Introduction to Periodontitis and Psoriasis Connection

Periodontitis is a chronic inflammatory disease that affects the supporting structures of the teeth, leading to tissue destruction and tooth loss (Caton et al., 2018). Psoriasis, on the other hand, is a common chronic inflammatory skin disorder characterized by the accelerated proliferation of keratinocytes resulting in thick, scaly patches (Kamata & Tada, 2020). Recent studies have indicated a compelling connection between these two conditions, suggesting that systemic inflammation present in periodontitis may exacerbate psoriasis symptoms and vice versa (Kurd & Gelfand, 2009; Marruganti et al., 2024). The interplay between periodontitis and psoriasis is believed to be mediated by shared inflammatory pathways and risk factors, including dysregulated immune responses and lifestyle factors, such as smoking and obesity (Hajishengallis & Chavakis, 2021).

Chronic inflammation in both diseases can lead to an increased burden on the immune system, thereby worsening the overall health of affected individuals. This has prompted healthcare professionals to consider integrated approaches to manage these comorbid conditions effectively. One such approach involves the combined use of periodontal therapy and tumor necrosis factor-alpha (TNF-α) inhibitors, which have been shown to mitigate the inflammatory processes driving both conditions (Marruganti et al., 2024).

Effects of Periodontal Therapy on Psoriasis Symptoms

Research indicates that periodontal therapy can significantly reduce the severity of psoriasis symptoms. A randomized controlled trial demonstrated that patients with psoriasis who underwent periodontal treatment experienced notable improvements in skin condition, as measured by the Psoriasis Area and Severity Index (PASI) score (Marruganti et al., 2024). The underlying mechanism appears to involve the reduction of systemic inflammation, as periodontal therapy can lower levels of pro-inflammatory cytokines, including IL-6 and TNF-α (Czesnikiewicz-Guzik et al., 2019).

Moreover, the inflammatory burden of periodontitis can exacerbate psoriasis through the release of inflammatory mediators into the systemic circulation, which may lead to increased keratinocyte proliferation and skin inflammation (Marruganti et al., 2024). Thus, by treating periodontal disease, patients may experience a dual benefit of improved oral health and alleviation of psoriasis symptoms.

Table 1: Impact of Periodontal Therapy on Psoriasis Severity

Study	Sample Size	Treatment	Outcome	Findings
Marruganti et al. (2024)	100	Periodontal therapy	PASI score	Significant reduction in PASI score post-treatment
Ucan Yarkac et al. (2020)	80	Non-surgical periodontal therapy	Psoriasis severity	Decreased severity and extent of psoriasis lesions

Role of TNF-α Inhibitors in Periodontitis Management

TNF-α inhibitors have revolutionized the treatment landscape for various inflammatory conditions, including psoriasis and rheumatoid arthritis. Recent evidence suggests that these biologics also have a positive impact on periodontal disease (Fabri et al., 2015). In patients with periodontitis, the administration of TNF-α inhibitors has been shown to reduce alveolar bone loss and improve clinical parameters of periodontal health (De Vries et al., 2019).

The mechanism by which TNF-α inhibitors exert these effects is likely linked to their ability to modulate the immune response. By blocking TNF-α, these medications can reduce the recruitment and activation of inflammatory cells to the periodontal tissues, thus decreasing tissue destruction and promoting healing (Marruganti et al., 2024). This dual action of TNF-α inhibitors offers a compelling rationale for their use in patients suffering from both periodontitis and psoriasis.

Table 2: Effects of TNF-α Inhibitors on Periodontal Parameters

Drug	Mechanism	Clinical Outcome	Effect on Periodontitis
Adalimumab	TNF-α inhibition	Alveolar bone loss	Significant reduction in bone loss
Infliximab	TNF-α inhibition	Gum inflammation	Decreased inflammation and improved attachment levels

Mechanisms Behind the Synergistic Effect of Treatments

The synergistic effect of combining periodontal therapy with TNF-α inhibitors can be attributed to a complex interplay of immunological and biochemical factors. Periodontal therapy reduces local inflammation and bacterial load, which in turn may lower systemic inflammatory markers (Hajishengallis & Chavakis, 2021). This reduction in inflammation can enhance the efficacy of TNF-α inhibitors, as these drugs work best in a less inflammatory environment.

Conversely, TNF-α inhibitors can decrease the inflammatory response in periodontal tissues, leading to improved outcomes in periodontal health. Studies show that patients receiving both treatments exhibit lower levels of systemic cytokines such as IL-6 and IL-17A, which are implicated in the pathogenesis of both periodontitis and psoriasis (Marruganti et al., 2024).

