Periodontitis Risk in Patients With and Without Systemic Lupus Erythematosus: A Retrospective Study

Objectives: Systemic lupus erythematosus is a systemic, long-term autoimmune condition that has chronic inflammatory effects in connective tissue throughout the body. There are numerous studies that have examined the association between systemic lupus erythematosus and chronic periodontitis, with varying conclusions. The purpose of this cross-sectional study is to evaluate and compare the risk for periodontitis in patients with SLE to patients without SLE. Materials and Methods: Medical and dental records were retrospectively reviewed for patients that had been admitted to the Temple University School of Dentistry from 2010 to 2018. A roster of 22 SLE positive patients were generated from the Temple University patient database and matched to a control population of 22 patients without SLE. Periodontal probing depths were then documented and used to evaluate periodontal statuses in both test and control groups. Sites with probing depths ≥5 mm were considered to be at increased risk for periodontal breakdown. Prevalence was defined as the percentage of individuals having at least one site with a ≥5 mm probing depth, and extent was defined as the average percentage of sites with increased periodontitis risk. The number of missing teeth in patients from each group were also recorded as a secondary outcome. Results: The prevalence of ≥5 mm probing depths in SLE and control groups was 50% (10/20) and 40.9% (9/22), respectively. Calculations of relative risk (1.22) and odds ratio (1.44) were not statistically significant between the two populations (p>0.05). The extent of ≥5 mm probing depths was 1.5% in SLE patients and 3.7% in healthy patients, which was also not significant between groups (p>0.05). SLE patients were missing an average of 9.6 teeth per individual compared to 3.8 in healthy patients (p<0.05). Journal of Dentistry and Oral Epidemiology www.acquirepublications.org/JDOE 2


Introduction
Systemic Lupus Erythematosus (SLE), also called lupus, is a chronic autoimmune disease that has clinical manifestations throughout the human body. The condition results in widespread inflammation and can affect multiple organ systems, including the heart, kidneys, joints, and blood vessels. Although detection methods have improved in recent years, diagnosing the disease is challenging and often requires an array of x-rays, laboratory tests, and clinical evaluations. Symptoms can be mild to more severe and may include oral ulcers, joint pain, chest pain, fatigue, weight loss, hair loss, photosensitivity, and in about half of SLE patients, a characteristic "butterfly rash" [1].
There are about 20 to 70 cases of SLE per 100,000 individuals in the United States, with a greater prevalence in individuals of Black, Asian or Hispanic descent. It is also found nine times more frequently in women than in men. Studies have demonstrated that there may be a hormonal mechanism that leads to the increased prevalence of SLE in females and that the immunological genes that contribute to SLE vulnerability are located on the X-chromosome. Although the exact etiology is not widely known, the onset of lupus can be influenced strongly by both genetic predisposition and environmental triggers [2].
Periodontitis is another multi-factorial, chronic inflammatory disease that affects the supporting structures of the teeth, such as cementum, bone, and periodontal ligament. As dental plaque and its associated microorganisms accumulate around the gingival margin, they can elicit an amplified host immune response that leads to bone loss around the teeth. The resulting damage often leads to deep pocketing, gingival recession, tooth mobility, and tooth loss. It is estimated that periodontitis is prevalent in 20-50% of the world's population, making it the most common condition affecting the oral cavity [3]. While

Materials And Methods
The present investigation is an observational study of cross-  ( Table 3).
The progression of probing depths 5mm in patients of increasing age can be seen graphically in Figure 1. The extent of 5mm probing depths, however, were not found to be statistically significant between test and control groups, or between age groups.  The comparative statistical analysis used to compare the SLE, and control groups can be seen in Tables 4, 5

, 6, and 7.
Clinical parameters were processed both as raw numbers and as percentages, with the same results. No significant differences in terms of probing depths were found between age groups or SLE status.   surveillance or maintenance protocols in order to mitigate any resulting pathologic effects on the oral condition.

Conclusion
Despite its limitations, the present study provides some further insight into the periodontitis risk in patients with SLE.
The results support the conclusion that patients with SLE do not have an increased risk for periodontitis when compared to patients without SLE. Risk analysis on the prevalence and extent of deeper probing depths between SLE and control groups did not reach statistically significant p-values, indicating that the null hypothesis could not be rejected.
Further studies with a larger sample size and elimination of unseen confounders are needed in order to validate the results.
An interesting observation was the finding that SLE patients have a significantly greater number of missing teeth. The exact mechanism through which SLE patients experience periodontal breakdown and increased tooth loss is an avenue that merits future research.