Oral manifestations of gastrointestinal diseases

Specific Oral Manifestations in Adults with Crohn's Disease

Background: Oral manifestations of Crohn's disease (CD) include non-specific lesions and specific lesions directly related to intestinal inflammation. Oral lesions that can be overlooked in CD are sometimes challenging to treat. Methods: In this retrospective single-center study, patients with CD aged over 18 years who complied with follow-up and treatment were included. Clinical definitions of specific oral lesions included pyostomatitis vegetans, glossitis with fissuring, lip swelling with fissuring, cobblestoning, and orofacial granulomatosis. Experienced dentists confirmed the specific lesions in each case. Three groups of patients were identified: those without oral lesions, those with non-specific oral lesions, and those with specific oral lesions. The groups were compared based on demographics, disease extent and behavior (based on the Montreal classification), extraintestinal involvement, biologic and steroid treatment, and the requirement of resective surgery. Results: A total of 96 patients (14.2%) with oral lesions were found among the 676 patients with CD (59.7% male, median age 38 years) who were followed for 6.83 years (IQR 0.5-29.87 years). Eight patients (1.2%, 9 lesions) had specific oral lesions, while eighty-eight patients (13%) had non-specific lesions. Orofacial granulomatosis (n = 3), cobblestoning (n = 2), glossitis with fissuring (n = 2), and lip swelling with fissuring (n = 2) were among the specific lesions. The majority of patients (75%) with specific lesions were male, and their median age was 46.5 years (range: 23-68 years). Disease localization was commonly ileocolonic (50%), and perianal disease was present in 25% of patients. Three patients were active smokers. Extraintestinal manifestations were peripheral arthritis/arthralgia (n = 7) and sacroiliitis (n = 1). All specific lesions were associated with moderate-to-severe disease. Five patients improved with biologic therapy, and two patients with immunomodulatory therapy. Conclusions: Specific oral lesions in CD were associated with active disease and improved with immunomodulators or biologic therapy. Close cooperation between gastroenterologists and dentists is essential for early diagnosis and optimal management of CD.

A rare case of Gardner syndrome in an African adult male: A case report

Gardner's syndrome with the complete manifestation of colonic and extracolonic features is uncommon. Therefore, every clinician should view extracolonic features with a high index of suspicion. This may be key to early diagnosis, definitive management in these patients and importantly, helps prevent malignant transformation of existing colonic polyps.

Case Report: Case report: Rapidly progressing tooth wear dominated by intrinsic and extrinsic erosion

Tooth wear is multi-factorial presenting as a combination of abrasion, attrition, and erosion. This case report represents a case of combined tooth wear in a 46-year-old Indo-Trinidadian male, with a predominant erosive component with both the clinical signs and features of intrinsic and extrinsic erosion. This patient case is unique since the wear predominated by dental erosion has occurred rapidly evidenced by the physical clinical appearance of a lack of compensation and the upper left premolars and molars relatively unaffected by the overall effects of tooth wear. This lack of compensation, where opposing teeth have not supra-erupted to maintain inter-arch stability, and the maintenance of occlusal vertical dimension on the left due to the non-worn posterior maxillary teeth, provides the benefit of simplifying subsequent restorative management. The medical and diet history corroborates the diagnoses of intrinsic and extrinsic erosion respectively. Complications noted with rapid tooth wear, such as dentine sensitivity and pulpal necrosis are known sequelae of tooth wear however the patient presented in this case report shows a concomitant high caries experience and poor oral hygiene. Cases such as the one presented here require not only comprehensive dental management, utilizing a restorative approach but also medical referral for confirmation of a diagnosis and management of gastroesophageal reflux disease. Inherent to the management of this patient should be a multidisciplinary medical and dental approach, with confirmation and management of the cause of the intrinsic erosion as well as restorative dental management, together with dietary counseling to mitigate the effect of intrinsic and extrinsic sources of acid on dental hard tissue. A key lesson learned from this case is the importance of history and targeted questioning when trying to determine the cause of tooth wear dominated by intrinsic and extrinsic erosion.

