Association between toothbrushing habits and mucosal healing in Japanese patients with ulcerative colitis

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However, evidence regarding the association between oral health parameters and disease activity of UC is limited. This study aimed to evaluate the association between remaining tooth number, and toothbrushing frequency and mucosal healing (MH) in Japanese UC patients. Method The study included 275 patients with UC. Information on lifestyle and oral health parameters was collected via self-administered questionnaires. The definition of MH was based on the Mayo endoscopic subscore (MES) of 0. Results The prevalence of MH in this cohort was 24.7%. The distribution of remaining teeth was as follows: 13.1% had 20 or fewer teeth, 32.7% had 20–27 teeth, and 54.2% had 28 or more teeth. Toothbrushing frequency was: 23.6% brushed once or less per day, 46.9% brushed twice per day, and 29.5% brushed three or more times per day. No significant difference was observed between remaining teeth and MH. However, toothbrushing frequency is independently positively associated with MH (adjusted odds ratio: 2.87 [95% CI: 1.19–7.29]; p-value for trend = 0.021). Conclusion Toothbrushing frequency but not remaining tooth number was independently and positively associated with MH in Japanese patients with UC. ulcerative colitis toothbrushing habits mucosal healing Introduction Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by recurrent inflammation of the colonic mucosa, leading to mucosal ulceration, diarrhea, and rectal bleeding [ 1 ]. In recent years, evidence regarding the association between extraintestinal factors, including the oral environment and IBD increased [ 2 – 4 ]. The oral cavity and gut share a complex immunological and microbial interface, and dysbiosis in the oral microbiome has been implicated in intestinal inflammation through oral–gut axis [ 2 , 5 , 6 ]. Periodontal disease and dental caries are both closely associated with tooth loss and are linked to systemic inflammation and mortality. Several epidemiological studies show the association between periodontitis and UC and Crohn’s disease (CD) [ 7 – 9 ]. Similarly close association between dental caries and IBD was reported in several studies [ 10 – 12 ]. Moreover, associations of periodontal disease and subsequent tooth loss with IBD activity have been reported [ 13 ]. In previous study of patients with UC, number of tooth loss is associated with quality of life [ 14 ]. Toothbrushing frequency is inversely associated with periodontitis and dental caries. Tooth brushing plays a key role in reducing oral bacterial load and inflammation, which may in turn modulate gut microbiota composition and systemic inflammatory responses [ 3 , 6 , 15 ]. Some previous studies investigated the association between frequency of toothbrushing and incidence of IBD [ 15 , 16 ]. We hypothesized that the number of remaining teeth and frequency of toothbrushing may be associated with diseases activity in patients with UC. Mucosal healing (MH) has become an important therapeutic goal in UC, as it is associated with sustained clinical remission and improved long-term outcomes [ 17 ]. However, evidence regarding the association between oral hygiene behavior and intestinal mucosal outcomes in ulcerative colitis remains limited. In particular, it is unclear whether daily oral health practices are related to objective endoscopic outcomes. Therefore, the present study aimed to investigate the relationship between oral health parameters including the number of remaining teeth and tooth brushing frequency, and MH in patients with UC. Materials and Methods Ethics approval and consent to participate This cross-sectional analysis was conducted using baseline data derived from an ongoing prospective cohort. The study protocol was reviewed and approved by the Clinical Trial Review Committee of the Ehime University Graduate School of Medicine (approval number: 1505011). All procedures adhered to the ethical standards outlined in the Declaration of Helsinki (1964) and its later amendments. Written informed consent was obtained from all participants by trained research personnel. The study was prospectively registered in the University Hospital Medical Information Network (UMIN000051334). Study population This study included 275 patients with UC who received clinical management, either as inpatients or outpatients, at the Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, and its affiliated institutions in Ehime Prefecture, Japan, between 2015 and 2019. The diagnosis of UC was established according to characteristic endoscopic features and confirmed by clinical, radiologic, and histopathological assessments. All participants gave informed consent and were capable of completing a self-administered questionnaire. Measurement Items Information on lifestyle habits and socioeconomic factors, including smoking status, alcohol consumption, toothbrushing frequency, remaining teeth, and household income, was collected via self-administered questionnaires. Clinical details such as use of UC medications, disease extent, and duration of disease were extracted from medical records. Participants reporting smoking at the time of the survey were classified as current smokers, regardless of the number of cigarettes smoked. Similarly, individuals reporting regular drinking habits were considered current drinkers, regardless of frequency or amount consumed. The definition of Clinical remission (CR) and mucosal healing (MH) Endoscopic activity of UC was assessed by endoscopists with colonoscopy. Clinical remission (CR) was defined as the absence of rectal bleeding and abnormal frequency of bowel movements (less than 3 times per day) [18]. Clinical symptoms were assessed by board-certified gastroenterologists. In this study, a Mayo Endoscopic Score (MES) of 0 was defined as a disease-free state (MH) [19]. One endoscopist assessed both MES and MH while blinded to oral health parameters. The number of remaining teeth and frequency of tooth brushing The number of remaining teeth was assessed using a self-administered questionnaire. Participants responded to the following question: ‘Currently, excluding wisdom teeth, how many of your own natural teeth do you have in total, upper and lower combined? (Permanent teeth excluding wisdom teeth total 28. Please exclude dental implants).’ Respondents reported the number in free-text format. A self-administered questionnaire was used to assess toothbrushing habits. Participants were first asked whether they brushed their teeth daily (yes/no). Those who answered “yes” were subsequently asked to report the number of times they brushed their teeth per day, and they provided an approximate daily frequency in a free-response format. Statistical analysis Remaining teeth were categorized into three groups: (1) fewer than 20 teeth, (2) 21 to 27 teeth, and (3) 28 or more teeth. Tooth brushing frequency was also categorized into three groups: (1) once per day or less, (2) twice per day, and (3) three or more times per day. Odds ratios (OR) and adjusted ORs were estimated using logistic regression analysis, along with 95% confidence intervals (CI). Sex was considered as a biological variable in the study design and statistical analyses. Both male and female patients were included without sex-based exclusion criteria. Multivariable models were adjusted for sex to account for potential biological differences. The multivariate model adjusted for age, sex, prednisolone use, alcohol consumption, smoking, BMI, disease duration, and disease extent. Analyses were performed using SAS 9.4 (SAS Institute, Cary, NC, USA), and a two-sided p-value <0.05 was considered statistically significant. Results A total of 275 patients with UC were included in the analysis (Table 1). The median age was 50.65 years, and 58.2 % were male. The prevalence of MH (MES 0), and CR were 24.7%, and 59.3%, respectively. The average number of remaining teeth was 24.6. The distribution was as follows: 13.1% had 20 or fewer remaining teeth, 32.7% had 20 to 27 remaining teeth, and 54.2% had 28 or more remaining teeth. Frequency of tooth brushing was 23.6% (n = 65) for ≤ 1 time/day, 46.9% (n = 129) for 2 times/day, and 29.5% (n = 81) for ≥ 3 times/day, respectively. Table 2 presents the crude and adjusted ORs and 95% CIs for the associations between number of remaining teeth and clinical outcomes. MH (MES <1) and CR rates by number of remaining teeth were 30.6% and 69.4% for <20 teeth, 27.8% and 60.0% for 21–27 teeth, and 21.5% and 56.4% for ≥28 teeth, respectively. Remaining tooth was not associated with MH or CR. Table 3 presents the crude and adjusted ORs and 95% CIs for the associations between frequency of tooth brushing and clinical outcomes. MH (MES <1) and CR rates by toothbrushing frequency were 15.4% and 60.0% for ≤1 time/day, 24.8% and 54.3% for 2 times/day, and 32.1% and 66.7% for ≥3 times/day, respectively. After adjustment, toothbrushing frequency was independently and positively associated with MH but not CR (adjusted odds ratio: 2.87 [95% CI: 1.19–7.29], p for trend = 0.021). Discussion In this study, we demonstrated that a high frequency of tooth brushing was independently associated with MH in patients with UC, whereas the number of remaining teeth showed no such association. In addition, tooth brushing frequency was not associated with CR. These findings suggest that daily oral hygiene behavior, rather than the structural condition of dentition, may influence intestinal mucosal recovery in UC, potentially through modulation of systemic and mucosal inflammation. In epidemiological studies, number of teeth is associated with cardiovascular disease [20, 21], stroke [20], and mortality [21-23]. Especially, several epidemiological studies have demonstrated that having fewer than 20 teeth is associated with all-cause mortality [21, 24]. Evidence regarding the association between the number of teeth and IBD is limited, while the meta-analysis of periodontitis in IBD showed the close association between periodontitis and IBD including UC. In a Danish study of patients with IBD, individuals with CD had fewer teeth than those with UC, and fewer than 20 remaining teeth was associated with greater IBD disease activity [13]. In a Denmark case–control study of 4,537 participants (including 527 patients with CD and 566 with UC), both UC and CD were associated with a higher prevalence of severe periodontitis and poor self-rated oral health compared with controls, and the proportion of individuals with fewer than 20 remaining teeth was higher among patients with CD than among those with UC [14]. Within IBD, CD tends to be associated with fewer remaining teeth, and the impact of tooth loss on disease activity appears to be more pronounced in CD, whereas studies have not consistently demonstrated a clear association in UC. Therefore, our findings regarding the number of remaining teeth may be considered broadly consistent with the existing literature. Toothbrushing frequency is inversely associated with incidence of chronic diseases, including hypertension [25], diabetes [26], cardiovascular disease [27], and cancer [28] in previous epidemiological studies. Some studies show the association between toothbrushing frequency and onset of IBD. In a Korean national health insurance database study, high frequency toothbrushing (≥3 times a day) is inversely associated with incidence of CD, but not UC [15]. On the other hand, in a US case-control study of IBD (26 UC, 57 CD, and 54 healthy cases), the frequency of toothbrushing in IBD cases is higher than control [16]. Several biological mechanisms may explain this association. The oral–gut axis describes the ectopic colonization of oral bacteria within the intestinal tract, where they may exacerbate intestinal inflammation. Studies have shown that oral pathobionts such as Fusobacterium nucleatum and Porphyromonas gingivalis can migrate to the gut and promote colitis by activating immune pathways and disrupting the epithelial barrier [2, 3]. Atarashi et al. further confirmed that oral bacteria can directly drive intestinal inflammation [29]. Tooth brushing might improve indirectly and directly the mucosal inflammation via preventing dissemination of bacterial endotoxins and inflammatory mediators from the oral cavity and stopping migration of oral pathobionts to the gut [3, 6, 7, 29]. The lack of association between the number of remaining teeth and MH in this study may indicate that structural dental status reflects past oral disease rather than current inflammatory activity. Our study also found no association between tooth brushing frequency and CR. This discrepancy highlights the well-recognized dissociation between clinical symptoms and endoscopic inflammation in UC. MH reflects objective resolution of intestinal inflammation and has been associated with improved long-term outcomes, including reduced hospitalization and colectomy rates [18]. In contrast, clinical remission is influenced by subjective symptoms, which may persist despite endoscopic improvement [30]. Therefore, oral hygiene may preferentially affect mucosal inflammation without necessarily producing immediate symptomatic benefit. From a clinical perspective, these results suggest that promoting oral hygiene, a simple and non-invasive intervention, might contribute to intestinal mucosal recovery in UC. Regular tooth brushing may therefore represent an adjunctive, patient-centered strategy to optimize mucosal outcomes alongside standard pharmacological therapy. Several limitations should be acknowledged. First, the cross-sectional design precludes causal inference, and reverse causality cannot be excluded; patients with MH may be more likely to engage in health-promoting behaviors. Second, oral microbiome composition and inflammatory biomarkers were not assessed, limiting mechanistic interpretation. Third, other oral health practices, such as professional dental care and use of antiseptic mouthwash, were not evaluated. Finally, there are limitations in generalizing the study population. Thus, the study population may not be fully representative of all Japanese UC patients. Nevertheless, the mean age, sex ratio, and medication use in this study were comparable to those reported in Japanese national UC surveys [31]. In conclusion, the present study identified a significant association between frequent tooth brushing and mucosal healing in patients with ulcerative colitis. These findings suggest that oral hygiene may be linked to intestinal inflammatory status through the oral–gut axis. Maintaining good oral hygiene could represent a simple and potentially modifiable factor in the comprehensive management of ulcerative colitis. Further