Dental professionals have long known the impact of their care on systemic health conditions, and vice versa. Many patients will be exposed to poor oral health outcomes due to conditions they have developed over time, but may not realise the full impact.
Immunodeficiency disorders are some prominent examples. The variety of conditions that compromise an individual’s ability to fight off infection may require such a magnitude of medications, treatments, and visits to healthcare institutions, that regular appointments at the dental practice and diligent oral hygiene routines could be neglected.
Neutrophil disorders are a group of immunodeficiency conditions that dental professionals could positively impact. It is worth considering how dental professionals can help patients manage their conditions appropriately, however, this is only possible with a complete understanding of the individual’s needs.
Understanding neutrophil disorders
Neutrophils are effective antimicrobial cells, typically outnumbering any other immune cell found in human blood, and are replenished within an individual’s bone marrow. Of all people with congenital primary immunodeficiency disorders, approximately 20 per cent will experience abnormal neutrophil quantity or function.
Neutrophil disorders may be caused by chemotherapy needed for cancer treatment, or due to an autoimmune condition which produces antibodies to the neutrophils or the bone marrow stem cells that produce them. The defect can also be inherited from an individual’s parents if they are carriers.
Patients may experience a variety of symptoms ranging from anaemia, to bleeding and bruising tendencies, or damage to the skin that results in abscesses or fungal infections, and generally poor wound healing, amongst others.
Treatment could take the form of G-SCF (granulocyte colony-stimulating factor) injections, which can encourage the production of neutrophils. A haematopoietic stem cell transplant may be considered a permanent cure. Those living with neutrophil disorders should try to reduce the potential for infection wherever possible, including preventing gingival diseases.
The oral impact
Neutrophil defects can affect a variety of functions that keep the cells in homeostasis. When this is achieved, patients can develop oral health infections that could become periodontitis without intervention. Deficiency is especially of concern as their role is so prevalent in the oral cavity – around 95 per cent or more leukocytes that are transferred to the gingival crevice in response to biofilm formation are neutrophils. The cells that are gathered at the crevice form what is described as a ‘defence wall’, stopping bacteria from invading underlying tissues.
When a patient develops gingivitis, the body invokes an inflammatory response, and when uncontrolled this may develop into periodontitis. At this stage in an otherwise healthy patient, microbial pathogens cannot be eliminated or controlled by neutrophils; the immune system continues to recruit more to the gingival crevice, but the excess accumulation of neutrophils can promote damage to the periodontal tissue and potential bone loss. However, if a patient experiences neutrophil deficiency, periodontitis can develop with an uncontrolled inflammatory response. Without the impact of the neutrophils, the condition is able to develop untouched. In another form of neutrophil disorder, where patients produce too many of the cells, a chronic inflammatory state may be induced. Without adequate homeostasis, a patient is always at risk of harm, no matter which side of the abnormal neutrophil production boundaries they are on.
Interestingly, the deficiency of neutrophil and the ensuing inflammation has been described as a ‘paradox’ in clinical literature. Comparing it to Leukocyte Adhesion Deficiency-I (LAD-I), where the paradigm presents that immune deficiency predisposes in an individual to an exaggerated inflammatory response, there are stark similarities. It is thought that the lack of an appropriate immune response requires the implementation of a compensatory effect, which is often unregulatable, eventually becoming excessive and misplaced. In the case of neutrophil defects, excessive IL-17-mediated inflammation is induced at the gingival crevice, driving tissue destruction.
The importance of oral hygiene
Patients with neutrophil defects may be able to manage periodontal disease effectively with twice-daily brushing, and exceptional interdental cleaning. The latter is vital when removing bacteria, debris and biofilm that aid the development of infection. Dental professionals could recommend high-quality water flosser solutions, which were proven in a 2023 study to outperform traditional dental floss at improving the composition of the oral microbiome to create a healthier environment.
Individuals could also use an oral hygiene adjunct from Waterpik, whose solutions stood out in the aforementioned study, such as the Cordless Advanced water flosser. It is proven to remove up to 99.9 per cent of plaque from treated areas with a second application. Patients using the solution will find it is up to 50 per cent more effective at improving gum health than traditional dental floss, and when used with the Pik Pocket tips, patients can gently deliver low-pressure rinses deep below the gumline into periodontal pockets.
Patients with conditions that affect their immune response must take active care to minimise the risk of developing disease over time. This includes keeping a strict, effective oral hygiene routine, which prevents the build-up of bacterial biofilm that induces the potentially uncontrollable cycle of tissue destruction.
References available on request.
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