Clinical Study of Oral Mucosal Lesions in the Elderly-Prevalence and Distribution

BACKGROUND

The aim of the study was to determine the prevalence, pattern, and distribution of oral mucosa lesions in elderly patients attending an outpatient oral pathology clinic.

METHODS

A retrospective analysis of 2747 patients' medical files was performed. Of these, 1398 (50.6%) belonged to seniors. The mean age was 69.8 ± 7.1, and women were in the majority.

RESULTS

Among the entire group of patients, the three most common mucosal lesions were: oral lichenoid diseases (OLDs), lingual changes, and small nodules. In the female group, the most common diagnoses were: OLDs, lingual changes, and oral candidiasis; in the male population, the most common diagnoses were: lingual changes, small nodules, and OLDs. Those suffering from OLDs were the youngest patients, and those with focal oral mucosa erosions and ulcerations were the oldest patients. In the groups aged 60-70 and 71-80 years old, the most common diagnoses were OLDs, and in the oldest group (+80 years old), they were lingual lesions.

CONCLUSIONS

Oral health has an obvious impact on the functional, psychological, and behavioral quality of life. There is a small number of publications concerning the prevalence and distribution of oral mucosa lesions in the senior population of European countries. Our study is filling in that void.

Prevalence and Characteristic of Oral Mucosa Lesions

(1) Background: Oral mucosa lesions (OMLs) are diagnosed worldwide in any population, age or gender, but in varied prevalence. OMLs can be found in each site of the oral mucosa; for some of them, it is characteristic to have a bilateral/symmetrical or unilateral/nonsymmetrical mucosal manifestation. The knowledge about its prevalence in varied populations can be useful from a clinical point of view. The aim of this study is to assess the prevalence of OMLs in patients attending outpatient dental clinic; (2) Retrospective analysis of 2747 patients’ oral cavity medical charts, who referred to oral pathology outpatient clinic. The type of diagnosed oral lesion, sex and age were evaluated. p ≤ 0.05 was considered statistically significant; (3) Results: In this study, the overall prevalence of oral mucosal lesions was found to be higher in older than younger patients. In our study, the age median was the highest in patients with xerostomia, burning mouth syndrome, angular cheilitis and oral candidiasis. The youngest median age was observed in patients with aphthae, mucocele and gingival enlargement. The higher OMLs frequency was related with the female gender. (4) It is important for clinicians to be familiar not only with distinctive features, which sometimes may not be clear, but also with linking the occurrence of OMLs with the gender and age.

Clinical manifestations of gastrointestinal diseases in the oral cavity

Aim

In this review, several gastrointestinal diseases that dentists may encounter in practice are highlighted and discussed.

Materials and methods

Using MEDLINE (PubMed), a comprehensive review of gastrointestinal diseases and their oral cavity manifestations was performed.

Results

Many gastrointestinal diseases present with oral symptoms that are detectable by dentists and dental hygienists. Often, oral manifestations of the disease may appear before systemic signs and symptoms. Managing patients with these conditions requires dentists to adjust their treatment and/or involve other health professionals.

Conclusion

Care must be taken when providing periodontal therapy or dental implants to patients suffering gastrointestinal diseases who are at high risk of bleeding, infection, or malnutrition, for example. Also, pharmacological therapy for these patients may need to be customized.

Comparative Analysis of Change in pH, Oral Health Status, and the Count of Streptococcus mutans and Lactobacillus Species in the Oral Cavity in Patients with Gastroenteral Diseases Using Saliva: A Pilot Study

BACKGROUND

Seventy million people are affected by gastroenteral (GI) disturbances throughout the world. Oral cavity possesses various bacteria that remain as healthy commensals or turn pathogenic due to shift of balance with disturbances in health, which is reflected in the oral cavity too. Studies have shown a possible oro-systemic link. This study aimed at assessing the effect of GI disease on oral health comparing levels of pH, microbiological counts, and oral health status between test and control groups.

