Gastrointestinal Disease     

Gastrointestinal disease is relevant mainly because of possibility of vomiting with general anaesthesia and oral manifestations. Anaemia subsequent to bleeding from a peptic ulcer or intestinal cancer, or to malabsorption in small intestinal disorders (Crohn’s, gluten-sensitive enteropathy) may predispose to:

1. Burning mouth syndrome

2. Aphthae

3. Candidosis

4. Angular stomatitis.

 

Crohn’s Disease

¨ Affects any part of gut, from the mouth to anus

¨ Discontinuous involvement (‘skip lesions’)

¨ Deep ulcers and fissures in mucosa, ‘cobblestoning’

¨ Transmucosal inflammation and granulomata                         

 

Ulcerative colitis

¨ Affect only the colon

¨ Begins in the rectum—extends proximally

¨ Continuous involvement

¨ Red mucosa which bleeds easily

¨ Ulcers and pseudopolyps (regenerating mucosa) in severe disease

¨ No granulomata, but goblet cell depletion and crypt abscesses

 

Dental Aspects

¨ Complicated by malabsorption

¨ Malabsorption: Anaemia, angular chelitis, atypical ulcers, changes in the tongue mucosa

¨ Crohn’s: Ulcers, swelling of the lips with characteristic tags or mucosal cobblestoning

¨ Biopsy of the lesions in the mouth are similar to other areas in that there is an infiltration of lymphoedema and granuloma formation

¨ Ulcerative colitis: rarely has oral manifestations. Pyostomatitis gangrenous— chronic ulcers with large ragged margins an a sloughing base. Pyostomatitis vegetans—microabscess in the epithelium

¨ The side-effects of corticosteroids and any immunosuppressant drugs may affect the treatment.

 

 

Peptic ulcers

Duodenal ulceration can occur in 15% of the population at one time or another. Three times more common than gastric ulceration and far more common in men. There is a marked association with ulceration and the presence of Helicobacter pylori.

 

Dental Aspects

¨ Drugs know to be associated with peptic ulceration or disturbance in bleeding should be avoided in someone who is being treated, i.e. Aspirin, NSAIDs

¨ Anaemia may lead to typical oral epithelium changes

¨ Recurrent vomiting—erosion of palatal aspects of incisors

¨ Oral side-effects of drugs. Ranitidine associated with erythema multiforme and Omeprazole affecting taste

 

Inflammatory bowel disease is more common in the Western world. It commonly presents between the ages of 20—40 years old.