That Gut Feeling: Oral Manifestations of Gastrointestinal Inflammatory Conditions

About 1.1 million Indians are diagnosed with inflammatory bowel disease (IBD)—Crohn’s & ulcerative colitis—and the number is increasing by twenty thousand new cases annually. At the same time, about 10-20% of the adult population has irritable bowel syndrome (IBS). Gastrointestinal inflammatory conditions, such as Crohn’s disease, ulcerative colitis, and celiac disease, often exhibit oral manifestations, serving as potential indicators of systemic disease. These manifestations can precede, accompany, or follow intestinal symptoms, underscoring the interconnectedness of the oral and gastrointestinal systems.

In these diseases, oral lesions are common, including aphthous ulcers, mucosal tags, and cobblestone appearances of the buccal mucosa. Swelling of the lips, angular cheilitis, and granulomatous inflammation may also occur. These symptoms can mimic other conditions, requiring careful differential diagnosis.

Celiac disease is associated with enamel defects, recurrent aphthous stomatitis, and atrophic glossitis due to malabsorption of nutrients like iron and folic acid.

Also, the effects of medications, the need for medical consultation, modifications to routine dental care, and oral hygiene instructions for patients with these conditions.

Oral Effects of Medications Used to Treat Gastrointestinal Inflammatory Conditions.

Medications prescribed for gastrointestinal inflammatory conditions, can also have significant oral side effects that impact oral health and require attention during dental care. Corticosteroids are commonly prescribed for inflammation management, which can suppress the immune system, increasing the risk of oral fungal infections like candidiasis. Prolonged use may also lead to delayed wound healing, gingival irritation, and xerostomia (dry mouth). Other immunosuppressants also can cause oral ulcers, mucositis, and increased susceptibility to infections due to immunosuppression. Proton Pump Inhibitors (PPIs): Used to manage acid reflux, PPIs may contribute to xerostomia and altered taste sensation, affecting oral hygiene.

Patients taking these medications require regular oral examinations, preventive measures against infections, and tailored oral hygiene instructions to mitigate adverse effects.

Modifications Needed for Routine Dental Care and Oral Hygiene Instructions for Patients with Gastrointestinal Inflammatory Conditions:

  Pre-Treatment Assessment:

Obtain a detailed medical history, including current medications (e.g., corticosteroids, immunosuppressants) and disease activity. Assess for oral manifestations like ulcers, xerostomia, or mucosal lesions that may complicate dental procedures.

   Oral Hygiene Instructions:

Recommend soft-bristled toothbrushes and non-abrasive toothpaste to prevent mucosal irritation. Encourage alcohol-free mouthwashes to reduce dryness and discomfort. Suggest fluoride treatments to prevent dental erosion, particularly in patients with frequent vomiting.

    Dietary Advice:

Advise avoiding acidic, spicy, or coarse foods that may exacerbate oral lesions. Reinforce the importance of a balanced diet and supplementation if deficiencies are present. Close communication between dental and medical professionals is vital to ensure safe, effective care for these patients.

These oral manifestations not only impact quality of life but also provide diagnostic clues for underlying gastrointestinal disorders. A multidisciplinary approach is critical for comprehensive care and improved patient outcomes.