MATERIALS AND METHODS

This pilot study consisted of two groups: test group containing 14 participants (GI disease) and control group (healthy) containing 3 participants. Two saliva samples were collected per patient. One sample was inoculated onto Mitis Salivarius and Rugose agar plates at 37oC in the CO2 incubator for 2 days. The second sample was used for recording pH. Parameters such as decayed, missing, and filled teeth, plaque index, gingival index, probing pocket depth, and clinical loss of attachment were also recorded. The results were analyzed using Statistical Package for Social Sciences (SPSS) version 11.5. Regression analysis was applied to predict the three-microbe culture based on the pH and GI disease.

RESULTS

The oral health parameters showed a higher number of missing teeth, higher bleeding on probing, higher values of plaque and gingival index, a higher amount of clinical loss of attachment, and acidic pH of saliva in the test group. Microbiological analysis showed more Streptococcus mutans in the control group (7,500-10,000 cfu/mL), with a mean of 8,833.33±1,258.31 cfu/mL; S. salivarius was more in the test group (2,000-25,000 cfu/mL) with a mean of 15,866.67±6,697.76 cfu/mL. Candida was seen only in the test group (2,166.67±2,549.51 cfu/mL) and absent in the control group. Lactobacillus was absent in both the groups.

CONCLUSION

The present study suggests the relation between oral health and GI diseases. Hence, saliva could be used as an easy, non-invasive biomarker to analyze the gastroenteric status of the patient.



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Oral manifestations of inflammatory bowel disease: the neglected piece of the puzzle

Inflammatory bowel disease (IBD) is a chronic relapsing remitting autoimmune disease including Crohn's disease and ulcerative colitis. IBD is associated with various extra-intestinal manifestations including oral manifestation. To date, only limited studies addressing the characteristics of the oral manifestations are available. The aim of the present review is to report the oral manifestations and their characteristics in IBD. A Medline/PubMed and Embase databases search were conducted and all relevant studies were extracted and analyzed. Overall, the oral manifestations in IBD were mostly associated with Crohn's disease rather than Ulcerative colitis where their prevalence ranged from 8 to 50%. Specific lesions for Crohn's disease include mucosal tags, cobblestoning and deep linear ulcerations with vertical fissures, while for ulcerative colitis, pyostomatisis vegetans was more disease specific. Notably, most of the oral manifestations were unrelated to disease activity, however more data are needed to accurately assess this correlation. Oral manifestations among IBD patients are not uncommon as Crohn's disease account for most of them. More data are warranted to precisely characterize their prevalence and association to intestinal activity.

Genetic and developmental disorders of the oral mucosa: Epidemiology; molecular mechanisms; diagnostic criteria; management

