J Crohns Colitis. 2024 Aug 14;18(8):1319-1341. doi: 10.1093/ecco-jcc/jjae028.

Himanshi Tanwar ¹, Jeba Mercy Gnanasekaran ¹, Devon Allison ¹, Ling-Shiang Chuang ², Xuesong He ³, Mario Aimetti ⁴, Giacomo Baima ⁴, Massimo Costalonga ⁵, Raymond K Cross ⁶, Cynthia Sears ⁷, Saurabh Mehandru ², Judy Cho ², Jean-Frederic Colombel ², Jean-Pierre Raufman ⁶, Vivek Thumbigere-Math ^1 8

Author information

¹Division of Periodontology, University of Maryland School of Dentistry, Baltimore, MD, USA.

²Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

³Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA.

⁴Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy.

⁵Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.

⁶Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA.

⁷Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

⁸National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD, USA.

PMID: 38417137

Abstract

As the opposite ends of the orodigestive tract, the oral cavity and the intestine share anatomical, microbial, and immunological ties that have bidirectional health implications. A growing body of evidence suggests an interconnection between oral pathologies and inflammatory bowel disease [IBD], implying a shift from the traditional concept of independent diseases to a complex, reciprocal cycle. This review outlines the evidence supporting an 'oral-gut' axis, marked by a higher prevalence of periodontitis and other oral conditions in IBD patients and vice versa. We present an in-depth examination of the interconnection between oral pathologies and IBD, highlighting the shared microbiological and immunological pathways, and proposing a 'multi-hit' hypothesis in the pathogenesis of periodontitis-mediated intestinal inflammation. Furthermore, the review underscores the critical need for a collaborative approach between dentists and gastroenterologists to provide holistic oral-systemic healthcare.