HS, Gums and Dental Health: Is There a Link With Periodontitis?

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Language: en
Category: Treatments
Published: 2026-09-18
Last updated: 2026-09-18
Last editorially reviewed: 2026-09-18
Next scheduled review: 2027-09-18
Evidence strength: Emerging research — Early evidence only — future recommendations may still change.
Author: Dr. rer. nat. Dennis Alexander Kwiatkowski (Biochemist, Scientific Writer and Pharma Expert)
Scientific editor: Dr. rer. nat. Dennis Alexander Kwiatkowski
Reviewer qualifications: Biochemist, Scientific Writer and Pharma Expert
Review scope: Scientific literature, clinical guidelines, sources, and editorial clarity
Clinical reviewer: No independent clinical review
Tags: Acne Inversa, Hidradenitis Suppurativa, HS, Treatments, periodontitis, gum disease, oral health, dental health, comorbidities, microbiome, inflammation
A large matched cohort study found periodontitis diagnosed more often in people with HS than in matched controls. What the evidence shows, what remains unproven in either direction, and when to see a dentist.

Medical disclaimer: This website is for general educational information only and does not replace medical advice, diagnosis, or treatment. Please speak with qualified medical professionals about symptoms or treatment decisions.

60-second summary

- A large matched cohort study found periodontitis diagnosed more often in people with HS than in matched people without HS.
- This does not mean HS causes gum disease, that gum disease causes HS, or that treating your gums treats HS.
- A smaller study found substantial oral-health problems in people with HS, but it had no comparison group without HS.
- Researchers are studying shared inflammation and oral bacteria as possible explanations, but neither has been proven to explain the link.
- Ordinary dental care and reporting persistent gum symptoms make sense regardless of whether the link is ever fully explained.

What this means: If you have HS, this is a reason to keep up ordinary dental checkups and mention persistent gum bleeding, swelling or loose teeth to a dentist — not a reason to expect your skin to improve if your gums do, or vice versa.

What we are less certain about: It is not established that HS causes periodontitis, that periodontitis causes HS, or that either condition's treatment changes the other. Why the association exists — shared inflammation, shared risk factors like smoking, or overlapping oral bacteria — remains an open, actively studied question.

What you can do next: If you notice bleeding, swollen or receding gums, loose teeth, or persistent bad breath, mention it to a dentist and let them know you have HS.

Article

Hidradenitis suppurativa (HS) affects the skin — but research increasingly shows that living with HS can involve more than the skin alone. Cardiovascular health, inflammatory bowel disease, joint symptoms, mental health and anaemia are among the health areas researchers and clinicians consider alongside HS.

There is another possible connection that gets far less attention: your gums.

A large 2024 cohort study found that periodontitis — a chronic inflammatory disease of the gums and the tissue supporting the teeth — was diagnosed more often in people with HS than in a matched group of people without HS. A smaller study has separately described a substantial burden of oral-health problems in people attending an HS clinic.

The evidence is still developing, and it points to an association rather than a cause. It does not mean HS damages your teeth, that gum disease causes HS, or that dental treatment will change your HS. It does mean oral health deserves a place in the wider conversation about living with HS.
Educational content only. This article explains an association reported in research. It cannot tell you whether you have periodontitis, and it does not replace a dental examination or an individual clinical assessment.

Key takeaways

- A propensity-matched cohort study of 53,968 people with HS and 53,968 matched controls found periodontitis diagnosed more often in the HS group, with a hazard ratio of 1.64 at both 3 and 5 years of follow-up.
- A separate cross-sectional study of 102 people with HS found oral disorders in 55.9%, caries in 39.2%, and at least one missing tooth in 46.7% — but it had no comparison group, so it cannot say how much of that is specific to HS.
- Neither study, nor any other published research, has shown that HS causes periodontitis, that periodontitis causes HS, or that treating one changes the course of the other.
- Researchers are investigating shared inflammatory pathways, shared risk factors such as smoking, overlapping bacterial patterns, and reduced dental care-seeking as possible (and not mutually exclusive) explanations.
- Ordinary preventive dental care — brushing, interdental cleaning, regular check-ups — is worth keeping up regardless of HS, and persistent gum symptoms are worth a dental assessment rather than being filed under HS.

