This document summarizes common gastrointestinal diseases that may affect dental care: 1) Peptic ulcer disease affects 15% of industrialized populations and is caused by an interaction of aggressive factors like H. pylori and defensive factors. Symptoms include epigastric pain and bleeding. Treatment involves anti-secretory agents and antibiotics. 2) Inflammatory bowel disease (IBD) describes ulcerative colitis and Crohn's disease. IBD is managed but not cured through medications, immunosuppressants, or surgery. Patients may experience oral lesions. 3) Pseudomembranous colitis is a severe, potentially fatal form of colitis associated with certain antibiotics in at-risk patients.

1. Gastrointestinal Disease
December 03, 2006
Dr. Suresh. C. S. BDS; MDS; MDSc (UK)
Oral Diagnosis I

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. 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. 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. 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. 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. Peptic Ulcer Disease
Medical Management
 Anti-Secretory agents alone or accompanied
with antimicrobial agents are recommended.

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. 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. 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. 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. Inflammatory Bowel Disease
Incidence & Prevalence
 In the average general dentistry practice
having 2000 adult patients, approximately
5 adults are predicted to have IBD.

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. 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. 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. 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. 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.