1. A comparison of Periodontal Disease in Crohns Disease and matched control patients A pilot study by Brittany Le Sueur

2. Study Introduction Summer Research Studentship GUT Health Network Colgate Auckland University of Technology (AUT)

3. Aim To understand how the gingiva relates to intestinal Crohns disease. Studies suggest there may be a link between oral health and the development of Crohns Disease Compare and establish what is normal between Crohns and non-Crohns patients

4. INFLAMMATORY BOWEL DISEASE (IBD) A range of chronic, immune mediated inflammatory diseases of the gastrointestinal tract (includes Crohns disease) 47% of people with IBD may suffer from extra-intestinal manifestations of IBD

5. Crohns Disease A chronic, incurable bowel disorder that affects all age groups and causes pain, illness and disruption to life. It may affect any part of the GIT, including the mouth & often in a discontinuous fashion New Zealand has the 2 nd highest incidence of disease in the world.

6. CHARACTERISTICS OF CHRONIC PERIODONTITIS Most Common Form Of Periodontitis Can Affect The Primary & Permanent Dentition Usually Has A Slow To Moderate Progression It May Also Have Periods Of Rapid Progression Can Be Localised or Generalised Can be modified by systemic factors

7. Systemic Risk Factors for Periodontal Disease Behavioural/life Style Environmental Metabolic/Autoimmune Diseases Haematological

8. PERCEIVED ORAL HEALTH IN PATIENTS WITH CROHNS DISEASE 1943 patients with CD in Sweden. Given questionnaires and allowed for variables Reported significantly greater need for dental treatment compared with controls More dental caries, more periodontal disease and other mouth problems such as mouth ulcers Oral Health Prev Dent 2009; 7(3):277-82 Rikardsson S et al

9. Study (Grossner-Schreiber B 2006) Patients with IBD had slightly greater Probing pocket depth (PPD) and Clinical Attachment Loss (CAL) compared with controls. Unsure re micro-organisms and if this further exacerbates IBD as in other diseases Need for studies on the impact of oral disease and micro- organisms on IBD

10. Research Hypothesis Crohns disease patients are more susceptible to periodontal disease either as a result of the disease itself or as a result of immunosuppressant treatment

11. Methodology Study commenced beginning of December 2013 with full ethical approval Patients were sourced from gastrointerologist clinics Control patients were matched where possible to existing Crohns study patients Age 18 and upwards Aimed for an equal spread of M/F

12. Methodology Completion of the required informed consents and questionnaires A plaque index is recorded Periodontal pocket depths are recorded Bleeding on probing – noted as PPD are recorded Mobility scores recorded A plaque sample is taken and frozen in 1ml of PBS

13. Plaque Sample Mature biofilm was sampled from each patients mouth, where ever the plaque was most abundant Plaque was frozen in PBS and stored It is to be sent to Canada for DNA sequencing, where the bacteria in the biofilm samples will be identified and quantified Then I will compare the bacteria of CD and Controls, looking to see if there is any correlation between the two study groups

14. Limitations/Observations Small study group to work with CD patients were motivated, mobile and not seriously ill Preliminary observations show that controls were less frequent dental attenders There was marginally more bleeding on probing in the control group

15. Where the Study stands now Awaiting sample analysis of plaque samples, continue with statisticians analysis Important to raise awareness of the periodontal disease in patients, particularly those with autoimmune diseases such as crohns

16. Thank You