Oral Health Problems in AIP Linked to Kidney, Liver Issues in Study

Patients with kidney failure, liver scarring likely to have worse teeth

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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People with acute intermittent porphyria (AIP) who have health problems related to the kidneys or liver are more likely to have issues with oral health than those without the genetic disorder, according to a new study.

Specifically, patients with kidney failure or liver scarring were found to have worse dental health, with a greater number of filled or missing teeth.

The study, “Dental and Periodontal Health in Acute Intermittent Porphyria,” was published in the journal Life.

The state of a person’s mouth and teeth can have a substantial impact on health. Thus far, no study has systematically examined dental health and its connection to disease manifestations in people with AIP.

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Here, a team led by scientists in Norway conducted analyses aiming to fill this gap in the literature.

The observational study (NCT01617642) included 47 adults with AIP, as well as 47 individuals without the disease, who were matched by age, sex, and place of residence to serve as controls.

All participants underwent a comprehensive oral health exam, as well as other clinical and laboratory assessments. Dietary habits were recorded with a seven-day diary.

Results showed the rates of periodontitis — gum disease — were not significantly different between AIP patients and controls (30% vs. 21%). Researchers noted that AIP patients with periodontitis were generally older, by about a decade on average, than those without gum disease.

AIP patients are often advised to eat a relatively high proportion of carbohydrates, which can help prevent disease attacks. Although overall sugar consumption was not different between patients and controls, researchers noted that carbohydrate consumption was markedly increased among AIP patients with periodontitis.

“In AIP cases with periodontitis, the carbohydrate intake was significantly higher than those without periodontitis, suggesting that diet plays a role in the development of periodontitis in AIP,” the team wrote, though they noted the difference in age among patients with or without gum disease might have also influenced these results.

The individuals with AIP found to have periodontitis also had increased levels of insulin and C-peptide, suggestive of insulin resistance — a phenomenon in which cells don’t respond well to insulin and are less able to take in sugar from the bloodstream.

A measure of kidney function known as the estimated glomerular filtration rate, or eGFR, was significantly correlated with the number of decayed, missing, or filled teeth (DMFT) in patients and controls. DMFT also correlated with measures of liver fibrosis (scarring) in both patients and controls.

“This study demonstrates that AIP patients with the AIP-related complication kidney failure or liver fibrosis had worsened dental health as determined by DMFT,” as well as other measures, the researchers wrote.

Smoking cigarettes also was associated with worse DMFT outcomes among patients, and with more missing teeth and gum disease in both patients and controls. In addition, smoking showed associations with markers of inflammation and periodontitis, and these statistical connections were generally more pronounced among AIP patients compared with controls.

“Because we observed stronger correlations between smoking and inflammation in the AIP cases versus the controls, this might suggest that smoking has a greater effect on dental health in the AIP cases compared to the controls. We speculate that the combination of smoking and AIP might lead to more inflammation and organ damage than smoking alone,” the researchers wrote.

Taken collectively, results from this study suggest “that AIP-associated organ complications and chronic low-grade inflammation may worsen dental health,” the researchers wrote, though they added that “due to the small sample size, the possibility of false positive findings cannot be excluded.”

The team also noted that this study was limited by a lack of data on participants’ oral hygiene habits or dental treatment histories, which might have influenced the results.