for children with neutrophil defects, to prevent disease progression and tooth loss. 9,10 However, most published papers on periodontitis in children with immunodeficiencies are case reports or familial observations [11][12][13][14][15] or reviews, 3,4 A recent systematic review from our group revealed a high prevalence of periodontal diseases in children with PIDs and a modest response to treatment. However, the evidence was mainly based on case reports.…”

“…However, the evidence was mainly based on case reports. 4 Therefore, there is a lack of well-designed studies investigating both the prevalence of periodontitis and oral diseases in general in children with neutrophil defects and their response to treatment. A better understanding of the causative factors may help in early diagnosis and treatment, eventually improving disease management.…”

Single-cell atlas of human oral mucosa reveals a stromal-neutrophil axis regulating tissue immunity in health and inflammatory disease

“…Finally, expression of known disease susceptibility genes within oral tissues reflects a predominant expression of Mendelian-disease associated genes within tissue neutrophils. Indeed, it is well recognized that patients with genetic neutrophil defects commonly develop dominant severe oral phenotypes including aggressive periodontitis in children and recurrent oral ulcerations in lining mucosa 15,37 . Furthermore, our atlas allows us to evaluate the expression of genes related to periodontal susceptibility in common forms of periodontitis, identified through GWAS studies.…”