By : Dyah Indartin

Setyowati

Bagian Klinik Ilmu Penyakit Mulut

Fakultas Kedokteran Gigi
Universitas Jember
2017
• Gastrointestial diseases refer to diseases involving the gastrointestinal
tract, namely the oesophagus , stomach , small intestine , large
intestine and rectum , and the accessory organs of digestion , the liver ,
gallbladder , and pancreas.
IMPAIRED DIGESTION AND ABSSORPTION

ALTERED SECRETION

IMMUNE DYSREGULATION

IMPAIRED GUT BLOOD FLOW

NEOPLASTIC DEGENERATION

GENETIC INFLUENCES
 Recognize, diagnose, and treat oral conditions associated with
gastrointestinal diseases

Proper medical referral for management of systemic symptoms

Dentist’s role in monitoring patient compliance with recommended medical

therapy for gastrointestinal conditions
• Pernicious anemia
• Folic acid Deficiency anemia

• Bulimia
• Anorexia

• Gardner’s syndrome
• Peutz-Jegher’s syndrome

• Malignant neoplasm of liver

and GIT
IBD is currently considered an inappropriate immune response to
the endegenous commensal microbiota within the intestines
 ulcerative colitis

Alergy
Ethiologi Bacterial
:- Idiopathi and Viral
c invection
s

Psycological
and
Immunologica
l,genetic
factors
General Symptonis of ulcerative
colitis
Oral Manifestation of ulcerative
colitis
Major and Minor Aphthouse ulcers
• Commonly seen on buccal mucosa and
mucobuccal fold

Pystomatitis vegetans : A Purulent

inflammations of the mouth may occur
• Commonly seen on buccal mucosa and
mucobuccal fold
Ulcerative colitis patients also can
develope hairy leukoplakia, a lesion more
commonly associated with human
Immunodeficiency virus ( HIV ) disease
 Crohn’s Disease
Crohn’s disease is the inflammation of small and large
intestine involving all layer of gut

Ethiologi
Excessive
Smoking, Immune
stress reaction

Genetis
 General symptoms of Crohn’s
disease
The clinical presentation of Crohn’s disease depends
on the extent of inflammation and on the site of
intestinal involvemant
Inflammation of the small intestine may impair
absorption of vital nutriens

Involvement of terminal ileum interferes with

the absorption of bile salts and vitamin B12

Anaemia, Abdominal pain, Nausea,

Vomiting, Weight loss
 Oral Manifestation of Crohn’s
disease

Persistent Cobleston Diffuse Indurated

Linear and e mucosal swelling of polypold tag-
deep ulcer architectu the lips like lesions in
re and face the vestibule
Rostomatitis vegetans, cobblestone mucosal architecture and minor salivary
gland duct pathology represent anulomatous changes that constitute the
hallmark of Crohn’s disease
Dental Management of inflammatory bowel
disease

Frequent preventive and routine dental care to monitor

oral health

Evaluation of Hypothalamus-pituitary-adrenocortical
function

Diagnosis of oral inflammatory or granulomatous

lesions

Palliative rinses and topical steroid therapy

symptomatic oral lesions
• Sodium bicarbonate mouth rinses
• 0,05 % Fluosinonide
• If the lesion is disseminated to aropharynx,
dexamethasone elixir 0,5 mg / 5 ml gargle for 1
minute 4 times daily
 Peptic ulcer
disease
Peptic ulcer disease is a common benign (non-malignant) ulceration of the epithelial lining
of the stomacth (gastric ulcer) or duodenum (duodenal Ulcer)
 Peptic ulcer
disease
General symtoms of peptic
olcer

Epigastric pain
• Relieved by food (duodenal)
• Aggravated by food (Gastric)

Gastrointestinal
bleeding
Obstruction of Perforation
are seen
 Peptic ulcer
disease of Peptic Ulcer
Oral Manifestations
Disease
Bacterial
Xerostomia disease

Fungal disease
Atered
Drug taste
Indused perception

Anaemia Mucosal
pallor

Trombocytope Gingival
Agranulocyt nia bleeding
osis
Mucosal Necrotizing
Ulcerations stomatitis
 Dental management of Peptic ulcer
Disease
Minimize Stress
• Anticholinergic associated
xerostomia • Short Appointments

Selective usage of analgesics

• Avoid Aspirin containingcompounds

Check for platelet count before any surgical

prosedure
• Cimetidine may rarely be associated with
thrombocytopenia

Frequent recall and oral

prophilaxysisrecommended

Avoidance of tetracycline in patient taking

aluminium antacid
 Gastro-esophageal reflux
disorder
Gastroesophageal reflux disease (GERD) is one of the most commonly occurring diseases
affecting the upper gastrointestinal tract where in Gastric contents (chyme) passively move
up from the stomach into the esophagus
 General Symtoms of
GERD
Heartburn is the cardinal symtomp of GERD and is defined as a
sensation of burning or heat that spreads upward from the
epigastrium to the neck