prospective studies are warranted to clarify the causal relationship and underlying mechanisms. Declarations Acknowledgements The authors would like to thank Keitarou Kawasaki, Yuji Mizukami, Satoshi Imamine, Masamoto Torisu, Harumi Yano, Makoto Yano, Masato Murakami, Masumi Hino, and Tomo Kogama. Author Contributions All authors agree with the content of the manuscript.Sen Yagi and Shinya Furukawa contributed to the conception and design; Sen Yagi, Shinya Furukawa, and Teruki Miyake contributed to the investigation; Shinya Furukawa performed the formal analysis and visualization; Teruki Miyake, Eiji Takeshita, and Yoshio Ikeda contributed to data curation; Sen Yagi and Shinya Furukawa drafted the manuscript. Teruki Miyake, Osamu Yoshida, Kazuhiro Tange, Shogo Kitahata, Tomoyuki Ninomiya, Seiyuu Suzuki, Naozumi Shibata, Masakazu Hanayama, Katsuhisa Ohashi, Hideomi Tomida, Yasunori Yamamoto, Eiji Takeshita, and Yoshio Ikeda revised the manuscript critically for important intellectual content.Yoichi Hiasa contributed to the conception and design and provided supervision. Shinya Furukawa, Eiji Takeshita, Yoshio Ikeda, and Yoichi Hiasa contributed to project administration.All authors gave final approval of the version to be published, agreed on the journal to which the article has been submitted, and agreed to be accountable for all aspects of the work. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Conflict of interest The authors declare that they have no competing interests. Ethical approval This study was approved by the Ethics Committee of Ehime University. All procedures involving human participants were conducted in accordance with the Declaration of Helsinki. Informed consent Written informed consent was obtained from all patients prior to sample collection. 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Clinical characteristics of 275 study participants Variables Mean ± SD or n (%) Age (years) 50.65± 15.9 Male (%) 160 (58.2) Disease extent (n; pancolitis/left-sided/proctitis/other) 113/76/79/7 Duration of UC (years) 8.1 ± 8.4 BMI (kg/m2) 22.49 ± 4.52 Current smoking (%) 18 (6.6) Current drinking (%) 115 (41.8) Medication for UC 5-Aminosalicylates (%) 252 (91.6) Prednisolone (%) 55 (20.0) Thiopurines (%) 42 (15.3) TNF- α monoclonal antibody (%) 14 (5.1) Mayo Endoscopic Subscore (MES) 1.22 ± 0.91 Complete mucosal healing (MES <1, %) 68 (24.7) Clinical remission (%) 163 (59.3) Number of remaining teeth (n) 24.6 ± 6.6 <20 teeth (%) 36 (13.1) 20-27 teeth (%) 90 (32.7) ≥ 28 teeth (%) 149 (54.2) Frequency of tooth brushing (n) 2.1 ± 0.7 ≤ 1 time/day (%) (23.6) 2 times/day (%) 129 (46.9) ≥ 3 times/day (%) 81 (29.5) BMI, body mass index; UC, ulcerative colitis; SD, standard deviation; TNF, tumor necrosis factor; Other: right-sided, segmental colitis, and postoperative patients (lack of any preoperative medical records for postoperative patients) Table 2. Crude and adjusted odds ratios and 95% confidence intervals for the associations between number of remaining teeth and clinical outcomes Variable Prevalence, n/n (%) Crude OR (95% CI) Adjusted OR (95% CI) Complete MH (MES <1) Number of remaining teeth <20 teeth 11/36 (30.6) 1.00 1.00 20-27 teeth 25/90 (27.8) 1.61 (0.70–3.56) 1.23 (0.44–3.34) ≥ 28 teeth 32/149 (21.5) 1.41 (0.76–2.57) 1.26 (0.63–2.51) p for trend 0.600 Clinical remission Number of remaining teeth <20 teeth 25/36 (69.4) 1.00 1.00 20-27 teeth 54/90 (60.0) 1.76 (0.82–3.97) 1.15 (0.45–3.02) ≥ 28 teeth 84/149 (56.4) 1.16 (0.68–1.98) 0.89 (0.48–1.64) p for trend 0.933 Odds ratios were adjusted for sex, age, body mass index, current drinking, and current smoking,. OR, odds ratio; CI, confidence interval; MH, mucosal healing; MES, Mayo Endoscopic Score. Table 3. Crude and adjusted odds ratios and 95% confidence intervals for the associations between frequency of tooth brushing and clinical outcomes Variable Prevalence, n/n (%) Crude OR (95% CI) Adjusted OR (95% CI) Complete MH (MES <1) Frequency of tooth brushing ≤ 1 time/day 10/65 (15.4) 1.00 1.00 2 times/day 32/129 (24.8) 1.81 (0.85–4.15) 1.87 (0.85–4.36) ≥ 3 times/day 26/81 (32.1) 2.60 (1.18–6.13) 2.87 (1.19–7.29) p for trend 0.021 Clinical remission Frequency of tooth brushing ≤ 1 time/day 39/65 (60.0) 1.00 1.00 2 times/day 70/129 (54.3) 0.79 (0.43–1.44) 0.79 (0.42–1.48) ≥ 3 times/day 54/81 (66.7) 1.33 (0.68–2.64) 1.28 (0.60–2.72) p for trend 0.491 Odds ratios were adjusted for sex, age, body mass index, current drinking, and current smoking,. OR, odds ratio; CI, confidence interval; MH, mucosal healing; MES, Mayo Endoscopic Score. Additional Declarations No competing interests reported. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Seiyuu","middleName":"","lastName":"Suzuki","suffix":""},{"id":612260775,"identity":"4ae7c0a1-2785-4a6c-9f00-9e7585566c79","order_by":9,"name":"Naozumi Shibata","email":"","orcid":"","institution":"ehime prefectural niihama hospital","correspondingAuthor":false,"prefix":"","firstName":"Naozumi","middleName":"","lastName":"Shibata","suffix":""},{"id":612260776,"identity":"a763884c-b8b9-48d4-907c-743cbf8c739f","order_by":10,"name":"Hidehiro Murakami","email":"","orcid":"","institution":"Saiseikai Matsuyama Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hidehiro","middleName":"","lastName":"Murakami","suffix":""},{"id":612260777,"identity":"8ea4b3d0-8b02-403d-9c92-190d377a8cbb","order_by":11,"name":"Katsuhisa Ohashi","email":"","orcid":"","institution":"ohashi clinic","correspondingAuthor":false,"prefix":"","firstName":"Katsuhisa","middleName":"","lastName":"Ohashi","suffix":""},{"id":612260779,"identity":"a0a4aff2-57c2-49eb-9ad8-b90443132002","order_by":12,"name":"Hideomi Tomida","email":"","orcid":"","institution":"Ehime University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hideomi","middleName":"","lastName":"Tomida","suffix":""},{"id":612260781,"identity":"f84d2953-63bc-49a7-b40e-73ce87efc18e","order_by":13,"name":"Yasunori Yamamoto","email":"","orcid":"","institution":"Ehime University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yasunori","middleName":"","lastName":"Yamamoto","suffix":""},{"id":612260785,"identity":"123d6da9-e960-4f8b-987c-c93d3a4c8d65","order_by":14,"name":"Eiji Takeshita","email":"","orcid":"","institution":"Ehime University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Eiji","middleName":"","lastName":"Takeshita","suffix":""},{"id":612260786,"identity":"c8a3b66d-d4c3-42af-8b38-b338f7f06b1b","order_by":15,"name":"Yoshio Ikeda","email":"","orcid":"","institution":"Ehime University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yoshio","middleName":"","lastName":"Ikeda","suffix":""},{"id":612260787,"identity":"15907d03-d55f-400c-a333-a0c1bcc9b336","order_by":16,"name":"Yoichi Hiasa","email":"","orcid":"","institution":"Ehime University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yoichi","middleName":"","lastName":"Hiasa","suffix":""}],"badges":[],"createdAt":"2026-03-20 16:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9180685/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9180685/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105566877,"identity":"90c57981-c3da-41ad-a513-c513d7581594","added_by":"auto","created_at":"2026-03-27 12:57:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":659108,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9180685/v1/d034b9ff-faee-4f6b-892f-9991419729bd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association