P109 Relationship Between Proton Pump Inhibitors and Periodontal Disease: Treatment Considerations for IBD Patients

Abstract

BACKGROUND: Proton pump inhibitors (PPI) can be useful in the treatment of clinical manifestations of gastrointestinal (GI) reflux disease, but there is an increased risk of complications in patients with Crohn's disease and ulcerative colitis (IBD) associated with PPI medications. Alterations in GI and oral microbiota, as well as changes in bone metabolism, also might be affected by PPI. In addition, IBD has been associated with an inflammatory host response to bacterial infection that shares many characteristics of periodontal disease (PD). The objective of this study was to assess the influence of a variety of systemic conditions on the ability of PPI to decrease bone loss in patients with PD. METHODS: Following IRB approval, medical and dental history records were reviewed from patients aged ≥35 years old that were referred in 2010-2017 to the University at Buffalo postgraduate periodontics program for evaluation (N = 1,017). From that group, records from patients diagnosed with generalized, chronic, moderate-to-severe periodontitis (stage III to IV; grade B to C) were further used in this study (N = 518). PD severity was measured by calculating the percentage of teeth with probing depths ≥6 mm. The presence of systemic factors and medication history, such as IBD, smoking, diabetes, use of systemic steroids, peri-menopausal hormone replacement therapy (HRT), hypothyroidism, other autoimmune disease, and use of PPI medications were verified at patient examination as well as review of patient records. Significance was measured via independent sample t-tests using IBM SPSS Statistics v25. RESULTS: We found that there was an inverse relationship between use of PPI and severity of PD, independent of the systemic conditions noted above. With all such exclusions, the prevalence of pocket depths ≥6 was 13.1% in PD patients taking PPI, vs. 19.9% for PD patients not taking PPI (mean difference = 6.8%, 34.2% decrease, 95% confidence interval = 2.1%-11.6%, P = 0.006). Similar significant differences in PD severity between patients taking (or not taking) PPI were found in the original unadjusted patient population without any medical exclusions, as well as upon consideration of any individual systemic condition. Finally, there were no significant differences in patient age or oral hygiene efficacy in any of the groups analyzed (P > 0.05). CONCLUSION(S): In patients with chronic, generalized, moderate-to-severe periodontitis, our results suggest that use of PPI medications is associated with less severe PD. The presence of diabetes, smoking, autoimmune disease, or the use of steroids or HRT, did not affect that outcome. 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 W.M. Feagans Endowed Chair Research Fund and the Department of Periodontics and Endodontics, University at Buffalo, SUNY.