Gastrointestinal disease


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Oral Diagnosis I
Third Year

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Gastrointestinal disease

  1. 1. Gastrointestinal Disease December 03, 2006 Dr. Suresh. C. S. BDS; MDS; MDSc (UK) Oral Diagnosis I
  2. 2. Gastrointestinal Disease Overview  The following gastrointestinal diseases are common and may affect the delivery of dental care:  Peptic ulcer disease  Inflammatory bowel disease  Pseudomembranous colitis
  3. 3. Peptic Ulcer Disease Definition  It is a well defined break in the gastrointestinal mucosa (greater than 3 mm in diameter)  They develop in regions of the gastrointestinal tract that are proximal to acid-pepsin secretions.
  4. 4. Peptic Ulcer Disease Incidence & Prevalence  It affects 15% of the population in industrial countries.  5-10% of the world population.  500.000 new cases occurs annually in US.
  5. 5. Peptic Ulcer Disease Etiology  Current evidence supports a complex interaction between aggressive & defensive factors that are potentially destructive & protective to the mucosa, respectively. Aggressive factors Defensive factors Helicobacter pylori Mucus gel Acid hypersecretion Bicarbonate Tobacco Prostaglandins NSAIDs Mucosa blood flow Psychological & physical stress
  6. 6. Peptic Ulcer Disease Signs & Symptoms  Most patients develop epigastric pain that is long standing and sharply localized (burning)  The discomfort of a duodenal ulcer manifests most commonly on an empty stomach (90 min. to 3h. after eating) & awakens the patient in the middle of the night  Melena indicate blood loss due to gastrointestinal hemorrhage
  7. 7. Peptic Ulcer Disease Medical Management  Anti-Secretory agents alone or accompanied with antimicrobial agents are recommended.
  8. 8. Peptic Ulcer Disease Dental Management  Careful review of medications (aspirin, NSAIDs, oral anticoagulant) and alcohol consumption that can result in gastrointestinal bleeding.  If symptoms are suggestive of active disease, a medical referral is needed.
  9. 9. Peptic Ulcer Disease Dental Management  If the patient is under medical control, the dentist should update current medications in the dental record and follow the guidelines outlined in the following material.  Good oral hygiene measures and periodic scaling and prophylaxis may help for reducing the spread of H. Pylori.
  10. 10. Peptic Ulcer Disease Oral Manifestations  Use of systemic antibiotics can result in candidiasis  Medications taken by the patient can 1- Alter taste perception. 2- Have a toxic effect on bone morrow and infrequently cause anemia. 3- Xerostomia.
  11. 11. Inflammatory Bowel Disease Definition  It describes two idiopathic diseases.  Ulcerative colitis  It is a mucosal disease limited to the large intestine and rectum.  Crohn’s disease  It may produce focal ulcerations along any point of the alimentary canal from the mouth to the anus.
  12. 12. Inflammatory Bowel Disease Incidence & Prevalence  In the average general dentistry practice having 2000 adult patients, approximately 5 adults are predicted to have IBD.
  13. 13. Inflammatory Bowel Disease Signs & Symptoms Ulcerative colitis Crohn’s disease  Attack of diarrhea Recurrent diarrhea  Rectal bleeding Abdominal pain  Abdominal cramps Anorexia Unexplained fever Malaise Arthritis Weight loss
  14. 14. Inflammatory Bowel Disease Medical Management  Ulcerative colitis & Crohn’s disease can be managed but not cured  Anti-inflammatory medications.  Immunosuppressive agents  Monoclonal AB  Surgical resection to remove the diseased portion of the colon
  15. 15. Inflammatory Bowel Disease Dental Management  Use of steroid drugs is of concern to the dentist because of corticosteroids can suppress adrenal function and reduce the ability of the patient to withstand stress.
  16. 16. Inflammatory Bowel Disease Oral Manifestations  Ulcerative colitis:  20% of patients are affected with aphthous like lesions.  Crohn’s disease:  Atypical mucosal ulcerations & diffuse swelling of the lips & cheeks.
  17. 17. Pseudomembranous Colitis  Definition:  It is a severe form and sometimes fatal form of colitis  Dental Management:  Dentist should be aware that use of certain systemic antibiotics (exp. lincomycin, clindamycin, ampicillin & cephalosporins) is associated with higher risk of pseudomembranous colitis (PC.) in elderly, debilitated pts. or with previous history of PC.