between toothbrushing habits and mucosal healing in Japanese patients with ulcerative colitis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUlcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by recurrent inflammation of the colonic mucosa, leading to mucosal ulceration, diarrhea, and rectal bleeding [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, evidence regarding the association between extraintestinal factors, including the oral environment and IBD increased [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The oral cavity and gut share a complex immunological and microbial interface, and dysbiosis in the oral microbiome has been implicated in intestinal inflammation through oral\u0026ndash;gut axis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePeriodontal disease and dental caries are both closely associated with tooth loss and are linked to systemic inflammation and mortality. Several epidemiological studies show the association between periodontitis and UC and Crohn\u0026rsquo;s disease (CD) [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Similarly close association between dental caries and IBD was reported in several studies [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, associations of periodontal disease and subsequent tooth loss with IBD activity have been reported [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In previous study of patients with UC, number of tooth loss is associated with quality of life [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eToothbrushing frequency is inversely associated with periodontitis and dental caries. Tooth brushing plays a key role in reducing oral bacterial load and inflammation, which may in turn modulate gut microbiota composition and systemic inflammatory responses [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Some previous studies investigated the association between frequency of toothbrushing and incidence of IBD [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. We hypothesized that the number of remaining teeth and frequency of toothbrushing may be associated with diseases activity in patients with UC. Mucosal healing (MH) has become an important therapeutic goal in UC, as it is associated with sustained clinical remission and improved long-term outcomes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e However, evidence regarding the association between oral hygiene behavior and intestinal mucosal outcomes in ulcerative colitis remains limited. In particular, it is unclear whether daily oral health practices are related to objective endoscopic outcomes. Therefore, the present study aimed to investigate the relationship between oral health parameters including the number of remaining teeth and tooth brushing frequency, and MH in patients with UC.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional analysis was conducted using baseline data derived from an ongoing prospective cohort. The study protocol was reviewed and approved by the Clinical Trial Review Committee of the Ehime University Graduate School of Medicine (approval number: 1505011). All procedures adhered to the ethical standards outlined in the Declaration of Helsinki (1964) and its later amendments. Written informed consent was obtained from all participants by trained research personnel. The study was prospectively registered in the University Hospital Medical Information Network (UMIN000051334).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included 275 patients with UC who received clinical management, either as inpatients or outpatients, at the Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, and its affiliated institutions in Ehime Prefecture, Japan, between 2015 and 2019. The diagnosis of UC was established according to characteristic endoscopic features and confirmed by clinical, radiologic, and histopathological assessments. All participants gave informed consent and were capable of completing a self-administered questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurement Items\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformation on lifestyle habits and socioeconomic factors, including smoking status, alcohol consumption, toothbrushing frequency, remaining teeth, and household income, was collected via self-administered questionnaires. Clinical details such as use of UC medications, disease extent, and duration of disease were extracted from medical records. Participants reporting smoking at the time of the survey were classified as current smokers, regardless of the number of cigarettes smoked. Similarly, individuals reporting regular drinking habits were considered current drinkers, regardless of frequency or amount consumed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe definition of Clinical remission (CR) and mucosal healing (MH)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEndoscopic activity of UC was assessed by endoscopists with colonoscopy. Clinical remission (CR) was defined as the absence of rectal bleeding and abnormal frequency of bowel movements (less than 3 times per day)\u0026nbsp;[18]. Clinical symptoms were assessed by board-certified gastroenterologists. In this study, a Mayo Endoscopic Score (MES) of 0 was defined as a disease-free state (MH) [19]. One endoscopist assessed both MES and MH while blinded to oral health parameters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe number of remaining teeth and frequency of tooth brushing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe number of remaining teeth was assessed using a self-administered questionnaire. Participants responded to the following question: ‘Currently, excluding wisdom teeth, how many of your own natural teeth do you have in total, upper and lower combined? (Permanent teeth excluding wisdom teeth total 28. Please exclude dental implants).’ Respondents reported the number in free-text format.\u003c/p\u003e\n\u003cp\u003eA self-administered questionnaire was used to assess toothbrushing habits. Participants were first asked whether they brushed their teeth daily (yes/no). Those who answered “yes” were subsequently asked to report the number of times they brushed their teeth per day, and they provided an approximate daily frequency in a free-response format.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRemaining teeth were categorized into three groups: (1) fewer than 20 teeth, (2) 21 to 27 teeth, and (3) 28 or more teeth. Tooth brushing frequency was also categorized into three groups: (1) once per day or less, (2) twice per day, and (3) three or more times per day. Odds ratios (OR) and adjusted ORs were estimated using logistic regression analysis, along with 95% confidence intervals (CI). Sex was considered as a biological variable in the study design and statistical analyses. Both male and female patients were included without sex-based exclusion criteria. Multivariable models were adjusted for sex to account for potential biological differences. The multivariate model adjusted for age, sex, prednisolone use, alcohol consumption, smoking, BMI, disease duration, and disease extent. Analyses were performed using SAS 9.4 (SAS Institute, Cary, NC, USA), and a two-sided p-value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 275 patients with UC were included in the analysis (Table 1). The median age was 50.65 years, and 58.2 % were male. The prevalence of MH (MES 0), and CR were 24.7%, and 59.3%, respectively. The average number of remaining teeth was 24.6. The distribution was as follows: 13.1% had 20 or fewer remaining teeth, 32.7% had 20 to 27 remaining teeth, and 54.2% had 28 or more remaining teeth. Frequency of tooth brushing was 23.6% (n = 65) for \u0026le; 1 time/day, 46.9% (n = 129) for 2 times/day, and 29.5% (n = 81) for \u0026ge; 3 times/day, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 presents the crude and adjusted ORs and 95% CIs for the associations between number of remaining teeth and clinical outcomes. MH (MES \u0026lt;1) and CR rates by number of remaining teeth were 30.6% and 69.4% for \u0026lt;20 teeth, 27.8% and 60.0% for 21\u0026ndash;27 teeth, and 21.5% and 56.4% for \u0026ge;28 teeth, respectively. Remaining tooth was not associated with MH or CR.