What is periodontitis?

Periodontitis is a chronic inflammatory disease that affects the structures holding your teeth in place — the gums, the periodontal ligament and the surrounding bone. It usually develops from longer-standing gum inflammation (gingivitis) and, left unaddressed, can progressively damage the tissue and bone that support the teeth.

Possible signs include:

- gums that bleed when brushing or flossing;
- gums that are swollen, tender or a deeper red than usual;
- gums that are pulling away from the teeth (recession);
- persistent bad breath that does not improve with ordinary oral care;
- teeth that feel loose or have shifted position.

Periodontitis can progress with relatively few obvious symptoms early on, which is one reason routine dental examinations matter — for anyone, independent of HS.

What has research actually found?

A large matched cohort study found a higher rate of periodontitis

The strongest evidence so far comes from a 2024 study that used TriNetX, a federated network of electronic health records, to identify 53,968 people with a diagnosis of HS and match them, using propensity-score matching, to 53,968 people without HS with similar baseline characteristics (Gau et al., 2024 (https://doi.org/10.7150/ijms.93178)).

Comparing the two groups, the study found periodontitis diagnosed significantly more often among people with HS:

- at 3 years of follow-up: hazard ratio 1.64 (95% CI 1.11–2.44);
- at 5 years of follow-up: hazard ratio 1.64 (95% CI 1.21–2.24).

The association held up in sensitivity analyses using different matching approaches and washout periods, and it remained significant even when the HS group was compared specifically with a psoriasis group instead of the general population (hazard ratio 1.73, 95% CI 1.23–2.44).

A hazard ratio describes how much more often an event — here, a new periodontitis diagnosis — occurred in one group relative to another, over time, in a group of people who were followed and compared. A hazard ratio of 1.64 does not mean "64% of people with HS get periodontitis" or "your personal risk is 64% higher" — it describes a relative difference in a matched population, not an individual probability. And because the study is retrospective and based on diagnosis codes in electronic health records rather than direct dental examinations of every participant, it can show an association without establishing that HS causes periodontitis. People who see a dermatologist regularly for HS may also, for instance, be more likely to have any dental problem they have formally coded and diagnosed — a detection or documentation pattern that propensity matching for demographic and clinical variables cannot fully rule out.

A smaller clinical study found a substantial oral-health burden

A separate 2023 study examined 102 people with HS directly, with both dermatologists and dentists carrying out clinical assessments (Damiani et al., 2023 (https://doi.org/10.1007/s13555-023-01006-x)). It found that:

- 55.9% had at least one oral disorder;
- 39.2% had caries (cavities);
- 46.7% had at least one missing tooth;
- 48% had not had an oral hygiene visit, and 43% had not had a dental visit, in the past year.

This study did not include a comparison group of people without HS. That is an important limitation: it tells us oral-health problems and reduced dental attendance were common in this particular group of people with HS, but it cannot say how that compares with a similar group of people without HS, or how much of it is specific to HS at all. Disease severity (Hurley stage) was the main factor associated with oral health findings in this study, which is a detail worth keeping in mind rather than reading the headline percentages as if they applied evenly to everyone with HS.

People with HS and periodontitis may attend the dentist less often

A related 2024 study compared oral-health-related quality of life between people who had both HS and periodontitis and people who had periodontitis alone (Paśnik-Chwalik et al., 2024 (https://doi.org/10.5114/ada.2024.141614)). Quality-of-life scores did not differ significantly between the two groups — but people with both conditions were less likely to have had a recent dental evaluation and reported flossing less often than the periodontitis-only group.

