Periodontitis in oral pemphigus and pemphigoid: A systematic review of published studies

Periodontitis and autoimmune bullous diseases, including pemphigus vulgaris and mucous membrane pemphigoid, are immunoinflammatory disorders leading to microbial plaque- and autoantibody-elicited tissue injury of the oral cavity, respectively. Evidence indicates that these autoimmune conditions may represent a risk factor for periodontitis, but no systematic evaluation exists to corroborate this assumption. A systematic literature review of periodontal status in pemphigus and pemphigoid was conducted. Electronic searches using PubMed from inception to July 2016 identified 10 studies meeting predetermined inclusion and exclusion criteria. Most reported some correlation between poor periodontal health and both oral pemphigus vulgaris and mucous membrane pemphigoid. Some demonstrated beneficial effects of oral hygiene procedures on periodontal parameters and clinical disease severity of the established blistering diseases. Inconsistent results were found between studies and within analyzed patient cohorts, likely because of methodological shortcomings. This review preliminarily suggests that patients with oral pemphigus vulgaris and mucous membrane pemphigoid appear somewhat more susceptible to periodontitis, which in turn may potentially trigger the bullous disorders. These patients should be encouraged by dermatologists to pursue collaborative professional periodontal follow-up with dentists. The true relationship and mutual interaction between both diseases needs to be more comprehensively addressed in well-designed prospective studies.