Mouth matters

Abstract

<p><strong>Introduction:</strong> Juvenile idiopathic arthritis (JIA) and periodontal disease (PD) are both diseases of inflammation identified by redness and swelling.&nbsp; Most periodontitis cases among children and adolescents occur as a manifestation of certain systemic disease with an impaired immune system that compromises their response to microbial plaque (Alrayyes S, 2011).&nbsp; In 2016, Lange et al. reported children with CCP positive JIA having higher antibody titers to <em>Porphyromonas gingivalis (Pg)</em> and more symptoms of poor oral health.&nbsp; <em>Pg</em> is one of an estimated 500-700 species of bacteria that exist in the oral cavity with fewer than 5% of them being causative for periodontal disease (Bik, 2010)&nbsp;(Dewhirst FE).</p> <p><strong>Purpose:</strong> The purpose of this study was to determine the presence of the bacteria <em>porphyromonas gingivalis (Pg)</em> in children with JIA who are positive for either rheumatoid factor (RF) or CCP.</p> <p>Results of this study will guide further research in the role of oral microbiota and JIA.&nbsp; Ultimately such knowledge may lead to early intervention and prevention of inflammatory conditions.</p> <p><strong>Methods:</strong> A convenience sample of 12 children ages 10-21 with a diagnosis of JIA and either RF positive or CCP positive was selected from a hospital based rheumatology clinic.&nbsp; JIA disease activity is calculated as low, medium or high (Buekelman, 2011).&nbsp; PD is determined by oral exam. &nbsp;&nbsp;A saliva sample was collected to identify the presence of common pathogens associated with PD and increased risk of systemic disease.&nbsp; The bacteria were tested by PCR amplification followed by fluorescent endpoint detection of sample bacterial concentrations.&nbsp; Bacteria were reported as low, moderate or high risk for association with periodontal disease.</p> <p><strong>Results:</strong> Half of the children had medium disease activity for JIA (50%); one with high disease activity and the remaining 5 (41%) with low activity.&nbsp;&nbsp; Upon physical examination 7 of 12 children (58%) examined showed signs of localized inflammation of gingiva to one or more teeth, none of the 12 had generalized gingiva inflammation.&nbsp; The patient with the highest level of pathogens had low level of JIA disease activity.&nbsp; All 12 children were positive for a moderate risk pathogen Fusobacterium nucleatum (Fn).&nbsp; Fn is a common bacteria and when compared with a gender age matched control group this result was not significant.&nbsp; The control group consisted of patients undergoing evaluation and treatment for PD.&nbsp;&nbsp; Only 2 of 12 children (17%) had presence of Pg:&nbsp; neither had bleeding with brushing or flossing and one exhibited localized gingiva redness.</p> <p><strong>Discussion: </strong>Pg was not found to be prevalent in children with JIA who were positive RF or CCP.&nbsp;&nbsp; Presence of moderate and high risk bacteria existed in the children with JIA but was not significantly different than the control group children with PD.&nbsp; The study is limited by the small sample size and control group with PD.&nbsp; Future studies would include a control group from the general population or other children with JIA. &nbsp;The presence of bacteria associated with an inflammatory process such as PD emphasizes the importance of inclusion of oral health exam.</p>