Esophagitis

Esophagial ulcers, strictures and dysplasia

Dysphagia
 Oral manifestation Of
GERD

Dysgeusia (altered Erosio Mucosal

taste) n erythema

Esophagial stricture
Mucosal and Fibrosis Xerostomi
atropy a
Dental management of GERD
Patients
NaHCO₃ Mouth rinses to minimize
dysgeusia due acid reflux
Topical fluoride application to ensure
optimal mineralisation

Salivary substitutes may be

prescribed
Patients should be advised to have
adequate amount of fluit intake

Cimetidine
• Toxic reaction to IV lidocaine
• Inhibits absorption of systemic
antifungal drugs
 Desorders doe to Gastrointestinal
Malabsorption
Pernicious
Anemia
Severe deficiency of vitamin-B12 result in
pernicious anemia
• Occurs due to atrophy of Gastric mucosa resulting in
lack of intrinsic factor
• Macrocytic normochromic anemia

Diagnosis

• Serum Vitamin B12 levels

• Serum methylmalonic acid and homocystien levels
• Schilling test
 General Symptoms Pernicious
Anemia

Neurological
Manifestations Tiredness Dizziness
• Tremors and palsies
numbness of limbs

Depression Hair loss

 Oral Manifestations Of Pernicious
Anemia

inflamed Glossitis and

“beefy red” glossodynia
tongue
 Folic Acid Deficiency
anemia
It is a macrocytic anemia caused due to folic acid
deficiency

• Prevalent in Patients whose diet devoid of leafy

vegetables
• Alcoholics and drug abusers
• Increased requirement of folat – pregnant women and
young children
• Anticancer drugs like Methotrexate, Azathioprine and 6-
mercaptapurine leads to folate deficiency
• Normal shilling test and serum vitamin B12 but low
serum assay of folic acid
• It causes severe anemia but without any neurological
Oral Manifestation Folig Acid Deficiency
anemia
• Normal Dental
Protocol

• Stress reduction
•protocols
Shorter appointments
• Sedation techniques

Outpatients intra venous sedation

and general anaesthesia is
contraindicated
Hospitalization for moderate and
advance surgical procedurs
 Eating
Disorders
Two common eating disorders are Anorexia nervosa and
Bulimia nervosa

Anorexia nervosa Bulimia nervosa

• Intentional starving even • Patients consumes large
if the patient is already amount of food due to
underweight lack of control over
• Patient use laxatives and appetite
diuretics to lose body • Self induce vomiting,
weight laxatives and diuretics
are used to lose body
weight
Common intention of either of the disorders is
weight loss
 General Symptoms of Eating
Disorders

Cardiac
Anemia Amenorrho
Arrhythmi
ea
a

Pubertal Conspitati Osteoporosis

delay on
 Oral Manifestations Eating
Discorders

Erosion of lingual Increased risk of

surfaces of maxillary caries and
anterior teeth periodontal disease

Teeth sensitive to
Parotid gland thermal changes
swelling
Dental Management of Eating
disorders
Support the patient psychologically by
demonstrating a caring and
compassionate attitude
Avoid elective dental procedures until
patient is stable from a cardiac stand
point

Complex restorative treatment should be

avoided until the purging has been
corrected

Emphasis on oral hygiene maintenance

Crowns may have to be placed if thermal

symptoms are present in an actively
purging patient
 Genetic disorders

Gardner’s
sindrome
• It is an autosomal dominant where in defect is
on Adenomatous polyposis coli tumour
suppressor gene chromosome no 5
• It is characterised by intestinal polyps and
multiple impaction of supernumerary teeth
• Prevalence 1 : 8,300 – 1 : 16,00,000 live birth
Management of Gardener,s
Syndrome
Prophylak colecto is recoommen
tic my ded

Excision of Osteomas and

jaw for
Cysts epidermoid
reasons be
cosmetic may indicated
 Peutz- Jegher’s Syndrome

It is an autosomal dominan condision with a defect in

LKB 1 gene
Caracterised by hamartomatus polyposis

Prevalence : 1 : 20,000

Oral manifestation :
• Oral and peri oral pigmentation
• Freckling of skin arround lips and vermillion zone
of lip
• Intraoral lesion are usually painless brown patch
on buccal mucosa
 Management of Gardener,s
Syndrome
It is vital recognize oral manifestation of gastrointestinal
diseases as they are useful in development of differential
diagnosis for patient with gastrointestinal complaint

The severity of prognosis of the disease can be monitored by

the presence or extent of oral manifestation

The success of the management of gastrointestinal disease

may be reflected in response to oral tissues

Hence, the oral pshysicians play a critical role in recognising,

diagnosing, and treating oral condition related with
gastrointestinal disease and also to provide dental care to