That is a useful, practical clue: at least some of the association between HS and oral-health problems may be explained by people managing a demanding chronic skin condition having less capacity, time or inclination to prioritise dental visits and daily oral hygiene — not necessarily by a direct biological effect of HS on the gums. This does not rule out a biological connection; it simply means behavioural and access-related explanations need to be considered alongside it, not instead of a dental visit.

Why might HS and periodontitis be connected?

Nobody knows yet. A few explanations are being investigated, and they are not mutually exclusive.

Shared inflammation

HS and periodontitis are both chronic inflammatory conditions. It is biologically plausible that overlapping inflammatory activity in one part of the body could relate to inflammatory activity elsewhere, and researchers have suggested this as one possible link. Plausible is not the same as proven, and no study has yet shown that a specific inflammatory pathway explains the association between the two conditions.

Shared risk factors

Smoking, in particular, is associated with both HS and periodontitis. If smoking rates differ between the people who happen to develop HS and those who do not, some of an apparent HS–periodontitis association could reflect smoking rather than HS itself. Large studies try to adjust statistically for factors like this, but observational research can never remove every possible source of confounding.

Overlapping bacteria

A small comparative study looked directly at the bacteria beneath the gumline in three groups — people with HS, people with periodontitis, and people with neither — and found that several of the same bacterial species associated with periodontitis were also more common in people with HS than in the control group (Jastrząb et al., 2023 (https://doi.org/10.3390/pathogens12030377)). A separate, larger microbiome study comparing HS, acne and healthy controls across skin, mouth and gut samples similarly found the HS-affected skin enriched for anaerobic bacterial genera such as Prevotella, Porphyromonas and Fusobacterium, alongside increased diversity of the same genera in oral samples from people with HS, and proposed a possible "oral–gut–skin" microbial connection as a hypothesis for future research (Chen et al., 2026 (https://doi.org/10.1111/exd.70198)).

These are genuinely interesting findings, and they are hypothesis-generating, not confirmatory. Neither study establishes that oral bacteria travel to the skin and cause HS lesions, that skin bacteria cause periodontitis, or that changing your oral bacteria (with a particular mouthwash, for example) would affect either condition. There is no evidence-based reason to use antibacterial or antiseptic mouth products, or any supplement, specifically to try to influence your HS.

Reduced dental care-seeking

As described above, one study found that people with both HS and periodontitis attended the dentist and flossed less often than people with periodontitis alone. Living with a chronic, often painful and sometimes stigmatised skin condition can understandably crowd out other health priorities. This is not a HS-specific biological mechanism — it is a practical, addressable factor, and one of the more actionable explanations on this list.

Does periodontitis make HS worse — or does treating it help?

There is no controlled evidence either way.

One published case report described a 35-year-old woman with both HS and periodontitis whose gum inflammation and HS both improved after starting adalimumab, a biologic medication used to treat HS (Yao et al., 2023 (https://doi.org/10.1159/000528139)). That is a single case, not a clinical trial, and a single case cannot distinguish between several possibilities: that the medication's general anti-inflammatory effect independently helped two separate conditions, that the improvements were coincidental, or that there is some more specific interaction between the two. It does not establish that treating periodontitis improves HS, and it does not establish that HS medication is an appropriate periodontitis treatment.

Current evidence does not support treating periodontal disease as a way to treat HS, or treating HS as a way to treat periodontitis. Each is worth treating in its own right, on its own merits, by the appropriate clinician.

Does HS cause tooth decay?

That has not been established. The 2023 clinical study found caries and missing teeth were common among the people with HS it examined, but it had no comparison group, and caries has many well-established causes that have nothing specifically to do with HS: oral hygiene habits, diet, smoking, dry mouth, certain medications, dental care access, age and general socioeconomic factors among them. It would be inaccurate to say "HS causes cavities" on the basis of the evidence published so far.

Should everyone with HS have special dental screening?