A large number of disorders may affect the oral cavity, including genetic diseases, infections, cancers, blood diseases, skin diseases, endocrine and metabolic disorders, autoimmune and rheumatologic diseases, local lesions, to name a few. Oral mucosa shows a considerable variation in its normal structure and a wide range of conditions may affect it. Such conditions are often harmless or minor and could be primary or secondary to systemic disease. Several of them are quite rare and, hence, the diagnosis is not easy. Clinically, lesions may appear as ulcers, discoloration of the oral mucosa and alterations in size and configuration of oral anatomy. Genetic disorders have specific manifestations and can be caused by a derangement of one or more components of the tissue. Many of them follow the skin or systemic signs of the underlying genetic disease, but in a few cases oral signs could be the first manifestation of the disorder. Among them genodermatoses are prominent. They are inherited disorders characterized by a multisystem involvement. This review describes chondro-ectodermal dysplasia, dyskeratosis congenita, Ehlers-Danlos syndrome, hereditary benign intraepithelial dyskeratosis, keratosis follicularis, lipoid proteinosis, multiple hamartoma syndrome, pachyonychia congenita, Peutz-Jeghers syndrome, tuberous sclerosis and white sponge nevus. Other genetic disorders not included in the genodermatosis group and reported in the present review are: acanthosis nigricans, angio-osteo-hypertrophic syndrome, encephalotrigeminal angiomatosis, familial adenomatous polyposis, focal dermal hypoplasia, focal palmoplantar and oral mucosa hyperkeratosis syndrome, gingival fibromatosis, Maffucci's syndrome, neurofibromatosis (type 1) and oro-facial-digital syndrome (type 1). Disorders during embryonic development might lead to a wide range of abnormalities in the oral cavity; some of them are quite common but of negligible concern, whereas others are rare but serious, affecting not only the oral mucosa, but also other structures of the oral cavity (ie palate, tongue and gingiva). Fordyce's granules, leukoedema, cysts of the oral mucosa in newborns, retrocuspid papilla, geographic tongue, fissured tongue, median rhomboid glossitis, hairy tongue, lingual varices and lingual thyroid nodule are described. This review may help dentists, dental hygienists, but also general internists and pediatricians to diagnose different disorders of the oral mucosa, to understand the pathogenesis and to schedule a treatment plan.

Oral Ulcers Presentation in Systemic Diseases: An Update

BACKGROUND

Diagnosis of oral ulceration is always challenging and has been the source of difficulty because of the remarkable overlap in their clinical presentations.

AIM

The objective of this review article is to provide updated knowledge and systemic approach regarding oral ulcers diagnosis depending upon clinical picture while excluding the other causative causes.

METHODS

For this, specialised databases and search engines involving Science Direct, Medline Plus, Scopus, PubMed and authentic textbooks were used to search topics related to the keywords such as oral ulcer, oral infections, vesiculobullous lesion, traumatic ulcer, systematic disease and stomatitis. Associated articles published from 1995 to 2019 in both dental and medical journals including the case reports, case series, original articles and reviews were considered.

RESULTS

The compilation of the significant data reveals that ulcers can be classified according to (i) duration of onset, (ii) number of ulcers and (iii) etiological factors. Causation of oral ulcers varies from slight trauma to underlying systemic diseases and malignancies.

CONCLUSION

Oral manifestations must be acknowledged for precise diagnosis and appropriate treatment.

Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan

OBJECTIVE

Gastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study aimed (1) to identify oral soft and hard-tissue changes in patients with GORD and (2) to evaluate these oral changes as indices for assessing GORD and its severity.

SETTING

This cross-sectional study was conducted at four major tertiary care government hospitals, in two metropolitan cities of Pakistan.

PARTICIPANTS

In total, 187 of 700 patients who underwent oesophago-gastro-duodenoscopy and having GORD were included in the study. Patients with GORD were divided according to the presence of DE into group A (with DE, chronic/severe GORD) and group B (without DE, mild GORD). Patients who were unconscious and had extremely limited mouth opening were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

Abnormal conditions and lesions of the oral mucosa were recorded. The impact of oral hard and soft-tissue changes on the oral health-related quality of life was assessed using the Pakistani (Urdu) version of the validated Oral Health Impact Profile-14 (OHIP-14) instrument.

RESULTS

Oral submucous fibrosis (66.3%), ulceration (59.4%) and xerostomia (47.6%) were significantly more common in group A (p<0.05). The prevalence of GORD was 26.7%, within which the prevalence of DE was 35.3%. Unhealthy dietary pattern, nausea/vomiting, oesophagitis, xerostomia, ulceration, gingivitis and angular cheilitis showed a statistically significant association with chronic GORD and DE. All subscales of OHIP-14 were positively correlated (p<0.05) in patients with GORD and DE, with notable impact on psychological discomfort (rs=0.30), physical disability (rs=0.29), psychological disability (rs=0.27) and functional limitation (rs=0.20).

