Periodontitis and autoimmune bullous diseases, including pemphigus vulgaris and mucous membrane pemphigoid, are immunoinflammatory disorders leading to microbial plaque- and autoantibody-elicited tissue injury of the oral cavity, respectively. Evidence indicates that these autoimmune conditions may represent a risk factor for periodontitis, but no systematic evaluation exists to corroborate this assumption. A systematic literature review of periodontal status in pemphigus and pemphigoid was conducted. Electronic searches using PubMed from inception to July 2016 identified 10 studies meeting predetermined inclusion and exclusion criteria. Most reported some correlation between poor periodontal health and both oral pemphigus vulgaris and mucous membrane pemphigoid. Some demonstrated beneficial effects of oral hygiene procedures on periodontal parameters and clinical disease severity of the established blistering diseases. Inconsistent results were found between studies and within analyzed patient cohorts, likely because of methodological shortcomings. This review preliminarily suggests that patients with oral pemphigus vulgaris and mucous membrane pemphigoid appear somewhat more susceptible to periodontitis, which in turn may potentially trigger the bullous disorders. These patients should be encouraged by dermatologists to pursue collaborative professional periodontal follow-up with dentists. The true relationship and mutual interaction between both diseases needs to be more comprehensively addressed in well-designed prospective studies.
DISCUSSION
The literature search identified a limited number of case-control and pilot studies related to periodontitis in autoimmune bullous diseases with oral involvement that were restricted to PV and MMP.6-15 This is likely a result of the rarity of these blistering disorders with an estimated incidence of 0.75 to 5 and 1.3 to 2 per million per year, respectively.1,2 Similarly to what was recently described in patients with rheumatoid arthritis,16 it was observed in the identified studies that patients with PV and MMP showed an increase in the incidence of periodontitis as compared with healthy individuals. These patients had worse periodontal parameters such as bleeding on probing, clinical attachment level of the periodontal ligament, probing depth, plaque index, and/ or gingival index/recession.7,8,10,11,13 In 1 study, results have been obtained by the community periodontal index of treatment needs.7 The only partial periodontal data recording on which this index is based on may not reflect the true state of periodontal health or disease and is not adequately correlated with attachment loss.12,17-19 Moreover, the increase in gingival index observed in patients with MMP, which describes the degree of clinical gingival inflammation, erythema, and edema, should be regarded with caution because this measure may have been biased by the MMP morphology.10,11