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 presents the crude and adjusted ORs and 95% CIs for the associations between frequency of tooth brushing and clinical outcomes. MH (MES \u0026lt;1) and CR rates by toothbrushing frequency were 15.4% and 60.0% for \u0026le;1 time/day, 24.8% and 54.3% for 2 times/day, and 32.1% and 66.7% for \u0026ge;3 times/day, respectively. After adjustment, toothbrushing frequency was independently and positively associated with MH but not CR (adjusted odds ratio: 2.87 [95% CI: 1.19\u0026ndash;7.29],\u0026nbsp;\u003cem\u003ep\u003c/em\u003e for trend = 0.021).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we demonstrated that a high frequency of tooth brushing was independently associated with MH in patients with UC, whereas the number of remaining teeth showed no such association. In addition, tooth brushing frequency was not associated with CR. These findings suggest that daily oral hygiene behavior, rather than the structural condition of dentition, may influence intestinal mucosal recovery in UC, potentially through modulation of systemic and mucosal inflammation.\u003c/p\u003e\n\u003cp\u003eIn epidemiological studies, number of teeth is associated with cardiovascular disease [20, 21], stroke [20], and mortality [21-23]. Especially, several epidemiological studies have demonstrated that having fewer than 20 teeth is associated with all-cause mortality [21, 24].\u003c/p\u003e\n\u003cp\u003eEvidence regarding the association between the number of teeth and IBD is limited, while the meta-analysis of periodontitis in IBD showed the close association between periodontitis and IBD including UC. In a Danish study of patients with IBD, individuals with CD had fewer teeth than those with UC, and fewer than 20 remaining teeth was associated with greater IBD disease activity [13]. In a Denmark case\u0026ndash;control study of 4,537 participants (including 527 patients with CD and 566 with UC), both UC and CD were associated with a higher prevalence of severe periodontitis and poor self-rated oral health compared with controls, and the proportion of individuals with fewer than 20 remaining teeth was higher among patients with CD than among those with UC [14]. Within IBD, CD tends to be associated with fewer remaining teeth, and the impact of tooth loss on disease activity appears to be more pronounced in CD, whereas studies have not consistently demonstrated a clear association in UC. Therefore, our findings regarding the number of remaining teeth may be considered broadly consistent with the existing literature.\u003c/p\u003e\n\u003cp\u003eToothbrushing frequency is inversely associated with incidence of chronic diseases, including hypertension [25], diabetes [26], cardiovascular disease [27], and cancer [28] in previous epidemiological studies. Some studies show the association between toothbrushing frequency and onset of IBD. In a Korean national health insurance database study, high frequency toothbrushing (\u0026ge;3 times a day) is inversely associated with incidence of CD, but not UC [15]. On the other hand, in a US case-control study of IBD (26 UC, 57 CD, and 54 healthy cases), the frequency of toothbrushing in IBD cases is higher than control [16].\u003c/p\u003e\n\u003cp\u003eSeveral biological mechanisms may explain this association. The oral\u0026ndash;gut axis describes the ectopic colonization of oral bacteria within the intestinal tract, where they may exacerbate intestinal inflammation. Studies have shown that oral pathobionts such as Fusobacterium nucleatum and Porphyromonas gingivalis can migrate to the gut and promote colitis by activating immune pathways and disrupting the epithelial barrier [2, 3]. Atarashi et al. further confirmed that oral bacteria can directly drive intestinal inflammation [29]. Tooth brushing might improve indirectly and directly the mucosal inflammation via preventing dissemination of bacterial endotoxins and inflammatory mediators from the oral cavity and stopping migration of oral pathobionts to the gut [3, 6, 7, 29].\u003c/p\u003e\n\u003cp\u003eThe lack of association between the number of remaining teeth and MH in this study may indicate that structural dental status reflects past oral disease rather than current inflammatory activity. Our study also found no association between tooth brushing frequency and CR. This discrepancy highlights the well-recognized dissociation between clinical symptoms and endoscopic inflammation in UC. MH reflects objective resolution of intestinal inflammation and has been associated with improved long-term outcomes, including reduced hospitalization and colectomy rates [18]. In contrast, clinical remission is influenced by subjective symptoms, which may persist despite endoscopic improvement [30]. Therefore, oral hygiene may preferentially affect mucosal inflammation without necessarily producing immediate symptomatic benefit. From a clinical perspective, these results suggest that promoting oral hygiene, a simple and non-invasive intervention, might contribute to intestinal mucosal recovery in UC. Regular tooth brushing may therefore represent an adjunctive, patient-centered strategy to optimize mucosal outcomes alongside standard pharmacological therapy.\u003c/p\u003e\n\u003cp\u003eSeveral limitations should be acknowledged. First, the cross-sectional design precludes causal inference, and reverse causality cannot be excluded; patients with MH may be more likely to engage in health-promoting behaviors. Second, oral microbiome composition and inflammatory biomarkers were not assessed, limiting mechanistic interpretation. Third, other oral health practices, such as professional dental care and use of antiseptic mouthwash, were not evaluated. Finally, there are limitations in generalizing the study population. Thus, the study population may not be fully representative of all Japanese UC patients. Nevertheless, the mean age, sex ratio, and medication use in this study were comparable to those reported in Japanese national UC surveys [31].\u003c/p\u003e\n\u003cp\u003eIn conclusion, the present study identified a significant association between frequent tooth brushing and mucosal healing in patients with ulcerative colitis. These findings suggest that oral hygiene may be linked to intestinal inflammatory status through the oral\u0026ndash;gut axis. Maintaining good oral hygiene could represent a simple and potentially modifiable factor in the comprehensive management of ulcerative colitis. Further prospective studies are warranted to clarify the causal relationship and underlying mechanisms.