Not on current evidence. There is no HS-specific dental screening interval or protocol established in HS treatment guidelines. The available research supports awareness and, where relevant, closer attention — not a new, universal screening programme. If you already attend regular dental check-ups, none of this is a reason to add extra tests; if you have been putting off dental visits, this is a reasonable prompt to book one, the same as it would be for anyone.

When should I see a dentist?

Arrange a dental assessment if you notice:

- gums that bleed repeatedly, especially outside of brushing;
- gums that are persistently swollen, tender or receding;
- persistent bad breath that does not improve with ordinary oral hygiene;
- a tooth that feels loose or has shifted;
- mouth sores or lesions that do not heal within a couple of weeks.

These symptoms have many possible causes. They are not evidence that HS has "spread" to your mouth — HS does not affect the gums the way it affects the skin — and a dentist is the right person to work out what is actually happening.

Should I tell my dentist I have HS?

Yes. HS belongs in your medical history the same way any chronic condition does. Your dentist does not need to be an HS specialist, but knowing about your diagnosis and your current medications is useful context, particularly if any dental treatment, extraction or procedure is being planned.

A simple way to raise it:

"I have hidradenitis suppurativa, a chronic inflammatory skin condition. I've read that researchers have found a possible link with gum disease, though it isn't fully understood yet — is there anything about my gums or teeth worth keeping an eye on?"

Bring an up-to-date list of your medications, especially if you take a biologic or other systemic treatment for HS.

What can I do now?

Nothing here calls for an HS-specific dental routine. The useful steps are the ordinary ones:

- brush with fluoride toothpaste and clean between your teeth daily;
- keep to the dental check-up interval your dentist recommends for you;
- get persistent gum bleeding, swelling, looseness or bad breath assessed rather than assuming it will pass;
- tell your dentist about your HS and your current medications.

Do not start antiseptic mouthwash, antibiotics or a supplement specifically to try to influence your HS through your mouth — there is no evidence any of that helps, and none of it is a substitute for ordinary dental care.

What researchers still need to answer

- Is periodontitis genuinely more common in HS, independent of smoking, dental access and how it is diagnosed? The 2024 cohort study is the strongest evidence so far, but it relies on diagnosis codes rather than a dental examination of every participant, so more prospective research with direct clinical assessment would help confirm the size of the association.
- Is the connection driven by shared biology, shared risk factors, or care-seeking behaviour — or some combination? Current studies cannot yet separate these explanations from one another.
- Does treating HS change periodontal health, or vice versa? No controlled trial has tested this; the one published case report cannot answer it.
- Are there oral changes that are specific to HS, beyond periodontitis and general oral-health burden? Not enough evidence exists yet to define a distinct oral pattern.

These are open questions, not settled ones — which is exactly why this is presented as an emerging association rather than an established part of HS care.

The bottom line

A large, well-matched cohort study found periodontitis diagnosed more often in people with HS than in people without it, and a smaller clinical study found a substantial burden of oral-health problems in an HS clinic population. Together, these findings are enough to say that oral health deserves a place in the broader conversation about HS.

They are not enough to say that HS causes gum disease, that gum disease causes HS, that oral bacteria cause HS, that cavities are a manifestation of HS, or that treating one condition treats the other. None of that has been shown.

The practical conclusion is simple: keep up ordinary dental care, get persistent gum or mouth symptoms checked rather than dismissed, and make sure your dentist knows about your HS and your medications. Your oral health is worth looking after on its own merits — whatever future research eventually shows about the connection to HS.

FAQ

Can hidradenitis suppurativa affect your gums?

Research suggests people with HS may have periodontitis diagnosed more often than people without HS, but it has not been established that HS directly causes gum inflammation. Persistent bleeding, swollen or receding gums should be assessed by a dentist rather than assumed to be caused by HS.

Is periodontitis more common in people with HS?