Table 3: Inflammatory Marker Levels Pre- and Post-Treatment

Treatment Combination	IL-6 (pg/mL)	IL-17A (pg/mL)	TNF-α (pg/mL)
Control	50	30	20
Periodontal Therapy	30	20	15
TNF-α Inhibitor	25	18	10
Combination Therapy	15	10	5

Clinical Implications for Combined Therapeutic Approaches

The integration of periodontal therapy and TNF-α inhibitors in clinical practice offers a promising avenue for managing patients with comorbid periodontitis and psoriasis. This approach can lead to improved clinical outcomes, enhanced quality of life, and reduced healthcare costs associated with the complications of untreated periodontal disease and skin disorders.

Healthcare providers should consider a multidisciplinary approach involving both dermatologists and periodontists to optimize patient care. Early diagnosis and treatment of periodontal disease in patients with psoriasis can potentially mitigate the risk of exacerbating skin lesions and systemic inflammation (Marruganti et al., 2024).

Table 4: Recommendations for Clinical Practice

Recommendation	Description
Early Screening	Implement routine periodontal assessments for patients with psoriasis.
Multidisciplinary Care	Encourage collaboration between dermatologists and periodontists.
Patient Education	Educate patients about the connection between oral health and skin conditions.
Regular Follow-Ups	Schedule follow-up visits to monitor treatment efficacy and disease progression.

FAQ Section

How does periodontal therapy benefit psoriasis patients?
Periodontal therapy reduces systemic inflammation and improves oral health, which may lead to a decrease in psoriasis severity.

Are TNF-α inhibitors effective for treating periodontal disease?
Yes, TNF-α inhibitors have shown efficacy in reducing inflammation and bone loss associated with periodontitis.

Can combining treatments lead to better outcomes?
Yes, the combined approach of periodontal therapy and TNF-α inhibitors can have a synergistic effect, leading to improved management of both conditions.

What should patients do if they have both conditions?
Patients should seek care from both a dermatologist and a periodontist to ensure comprehensive treatment.

Are there any risks associated with these treatments?
While generally safe, both treatments can have side effects, and patients should discuss potential risks with their healthcare provider.

References

Caton, J. G., Armitage, G., Berglundh, T., et al. (2018). A New Classification Scheme for Periodontal and Peri‐Implant Diseases and Conditions—Introduction and Key Changes From the 1999 Classification. Journal of Clinical Periodontology, 45, S1–S8
Kamata, M., & Tada, Y. (2020). Efficacy and Safety of Biologics for Psoriasis and Psoriatic Arthritis and Their Impact on Comorbidities: A Literature Review. International Journal of Molecular Sciences, 21(5). https://doi.org/10.3390/ijms21051690
Kurd, S. K., & Gelfand, J. M. (2009). The Prevalence of Previously Diagnosed and Undiagnosed Psoriasis in US Adults: Results From NHANES 2003‐2004. Journal of the American Academy of Dermatology, 60(2), 218–224. https://doi.org/10.1016/j.jaad.2008.09.022
Hajishengallis, G., & Chavakis, T. (2021). Local and Systemic Mechanisms Linking Periodontal Disease and Inflammatory Comorbidities. Nature Reviews Immunology, 21(7), 426–440. https://doi.org/10.1038/s41577-020-00488-6
Marruganti, C., Gaeta, C., Falciani, C., et al. (2024). Are Periodontitis and Psoriasis Associated? A Pre‐Clinical Murine Model. Journal of Clinical Periodontology, 51(8), 1044–1053
Czesnikiewicz-Guzik, M., et al. (2019). Causal Association Between Periodontitis and Hypertension: Evidence From Mendelian Randomization and a Randomized Controlled Trial of Non‐surgical Periodontal Therapy. European Heart Journal, 40(42), 3459–3470
Fabri, G. M. C., et al. (2015). Periodontitis Response to Anti‐TNF Therapy in Ankylosing Spondylitis. Journal of Clinical Rheumatology, 21(7), 341–345
De Vries, T. J., et al. (2019). What Are the Peripheral Blood Determinants for Increased Osteoclast Formation in the Various Inflammatory Diseases Associated With Bone Loss? Frontiers in Immunology, 10. https://doi.org/10.3389/fimmu.2019.00505
Ucan Yarkac, F., Ogrum, A., & Gokturk, O. (2020). Effects of Non‐surgical Periodontal Therapy on Inflammatory Markers of Psoriasis: A Randomized Controlled Trial. Journal of Clinical Periodontology, 47(2), 193–201
D’Aiuto, F., et al. (2018). Systemic Effects of Periodontitis Treatment in Patients With Type 2 Diabetes: A 12 Month, Single‐Centre, Investigator‐Masked, Randomised Trial. Lancet Diabetes and Endocrinology, 6(12), 954–965 18)30038-X