CONCLUSION

Patients with GORD and DE presented with more severe oral manifestations than did those with GORD and no DE. We recommend timely dental check-ups to assess the severity of both systemic and oral disease.

A Guide to Yellow Oral Mucosal Entities: Etiology and Pathology

When faced with an uncertain clinical pathosis in the oral cavity, identifying the color of the mucosal lesion helps to narrow down a differential diagnosis. Although less common than red and white lesions, yellow lesions encompass a small group of distinct mucosal pathologic entities. Adipose tissue, lymphoid tissue, and sebaceous glands are naturally occurring yellow constituents of the oral cavity and become apparent with associated developmental or neoplastic lesions. Reactive and inflammatory lesions can create a yellow hue due to purulence, necrosis, and calcification. Some systemic diseases are known to deposit yellow bi-products such as amyloid or bilirubin into the oral mucosa of an affected person, and while not always yellow, unusual entities like verruciform xanthoma and granular cell tumor fall under the umbrella of yellow lesions given their occasional propensity to demonstration the color. This chapter aims to explore the unique group that is yellow lesions presenting in the oral mucosa.

Oral health-related quality of life in patients with upper gastrointestinal and hepatic disorders in Pakistan: validation of the Oral Health Impact Profile-14 in the Urdu language

Introduction

The Oral Health Impact Profile (OHIP-14) has been used extensively to measure the impact of oral disease on oral health-related quality of life (HRQoL) but has not been validated in the Urdu language or tested in gastroenterology.

Aims

To validate the OHIP-14 for use in Pakistan and its ability to assess oral health in patients with upper gastrointestinal (GI) and hepatic disorders.

Design

Multicentre, cross-sectional.

Setting

Four major tertiary care hospitals.

Methods

The OHIP-14 was tested for reliability and validity in 700 patients referred for oesophago-gastro-duodenoscopic (OGD) investigation of the symptoms of upper GI or hepatic disease. Socio-demographic details and oral examination findings (for oral lesions and DMFT) were recorded.

Results

The mean (±standard deviation) total OHIP-14 score (range 0–56) was estimated to be 23.38 ± 10.47, indicating a significant impact of upper gastrointestinal and hepatic disorders on oral health. The reliability coefficient of the OHIP-14 was above 0.7 threshold, and the tool had good internal consistency (α = 0.83). When associated with worsening DMFT (decayed, missed, and filled teeth) index value, the highest correlations (p < 0.01) were detected with functional limitation (rs = 0.234), physical disability (rs = 0.230), and psychological discomfort (rs = 0.221).

Conclusion

The OHIP-14 is a precise and valid instrument for assessing oral-HRQoL in a gastroenterological setting amongst Pakistani population.

Gastrointestinal diseases and their oro-dental manifestations: Part 2: Ulcerative colitis

Ulcerative colitis is a rather common inflammatory bowel disease, especially in the industrialised world. A limited number of studies have reported the prevalence of oral signs and symptoms in these patients, and widely varying prevalence rates have been reported ranging from 2 to 34%. Pyostomatitis vegetans is the most pathognomonic oral sign but also other abnormalities as oral ulcerations, caries and periodontitis are more often seen in patients with ulcerative colitis. In this review we describe the oral manifestations of ulcerative colitis and their potential dental implications.

Gastrointestinal diseases and their oro-dental manifestations: Part 1: Crohn's disease

Widely varying prevalence rates of oral lesions in patients with Crohn's disease have been reported, ranging from 0.5% to 37%. These manifestations may coincide with or precede intestinal symptoms. Oral manifestations can be classified as specific lesions, when macroscopic examination shows similar changes to those observed endoscopically in the intestine, and non-specific lesions including aphthous ulcerations. The most frequently observed oral lesions are oedema, ulcers and hyperplastic lesions on the buccal mucosa. In most patients these lesions are asymptomatic, however, some patients may experience discomfort. In this review we describe the most relevant oro-dental manifestations observed in patients with Crohn's disease and discuss the potential implications for oro-dental management.