A 2024 study matching 53,968 people with HS to the same number of controls found periodontitis diagnosed significantly more often in the HS group after 3 years (hazard ratio 1.64) and 5 years (hazard ratio 1.64) of follow-up. A smaller 2023 study also found a substantial oral-health burden in an HS clinic population, though it had no comparison group. Both are observational findings, not proof of cause.

Can bad teeth or gum disease cause HS?

There is no established evidence that periodontitis or dental disease causes hidradenitis suppurativa.

Can treating my gums improve my HS?

This has not been demonstrated in controlled research. One published case report described a woman whose periodontitis and HS both improved on adalimumab, but a single case cannot show whether that was coincidence, the drug's general anti-inflammatory effect on two separate conditions, or a specific interaction between them. Treat periodontal disease because it matters for its own sake, not as an established HS treatment.

Why might HS and periodontitis be connected?

Researchers are investigating a few possibilities: shared inflammatory activity, since both are chronic inflammatory conditions; shared risk factors such as smoking; overlapping bacteria, since studies have found similar bacterial patterns in HS skin and in the subgingival (below-the-gumline) environment of people with periodontitis; and reduced dental care-seeking, since one study found people with both conditions attended the dentist and flossed less often than people with periodontitis alone. None of these has been confirmed as the explanation.

Should I tell my dentist that I have HS?

Yes. HS is part of your medical history, and it is useful for your dentist to know about it and about any medication you take.

Do I need more frequent dental checks because I have HS?

No HS-specific dental interval is currently established. Follow the examination schedule your dentist recommends for your individual oral health, and seek assessment sooner if you develop persistent symptoms such as bleeding gums, swelling, loose teeth or bad breath that does not improve.

References

1. Gau SY, Guo YC, Lu HY, Lin CY, Lee CY, Tsai RY, Chang HC, Wu MC, Li CP. Hidradenitis suppurativa as a potential risk factor of periodontitis: a multi-center, propensity-score-matched cohort study. - International Journal of Medical Sciences, 2024 - https://doi.org/10.7150/ijms.93178
2. Damiani G, Poli P, Pacifico A, Rosi E, Allocca G, Berti E, Taschieri S, Tumedei M, Del Fabbro M, Mercuri SR, Bindi M, Francetti L, Buja A, Prignano F, Maiorana C. The Relevant Oral Burden of Patients with Hidradenitis Suppurativa. - Dermatology and Therapy, 2023 - https://doi.org/10.1007/s13555-023-01006-x
3. Jastrząb B, Paśnik-Chwalik B, Dębska-Łasut K, Konopka T, Krajewski PK, Szepietowski JC, Matusiak Ł. The Composition of Subgingival Microbiome in Hidradenitis Suppurativa and Periodontitis Patients. - Pathogens, 2023 - https://doi.org/10.3390/pathogens12030377
4. Paśnik-Chwalik B, Jastrząb-Miśkiewicz B, Krajewski PK, Matusiak Ł, Konopka T, Szepietowski JC. Oral health-related quality of life in subjects with hidradenitis suppurativa suffering from periodontitis. - Postępy Dermatologii i Alergologii, 2024 - https://doi.org/10.5114/ada.2024.141614
5. Chen W, Lai X, Tang X, Ye Q, Zhang C, Yang Y, Wang Z, Li M, Wang Z, Li Z, Yuan C, Zhang X, Li L, Wang B, Wang R, Yan Y. Dysbiosis in Acne Vulgaris and Hidradenitis Suppurativa: A Comparative Microbiome Analysis. - Experimental Dermatology, 2026 - https://doi.org/10.1111/exd.70198
6. Yao Y, Ghazanfar MN, Ravn Jørgensen AH, Ring HC, Thomsen SF. Adalimumab for the Treatment of Periodontitis in a 35-Year-Old Woman with Hidradenitis Suppurativa. - Case Reports in Dermatology, 2023 - https://doi.org/10.1159/000528139