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Keitarou Kawasaki, Yuji Mizukami, Satoshi Imamine, Masamoto Torisu, Harumi Yano, Makoto Yano, Masato Murakami, Masumi Hino, and Tomo Kogama.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors agree with the content of the manuscript.Sen Yagi and Shinya Furukawa contributed to the conception and design; Sen Yagi, Shinya Furukawa, and Teruki Miyake contributed to the investigation; Shinya Furukawa performed the formal analysis and visualization; Teruki Miyake, Eiji Takeshita, and Yoshio Ikeda contributed to data curation; Sen Yagi and Shinya Furukawa drafted the manuscript. Teruki Miyake, Osamu Yoshida, Kazuhiro Tange, Shogo Kitahata, Tomoyuki Ninomiya, Seiyuu Suzuki, Naozumi Shibata, Masakazu Hanayama, Katsuhisa Ohashi, Hideomi Tomida, Yasunori Yamamoto, Eiji Takeshita, and Yoshio Ikeda revised the manuscript critically for important intellectual content.Yoichi Hiasa contributed to the conception and design and provided supervision. Shinya Furukawa, Eiji Takeshita, Yoshio Ikeda, and Yoichi Hiasa contributed to project administration.All authors gave final approval of the version to be published, agreed on the journal to which the article has been submitted, and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003eThis study was approved by the Ethics Committee of Ehime University. All procedures involving human participants were conducted in accordance with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u0026nbsp;\u003c/strong\u003eWritten informed consent was obtained from all patients prior to sample collection.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUngaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitis. \u003cem\u003eLancet\u003c/em\u003e. 2017;389:1756\u0026ndash;1770.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKitamoto S, Nagao-Kitamoto H, Jiao Y, et al. The intermucosal connection between the mouth and gut in commensal pathobiont-driven colitis. \u003cem\u003eCell\u003c/em\u003e. 2020;182:447\u0026ndash;462.e14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang A, Zhai Z, Ding Y, et al. The oral\u0026ndash;gut microbiome axis in inflammatory bowel disease. \u003cem\u003eFront Immunol\u003c/em\u003e. 2024;15:1430001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanwar H, Gnanasekaran JM, Allison D, et al. Unravelling the oral\u0026ndash;gut axis: interconnection between periodontitis and inflammatory bowel diseases. \u003cem\u003eJ Crohns Colitis\u003c/em\u003e. 2024;18:1319\u0026ndash;1341.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou T, Xu W, Wang Q, et al. The effect of the oral\u0026ndash;gut axis on periodontitis in inflammatory bowel disease. \u003cem\u003eFront Cell Infect Microbiol\u003c/em\u003e. 2023;13:1132420.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDomokos Z, Uhrin E, Szab\u0026oacute; B, et al. Patients with inflammatory bowel disease have a higher chance of developing periodontitis: a systematic review and meta-analysis. \u003cem\u003eFront Med (Lausanne)\u003c/em\u003e. 2022;9:1020126.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKucharski R, Sobocki BK, Stachowska E, et al. Dental problems and oral microbiome alterations in ulcerative colitis. \u003cem\u003eFront Immunol\u003c/em\u003e. 2025;16:1502605.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHalboub E, Al-Maswary A, Mashyakhy M, et al. The potential association between inflammatory bowel diseases and apical periodontitis: a systematic review and meta-analysis. \u003cem\u003eEur Endod J\u003c/em\u003e. 2023;9:8\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang M, Shi J, Yu C, et al. Emerging strategy towards mucosal healing in inflammatory bowel disease: what the future holds? \u003cem\u003eFront Immunol\u003c/em\u003e. 2023;14:1298186.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarruganti C, Discepoli N, Gaeta C, et al. Dental caries occurrence in inflammatory bowel disease patients: a systematic review and meta-analysis. \u003cem\u003eCaries Res\u003c/em\u003e. 2021;55:485\u0026ndash;495.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Bian C, Yu C, et al. Bidirectional association between oral diseases caused by plaque and inflammatory bowel disease: a systematic review and meta-analysis. \u003cem\u003eJpn Dent Sci Rev\u003c/em\u003e. 2025;61:7\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGr\u0026ouml;ssner-Schreiber B, Fetter T, Hedderich J, et al. Prevalence of dental caries and periodontal disease in patients with inflammatory bowel disease: a case-control study. \u003cem\u003eJ Clin Periodontol\u003c/em\u003e. 2006;33:478\u0026ndash;484.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMadsen GR, Bertl K, Pandis N, et al. The impact of periodontitis on inflammatory bowel disease activity. \u003cem\u003eInflamm Bowel Dis\u003c/em\u003e. 2023;29:396\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBertl K, Tsakos G, Pandis N, et al. Health-related quality of life aspects of the \u0026ldquo;Periodontitis prevalence in ulcerative colitis and Crohn's disease\u0026rdquo; cohort. \u003cem\u003eJ Clin Periodontol\u003c/em\u003e. 2023;50:1601\u0026ndash;1620.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark Y, Park JH, Leem GH, et al. Periodontitis and the incidence of inflammatory bowel diseases: a nationwide population-based cohort study. \u003cem\u003eAm J Gastroenterol\u003c/em\u003e. 2025;120:2361\u0026ndash;2372.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinghal S, Dian D, Keshavarzian A, et al. The role of oral hygiene in inflammatory bowel disease. \u003cem\u003eDig Dis Sci\u003c/em\u003e. 2011;56:170\u0026ndash;175.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoal Carvalho P, Dias de Castro F, Rosa B, et al. Mucosal healing in ulcerative colitis\u0026mdash;when zero is better. \u003cem\u003eJ Crohns Colitis\u003c/em\u003e. 2016;10:20\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurner D, Ricciuto A, Lewis A, et al. STRIDE-II: an update on the selecting therapeutic targets in inflammatory bowel disease initiative. \u003cem\u003eGastroenterology\u003c/em\u003e. 2021;160:1570\u0026ndash;1583.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis: a randomized study. \u003cem\u003eN Engl J Med\u003c/em\u003e. 1987;317:1625\u0026ndash;1629.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOluwagbemigun K, Dietrich T, Pischon N, et al. Association between number of teeth and chronic systemic diseases: a cohort study followed for 13 years. \u003cem\u003ePLoS One\u003c/em\u003e. 2015;10:e0123879.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeukers NGFM, Su N, Loos BG, et al. Lower number of teeth is related to higher risks for ACVD and death: systematic review and meta-analyses of survival data. \u003cem\u003eFront Cardiovasc Med\u003c/em\u003e. 2021;8:621626.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu YH, Cheung WS, Steffensen B, et al. Number of teeth is associated with all-cause and disease-specific mortality. \u003cem\u003eBMC Oral Healt\u003c/em\u003e. 2021;21:568.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaekawa K, Ikeuchi T, Shinkai S, et al. Number of functional teeth more strongly predicts all-cause mortality than number of present teeth in Japanese older adults. \u003cem\u003eGeriatr Gerontol Int\u003c/em\u003e. 2020;20:607\u0026ndash;614.