Abstract
OBJECTIVES: To investigate whether common dental and oral symptoms are associated with an increased risk of systemic lupus erythematosus (SLE). METHODS: Participants initially free of SLE from the UK Biobank were included. Five prevalent dental and oral symptoms, namely, mouth ulcers, painful gums, bleeding gums, toothache, and loose or lost teeth or dentures, were ascertained from touchscreen questionnaires at baseline. The symptoms found to be associated with an increased risk of SLE were summed to evaluate the association of cumulative symptoms with SLE onset. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (95% CI). Subgroup analyses were conducted to identify potential effect modifiers. RESULTS: A total of 438,555 participants (mean age 56.2 years, 53.8% female) were included. During a median follow-up Duration of 11.76 years, 350 SLE cases were reported. The HRs (95% CIs) of incident SLE for five individual dental and oral symptoms, mouth ulcers, painful gums, bleeding gums, loose or lost teeth or dentures, toothache were 1.44 (1.04-1.98), 1.62 (1.01-2.58), 1.08 (0.78-1.48), 1.40 (1.08-1.81), and 0.99 (0.5-1.67), respectively. The HRs of the risk of SLE for participants with one, two, or three significant symptoms (including mouth ulcers, painful gums, and loose or lost teeth) were 1.30 (1.03-1.64), 1.78 (1.13-2.80), and 3.29 (1.35-8.02), respectively. A greater risk was observed in the female subgroup. CONCLUSIONS: Mouth ulcers, painful gums and loose or lost teeth were associated with an increased risk of SLE. Moreover, an increased number of oral health symptoms was associated with a greater risk of SLE onset.