Psoriasis is a chronic inflammatory disorder recognized for causing scaly, red patches on the skin due to rapid cell turnover. As a systemic disease, its underlying inflammatory processes affect various body systems. Research highlights a connection between this chronic inflammation and overall oral health, particularly concerning the gums and soft tissues. Understanding this link is important for proactively managing dental well-being.
Psoriasis and Hard Tooth Structure
Psoriasis does not typically target the hard tissues of the teeth, such as enamel or dentin, in a direct, destructive manner. The tooth’s structural integrity is generally not compromised by the disease process. The primary oral health concern shifts from the teeth’s surface to the surrounding supporting structures. Tooth decay or loss issues are often indirect consequences of systemic inflammation or secondary effects on the oral environment.
Some studies suggest individuals with psoriasis may have more acidic saliva, potentially contributing to enamel demineralization. A higher rate of missing or decayed teeth has been observed in psoriatic patients. This likely results from the increased prevalence of advanced gum disease and associated loss of supportive bone structure, rather than a direct attack on the tooth material.
Systemic Inflammation and Gum Disease
The most significant link between psoriasis and oral health lies in shared inflammatory pathways driving both the skin condition and gum disease. Psoriasis involves an overactive immune response releasing high levels of pro-inflammatory signaling molecules, such as Interleukin-17 (IL-17) and Tumor Necrosis Factor-alpha (TNF-\(\alpha\)). These molecules are deeply involved in the development and progression of periodontitis, the advanced form of gum disease.
This chronic, systemic inflammatory state circulating throughout the body can significantly exacerbate existing gum inflammation. Psoriasis patients show a more than two-fold increased risk of developing periodontitis compared to those without the condition. The severity of the skin disease often correlates with the severity of the periodontal disease, suggesting a reciprocal relationship.
In periodontitis, chronic inflammation destroys the tissues and bone that anchor the teeth. The heightened inflammatory environment created by psoriasis accelerates the loss of alveolar bone (the jawbone supporting the tooth roots). This accelerated bone loss can cause teeth to loosen and eventually result in tooth loss, even when dental hygiene is maintained. The relationship is often considered bidirectional, where the inflammation from gum disease also adds to the body’s overall inflammatory burden, potentially worsening psoriasis symptoms.
Specific Oral Mucosal Conditions
Beyond the gums and supporting bone, psoriasis can manifest on the soft tissues lining the mouth. While rare, psoriatic lesions can appear on the oral mucosa (tongue, lips, and inner cheeks). These lesions present as white, red, or gray patches, sometimes with raised borders, and may cause discomfort or a burning sensation.
A more common manifestation is Geographic Tongue, or benign migratory glossitis. This condition involves irregular, smooth, red patches on the tongue surface, which are surrounded by a slightly raised white or yellowish border. These patches represent areas where the tiny projections on the tongue, called filiform papillae, have been lost.
Geographic tongue is significantly more prevalent in people with psoriasis, with estimates suggesting that 10 to 15 percent of psoriatic patients may experience it at some point. While usually harmless and often asymptomatic, its presence is sometimes considered a possible oral manifestation or a marker for the severity of the underlying systemic disease. Another related finding, Fissured Tongue, is characterized by deep grooves on the tongue’s surface and is also seen more frequently in the psoriatic population.
Strategies for Maintaining Oral Health
Individuals with psoriasis must adopt a proactive approach to mitigate increased oral health risks. Diligent home care remains the foundation, including brushing twice daily with fluoride toothpaste and flossing or using interdental cleaners once a day to disrupt bacterial plaque. Removing this plaque reduces the initial trigger for inflammation in the gums.
Establishing a routine of frequent professional dental check-ups and cleanings is important for monitoring early signs of periodontitis. Dental professionals often recommend that high-risk patients, such as those with psoriasis, benefit from cleanings more often than the standard twice-yearly schedule. It is essential to inform the dentist about the psoriasis diagnosis and medications, as some treatments can cause dry mouth, which increases the risk of decay.
Managing the underlying systemic inflammation through coordination between the dermatologist and the dentist contributes to better outcomes for both conditions. Adopting a healthy lifestyle, which includes smoking cessation and maintaining a balanced diet, helps to lower the overall inflammatory burden in the body. By treating the oral disease, the systemic inflammation may be reduced, potentially leading to an improvement in psoriatic symptoms as well.