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIshikawa S, Konta T, Susa S, et al. Association between presence of 20 or more natural teeth and all-cause, cancer-related, and cardiovascular disease-related mortality. \u003cem\u003eBMC Oral Health\u003c/em\u003e. 2020;20:353.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZou L, Zhang M, Fu W, et al. Meta-analysis on the association between the frequency of tooth brushing and hypertension risk. \u003cem\u003eJ Clin Hypertens (Greenwich)\u003c/em\u003e. 2022;24:689\u0026ndash;697.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFu W, Lv C, Zou L, et al. Meta-analysis on the association between the frequency of tooth brushing and diabetes mellitus risk. \u003cem\u003eDiabetes Metab Res Rev\u003c/em\u003e. 2019;35:e3141.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang Z, Qiu T, Ma R, et al. The influence of habitual tooth brushing frequency on individuals diagnosed with coronary artery disease. \u003cem\u003eSci Rep\u003c/em\u003e. 2025;15:18463.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu L, Wang J, Zhang Q, et al. Association between the frequency of tooth brushing and esophageal carcinoma risk: an updated systematic review and meta-analysis. \u003cem\u003eJ Gastrointest Oncol\u003c/em\u003e. 2022;13:499\u0026ndash;509.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtarashi K, Suda W, Luo C, et al. Ectopic colonization of oral bacteria in the intestine drives TH1 cell induction and inflammation. \u003cem\u003eScience\u003c/em\u003e. 2017;358:359\u0026ndash;365.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColombel JF, Keir ME, Scherl A, et al. Discrepancies between patient-reported outcomes and endoscopic and histological appearance in ulcerative colitis. \u003cem\u003eGut\u003c/em\u003e. 2017;66:2063\u0026ndash;2068.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsuoka K, Igarashi A, Sato N, et al. Trends in corticosteroid prescriptions for ulcerative colitis and factors associated with long-term corticosteroid use. \u003cem\u003eJ Crohns Colitis\u003c/em\u003e. 2021;15:358\u0026ndash;366.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Clinical characteristics of 275 study participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"669\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD or n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e50.65\u0026plusmn; 15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eMale (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e160 (58.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eDisease extent (n; pancolitis/left-sided/proctitis/other)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e113/76/79/7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eDuration of UC (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e8.1 \u0026plusmn; 8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eBMI (kg/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e22.49 \u0026plusmn; 4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eCurrent smoking (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e18 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eCurrent drinking (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e115 (41.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eMedication for UC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003e5-Aminosalicylates (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e252 (91.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003ePrednisolone (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e55 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eThiopurines (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e42 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eTNF-\u003cem\u003e\u0026alpha; monoclonal antibody\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e14 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eMayo Endoscopic Subscore (MES)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e1.22 \u0026plusmn; 0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eComplete mucosal healing (MES \u0026lt;1, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e68 (24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eClinical remission (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e163 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eNumber of remaining teeth (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e24.6 \u0026plusmn; 6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt;20 teeth (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e36 (13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003e20-27 teeth (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e90 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003e\u0026ge; 28 teeth (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e149 (54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003eFrequency of tooth brushing (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e2.1 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003e\u0026le; 1 time/day (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003col start=\"65\"\u003e\n \u003cli\u003e(23.6)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003e2 times/day (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e129 (46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72.9447%;\"\u003e\n \u003cp\u003e\u0026ge; 3 times/day (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3.58744%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4679%;\"\u003e\n \u003cp\u003e81 (29.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI, body mass index; UC, ulcerative colitis; SD, standard deviation; TNF, tumor necrosis factor; Other: right-sided, segmental colitis, and postoperative patients (lack of any preoperative medical records for postoperative patients)\u003c/p\u003e\n\u003cp\u003eTable 2. Crude and adjusted odds ratios and 95% confidence intervals for the associations between number of remaining teeth and clinical outcomes\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"717\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003ePrevalence, n/n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003eComplete MH (MES \u0026lt;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003eNumber of remaining teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003e\u0026lt;20 teeth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e11/36 (30.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003e20-27 teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e25/90 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e1.61 (0.70\u0026ndash;3.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e1.23 (0.44\u0026ndash;3.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 47.2332%;\"\u003e\u0026ge; 28 teeth\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e32/149 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e1.41 (0.76\u0026ndash;2.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e1.26 (0.63\u0026ndash;2.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003efor trend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003eClinical remission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003eNumber of remaining teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003e\u0026lt;20 teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e25/36 (69.