Digestive Diseases and Sciences

, Volume 56, Issue 1, pp 170–175 | Cite as

The Role of Oral Hygiene in Inflammatory Bowel Disease

  • Shashideep Singhal
  • Delia Dian
  • Ali Keshavarzian
  • Louis Fogg
  • Jeremy Z. Fields
  • Ashkan Farhadi
Original Article



The ‘hygiene hypothesis’ suggests that a reduction in the microbial exposure due to improved health measures has contributed to an immunological imbalance in the intestine and increased the incidence of autoimmune diseases such as inflammatory bowel diseases (IBD). Accordingly, we investigated associations between oral hygiene practices and IBD.


We developed and administered a multiple choice questionnaire to evaluate oral hygiene and dental care practices of 137 subjects (83 with IBD and 54 healthy controls).


Of the 83 IBD cases, 31% had ulcerative colitis and 69% had Crohn’s disease. For subjects with IBD, the frequency of brushing at disease onset was significantly higher than in controls (P = 0.005). Also, the frequency of use of dental floss and breath freshener at disease onset was significantly higher in IBD patients (P = 0.005 and <0.001, respectively). Also, patients with IBD more frequently visited their dentist at disease onset (P < 0.001) and continued to visit their dentist more often (P < 0.001). IBD cases had a higher frequency of dental complications such as tooth caries (P = 0.007), oral ulcers (P = 0.04) and dry mouth (P = 0.001).


These findings suggest that oral hygiene practices may cause alterations in the flora of the oral mucosa, which causes imbalance in the gut microbiome (dysbiosis), and thereby contributes to the pathogenesis of IBD. Conversely, the increased frequency of dental problems in IBD patients might be due, at least in part, to alterations in oral flora or to their disease.


Oral hygiene Hygiene hypothesis Inflammatory bowel disease Ulcerative colitis Crohn’s Colitis 



Crohn’s disease


Inflammatory bowel disease


Ulcerative colitis


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Shashideep Singhal
    • 1
  • Delia Dian
    • 1
  • Ali Keshavarzian
    • 2
    • 3
  • Louis Fogg
    • 4
  • Jeremy Z. Fields
    • 3
  • Ashkan Farhadi
    • 5
  1. 1.Department of Internal MedicineChicago Medical School at Rosalind Franklin University of Medicine and ScienceChicagoUSA
  2. 2.Department of Pharmacology, Molecular Biophysics and PhysiologyRush University Medical CenterChicagoUSA
  3. 3.Department of Internal Medicine (Section of Gastroenterology and Nutrition)Rush University Medical CenterChicagoUSA
  4. 4.College of NursingRush University Medical CenterChicagoUSA
  5. 5.Digestive Disease CenterBristol Park Medical GroupCosta MesaUSA

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