Psoriasis is a chronic, immune-mediated disease primarily recognized for causing red, scaly patches on the skin, but its impact extends far beyond the surface. Because this is a systemic condition, the inflammatory processes driving skin symptoms can also affect other parts of the body, including oral health, teeth, and gums. This article explores the documented links between psoriasis and various dental and oral health issues.
The Systemic Link: Chronic Inflammation
Psoriasis is a systemic inflammatory disorder, not merely a localized skin issue. The body’s immune system mistakenly triggers a cascade of pro-inflammatory signaling proteins, known as cytokines, which circulate throughout the bloodstream. These cytokines, such as tumor necrosis factor-alpha (TNF-alpha), interleukin-17 (IL-17), and interleukin-23 (IL-23), are responsible for the accelerated skin cell turnover and inflammation seen in psoriatic plaques. This circulating inflammatory environment connects psoriasis to other bodily systems, including the oral cavity, where these mediators can contribute to inflammation in the tissues of the mouth and gums.
Psoriasis and Soft Oral Tissue Manifestations
Specific conditions affecting the soft tissues of the mouth are commonly observed in individuals with psoriasis. The most frequent correlation involves the tongue, where psoriasis may manifest as geographic tongue (benign migratory glossitis). This condition is characterized by distinctive, map-like patches of smooth, red areas on the tongue that migrate over time. Geographic tongue and psoriasis share microscopic and genetic similarities, including the presence of the common genetic marker HLA-C06.
A fissured tongue, involving deep grooves on the dorsal surface, is also more prevalent in psoriatic patients, often co-occurring with geographic tongue. Though rare, actual psoriatic lesions similar to those on the skin can appear on the buccal mucosa (inner cheeks) or gums, causing discomfort during flare-ups.
The Impact on Dental Stability and Periodontal Health
The circulating inflammation significantly exacerbates the progression of periodontitis, the advanced form of gum disease. Periodontitis is fundamentally an inflammatory condition, and the heightened systemic inflammation from psoriasis can accelerate the destruction of the tissues supporting the teeth. Studies consistently show that people with psoriasis have an increased risk for more severe periodontal disease compared to the general population.
This accelerated process begins with chronic gingivitis, where gums are inflamed and prone to bleeding, progressing to periodontitis if left unchecked. The continuous inflammatory assault leads to the gradual destruction of the periodontal ligament and the alveolar bone, which anchors the tooth root. This bone loss compromises the structural support of the teeth, leading to increased probing depths, gum recession, and tooth mobility. Consequently, patients with psoriasis often exhibit greater levels of alveolar bone loss and a higher number of missing teeth. The severity of the periodontal status often correlates with the severity of the skin disease, highlighting the shared inflammatory burden.
Collaborative Management and Monitoring
Proactive management of oral health is an important component of overall psoriasis care. It is beneficial to establish open communication between the dermatologist and the dentist or periodontist. Informing the dental team about a psoriasis diagnosis and any systemic medications being taken is helpful, as some treatments can influence oral health or the body’s healing response.
Patients should prioritize meticulous home care, including brushing twice daily and flossing once daily, to minimize local inflammation caused by plaque. Frequent and regular professional dental cleanings and comprehensive periodontal examinations are also recommended to detect and manage early signs of gum disease. Controlling oral inflammation through such measures is a crucial strategy, as it may help reduce the overall inflammatory load on the body, potentially benefiting the psoriatic condition.