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003e20-27 teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e54/90 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e1.76 (0.82\u0026ndash;3.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e1.15 (0.45\u0026ndash;3.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 47.2332%;\"\u003e\n \u003cp\u003e\u0026ge; 28 teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e84/149 (56.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e1.16 (0.68\u0026ndash;1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e0.89 (0.48\u0026ndash;1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 47.2332%;\"\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003efor trend\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8458%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 39.9209%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 23.8827%;\"\u003e\n \u003cp\u003e0.933\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOdds ratios were adjusted for sex, age, body mass index, current drinking, and current smoking,. OR, odds ratio; CI, confidence interval; MH, mucosal healing; MES, Mayo Endoscopic Score.\u003c/p\u003e\n\u003cp\u003eTable 3. Crude and adjusted odds ratios and 95% confidence intervals for the associations between frequency of tooth brushing and clinical outcomes\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"717\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003ePrevalence,\u003c/p\u003e\n \u003cp\u003en/n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003eComplete MH (MES \u0026lt;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003eFrequency of tooth brushing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003e\u0026le; 1 time/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e10/65 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003e2 times/day\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e32/129 (24.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e1.81 (0.85\u0026ndash;4.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e1.87 (0.85\u0026ndash;4.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 35.5517%;\"\u003e\u0026ge; 3 times/day\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e26/81 (32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e2.60 (1.18\u0026ndash;6.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e2.87 (1.19\u0026ndash;7.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003efor trend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003eClinical remission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003eFrequency of tooth brushing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003e\u0026le; 1 time/day\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e39/65 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003e2 times/day\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e70/129 (54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e0.79 (0.43\u0026ndash;1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e0.79 (0.42\u0026ndash;1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 35.5517%;\"\u003e\n \u003cp\u003e\u0026ge; 3 times/day\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e54/81 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e1.33 (0.68\u0026ndash;2.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e1.28 (0.60\u0026ndash;2.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 35.5517%;\"\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003efor trend\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0105%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 24.3433%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26.0946%;\"\u003e\n \u003cp\u003e0.491\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOdds ratios were adjusted for sex, age, body mass index, current drinking, and current smoking,. OR, odds ratio; CI, confidence interval; MH, mucosal healing; MES, Mayo Endoscopic Score.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"ulcerative colitis, toothbrushing habits, mucosal healing","lastPublishedDoi":"10.21203/rs.3.rs-9180685/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9180685/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eEvidence regarding the association between oral environment and inflammatory bowel disease (IBD), including ulcerative colitis (UC) exists. However, evidence regarding the association between oral health parameters and disease activity of UC is limited. This study aimed to evaluate the association between remaining tooth number, and toothbrushing frequency and mucosal healing (MH) in Japanese UC patients.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThe study included 275 patients with UC. Information on lifestyle and oral health parameters was collected via self-administered questionnaires. The definition of MH was based on the Mayo endoscopic subscore (MES) of 0.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of MH in this cohort was 24.7%. The distribution of remaining teeth was as follows: 13.1% had 20 or fewer teeth, 32.7% had 20\u0026ndash;27 teeth, and 54.2% had 28 or more teeth. Toothbrushing frequency was: 23.6% brushed once or less per day, 46.9% brushed twice per day, and 29.5% brushed three or more times per day. No significant difference was observed between remaining teeth and MH. However, toothbrushing frequency is independently positively associated with MH (adjusted odds ratio: 2.87 [95% CI: 1.19\u0026ndash;7.29]; p-value for trend\u0026thinsp;=\u0026thinsp;0.021).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eToothbrushing frequency but not remaining tooth number was independently and positively associated with MH in Japanese patients with UC.\u003c/p\u003e","manuscriptTitle":"Association between toothbrushing habits and mucosal healing in Japanese patients with ulcerative colitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-26 11:45:15","doi":"10.21203/rs.3.rs-9180685/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-29T04:07:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T07:17:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102091609299654376888863091806456722773","date":"2026-03-30T07:25:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280317131886430873037772264422022565109","date":"2026-03-30T05:45:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274054266173969770519414386107751604956","date":"2026-03-25T21:18:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-25T18:16:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152777554876079341164304131700493299659","date":"2026-03-25T17:51:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-25T03:45:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-23T22:50:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-21T05:15:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"Digestive Diseases and Sciences","date":"2026-03-20T16:10:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9a2d1b17-b8c3-4dea-bb94-7a14ea597cf4","owner":[],"postedDate":"March 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T03:10:37+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-26 11:45:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9180685","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9180685","identity":"rs-9180685","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}