Association of oral manifestations in ulcerative colitis: A pilot study

Background:

Ulcerative colitis (UC) is a chronic tissue destructive inflammatory bowel disease (IBD) of autoimmune origin characterized by predominant bowel symptoms such as abdominal pain, diarrhea and relapsing and remitting rectal bleeding, leading to loss of weight. Extraintestinal manifestations, including involvement of the oral cavity, may also occur. Oral involvement during IBD includes aphthous ulcers, pyostomatitis vegetans (PV) and lichen planus (LP).

Objectives:

The purpose of this study was to document the oral manifestations in UC patients and also to evaluate whether oral manifestation can predict relapse and remission of UC.

Materials and Methods:

Fifteen patients (8 men and 7 women) diagnosed for UC, in clinics of gastroenterology (with disease duration 5–15 years), with equal age- and sex-matched healthy controls were included in the study. All study participants were subjected to intraoral examination to evaluate for oral manifestation. The same patients were also asked a series of questions in the form of questionnaire to evaluate possible association between occurrence of oral manifestations and relapse of UC episode.

Results:

PV, minor aphthous ulcer, LP, halitosis, dysgeusia, dry mouth, tongue coating, gingivitis and periodontitis were documented as oral manifestations in UC. PV, minor aphthous ulcer and LP exhibited relapse and remission with the severity of UC.

Conclusion:

Our study revealed numerous and varied intraoral manifestations among the patients with UC. The previous episodes of oral manifestations were also similar and reported exacerbation of oral manifestations during relapses. Thus, oral manifestations can be used as an indicator of relapse in UC.

Orofacial Crohn’s disease: A case report

Background: Crohn’s disease (CD) and ulcerative colitis (UC) are the two major relapsing conditions of inflammatory bowel diseases. Case Report: A case of Crohn’s disease with orofacial manifestations in a 10 year old girl is described. She had suffered from fever, dysphagia, arthralgia, painful recurrent ulcers of the oral mucosa and swelling of the lower lip lasting over 6 weeks. Clinical examination and the punch biopsy from the buccal mucosa revealed major recurrent aphthous ulcerations. A partial regression and significant relief of lesions were achieved two weeks after the treatment, but the patient suffered from abdominal pain, irregular bowel movements, arthritis, multiple hyperplastic and swollen mucosal folds, after 3 months. The patient was referred to a pediatric gastroenterologist. Esophagogastroduodenoscopy showed pyloric ulcer formation. Abdominal ultrasound showed increased thickening of the ileal wall with multiple enlarged lympadenopathies in the periileal region. Colonoscopy images showed deep ulcers with surrounding erythema. The histopathological examination of biopsies from the terminal ileum and the colon showed basal plasmacytosis, minimal crypt distortions and aphthous ulcerations. The diagnosis of Orofacial Crohn’s disease was made. Exclusive enteral nutrition for 8 weeks, followed by azathiopurine treatment was started with an excellent clinical response on abdominal and oral symptoms. Conclusion: Diagnosis of the disease by dentists and other clinicians through the evaluation of oral clinical findings is very rare. Mucocutaneous and granulomatous lesions of the oral cavity should alert the clinician to pursue an underlying systemic cause. Early communication with a gastroenterologist can help early diagnosis of Crohn’s disease for better patient management and prognosis.

Oral Manifestations of Inflammatory Bowel Diseases: Two Case Reports

Inflammatory bowel diseases (IBD) are known as chronic inflammatory disorders of the digestive tract, represented mainly by Crohn's disease (CD) and ulcerative colitis (UC). Among the main oral manifestations of IBD are cobblestoning of the oral mucosa, labial swellings with vertical fissures, pyostomatitis vegetans, angular cheilitis, perioral erythema, and glossitis. In this sense, understanding these nosological entities by dentists would help reach early and differential diagnosis. Thus, two case reports are presented and discussed based on theoretical references obtained by a literature review. The first case report refers to an adult patient whose IBD diagnosis was established after stomatological assessment. The second case was a patient with CD diagnosed in childhood with characteristic oral lesions.

Oral mucosa lesions and oral symptoms in inflammatory bowel disease patients

BACKGROUND

Inflammatory Bowel Disease is known for its extra intestinal manifestations, the oral cavity is no exception.

OBJECTIVES

The aim of this study was to evaluate the association between Inflammatory Bowel Disease and oral mucosa lesions and symptoms, and complementary to evaluate their possible relation with oral hygiene, smoking habits, drug therapy, duration and activity of the disease.

METHODS

Patients were selected from the Gastroenterology Clinic of a Portuguese tertiary referral hospital. This sample consisted of 113 patients previously diagnosed with ulcerative colitis or Crohn's disease along with a control group of 58 healthy individuals that were accompanying the study group patients to their appointments. Clinical interviews and clinical examinations were performed for data collection.

RESULTS

The patients in the study group were more affected by oral symptoms (P=0.011), and showed a trend towards a higher incidence of oral mucosal lesions, even though statistical significance was not reached (8.8% versus 3.4% in the control group; P=0.159). Patients in active phase were the most affected. No differences were detected between Crohn's disease and ulcerative colitis, or concerning smoking habits. The corticosteroid and immunosuppressant therapy seemed to increase the incidence of oral symptoms (P=0.052). The oral mucosa lesions increased and the oral symptoms decreased over the course of the disease, however without statistical significance.

CONCLUSION

Oral mucosa's lesions and oral symptoms were positively associated with Inflammatory Bowel Disease, mainly during disease activity periods and conceivably, associated with corticosteroid and immunosuppressant therapy.

Molecular identification of Mycobacterium avium subspecies paratuberculosis in oral biopsies of Crohn's disease patients

Oral lesions may be found in patients with Crohn’s disease (CD), in a percentage up to 20%. The aim of this study was to investigate a possible relationship between Mycobacterium avium subsp. paratuberculosis (MAP) and oral lesions in CD patients. 23 oral biopsies were examined performing IS900 Nested PCR; 9 of them were positive: 8 from CD patients and 1 from a control. Our purpose is to go on with this study, amplifying the number of subjects examined and testing subjects with oral lesions related to diseases other than CD to verify the specific association between MAP and oral lesions in CD patients.

Oral manifestation of Crohn's disease without concomitant gastrointestinal involvement

Crohn's disease (CD) is a chronic relapsing inflammatory disorder of unknown etiology and uncertain pathogenesis with no known cure. CD can involve any segment of the gastrointestinal tract, and oral lesions consistent with granulomatous ulcers are considered an important extra-intestinal manifestation. Oral lesions in the absence of gastrointestinal involvement are rarely reported. We report a case of a 64-year-old man with a history of CD that was in remission for three decades, presenting with painful cobblestone-like ulcerations of the oral mucosa, but without gastrointestinal signs or symptoms. Surgical biopsy of the oral lesions revealed non-necrotizing chronic granulomatous ulcers on histopathologic examination, similar to results from a biopsy of his small intestine three decades previously which established his diagnosis of CD. The patient was successfully treated with potent topical corticosteroids which resulted in resolution of the oral lesions and associated symptoms.

Medical considerations relating to the oral health of older adults

This review paper was written in conjunction with the 2010 National Coalition Consensus Conference: Oral Health of Vulnerable Older Adults and Persons with Disabilities. It provides an overview of specific medical considerations involved with dental diagnosis and treatment of this "at risk population." The role of oral inflammation is referenced within the context of the oral/systemic paradigm (e.g., diabetes, cardiovascular disease/stroke, respiratory diseases, and cognition). Oral manifestations associated with multi-organ diseases, tobacco/alcohol use, and medications are additionally discussed. Finally, the paper encourages development of interdisciplinary approaches to positively influence health outcomes.

Oral adverse effects of gastrointestinal drugs and considerations for dental management in patients with gastrointestinal disorders

Gastrointestinal disease is associated with alterations in the mouth or influence the course of the dental diseases, and the dental health care workers are expected to recognize, diagnose, and treat oral conditions associated with gastrointestinal diseases and also provide safe and appropriate dental care for afflicted individuals. Drugs used in the management of these diseases result in oral adverse effects and also are known to interact with those prescribed during dental care. Hence, this article has reviewed the drug considerations and guidelines for drug use during dental management of patients with gastrointestinal diseases.

Medical management update: Peutz Jeghers syndrome

Peutz Jeghers syndrome (PJS) is an autosomal dominant disease characterized by hamartomatous polyposis and distinct mucocutaneous pigmentation. PJS is associated with an increased risk for several cancers and other complications such as small intestine intussusception, short bowel syndrome, and anemia. Medical management mainly consists of treatment of the polyps and surveillance. This medical management update will review clinical concepts, therapeutic advances, and emphasize features of PJS important to the oral health care provider.

Links between oral and gastrointestinal health

PURPOSE OF REVIEW

To review the links between oral and gastrointestinal health and discuss their implications in clinical management.

RECENT FINDINGS

There are many instances in which changes that occur within the oral cavity reflect systemic disease elsewhere in the body. Oral manifestations may be the first sign of gastrointestinal disease. This is definitely the case in the inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. However, although the oral manifestations are relatively well recognized, the links between pathobiology at different sites do not appear to be fully investigated in the literature. This is not the case with alimentary tract mucositis, a side effect of cancer treatment. Increasing interest in the pathobiology of mucositis and the links between changes that occur at different sites of the alimentary has changed the way that this common side effect of cancer treatment has been managed.

SUMMARY

Changes occurring in the oral cavity associated with systemic diseases, including gastrointestinal disease, have been long recognized. Further study into the pathobiology of oral links with inflammatory bowel disease is also recommended so that these diseases are better understood. Importantly, however, the oral manifestations of systemic disease must be highlighted so that, if they are the first manifestations that can be clinically recognized, patients can have appropriate investigations and be managed in a timely fashion. A multidisciplinary management of patients is crucial so that they receive appropriate and comprehensive healthcare.

Orofacial findings in chronic granulomatous disease: report of twelve patients and review of the literature

BACKGROUND

Chronic granulomatous disease is an extremely rare primary immunodeficiency syndrome that can be associated with various oral complications. This can affect high number of patients. However, data on oral complications is sparse. Here we will review the literature and describe the orofacial findings in 12 patients.

FINDINGS

The age range was 5-31 years. Oral findings were variable, and reflected a low level of oral hygiene. They included periodontitis, rampant caries, gingivitis, aphthous-like ulcers, and geographic tongue. One patient had white patches on the buccal mucosa similar to lichen planus. Another patient had a nodular dorsum of the tongue associated with fissured and geographic tongue. Biopsies from the latter two lesions revealed chronic non-specific mucositis. Panoramic radiographs showed extensive periodontitis in one patient and periapical lesions in another patient.

CONCLUSION

Patients with chronic granulomatous disease may develop oral lesions reflecting susceptibility to infections and inflammation. It is also possible that social and genetic factors may influence the development of this complication. Therefore, oral hygiene must be kept at an optimum level to prevent infections that can be difficult to manage.

[Oral manifestations of systemic diseases]

Many systemic diseases may present with oral manifestations and the oral mucosa may act as a mirror of internal involvement. We discuss the most common, specific and unspecific, as the most peculiar oral mucosal manifestations of systemic disease in the different organ systems. The most prevalent conditions of the oral mucosa in the course of HIV infection and marker lesions of multisystemic genodermatoses are elucidated.