Wednesday, January 31, 2018

The Oral Cavity in Crohn’s Disease

Resident: Wayne Dobbins                                                                                                      Date: 1/31/2017

Article Title: The Oral Cavity in Crohn’s Disease
Author(s): Pittock S, Drumm B, Fleming P, et al
Journal: The Journal of Pediatrics, Vol. 138 No. 5, 767-771
Date: 2001
Major Topic: Crohn’s Disease
Type of Article: Retrospective chart review
Main Purpose: Overview of medical complications seen with patients with Crohn’s disease
Key Points:

Crohn’s disease
An inflammatory bowel disease, characterized by granulomatous inflammation. It may affect any site along the GI tract, from the lips to the anus. Oral lesions are well described, and have a prevalence of 0.5% to 20% in CD patients.

Oral manifestations of CD include:
·         Recurrent apthous ulceration
·         Lip swelling
·         Cobblestoning of the buccal mucosa
·         Deep ulcerations, often linear
·         Mucosal tags
·         Localized mucositis and gingivitis

The Study
·         A retrospective chart review, over 5 years, ending in December 1998. 45 new diagnoses were made in this period, of those, 25 had undergone examination by the dental surgeon, 12 of whom (48%) had oral lesions related to Crohn’s.
·         The most frequent of these findings were: mucosal tags, and labial swelling.
·         The children with oral disease were more likely to have more numerous and more severe symptoms and earlier diagnosis.
·         In cases wherein oral lesions are present, they may be useful diagnostic markers of Crohn’s. Because the oral cavity is directly visible and can harbor lesions accessible for diagnostic biopsy, a systematic oral examination may be valuable in the initial diagnostic evaluation of children with suspected CD.

·         Only children already suspected of having oral manifestations of Crohn’s were referred for the oral evaluation.


An update of the etiology and management of xerostomia

An update of the etiology and management of xerostomia

Department of Pediatric Dentistry
Lutheran Medical Center
 Resident’s Name:       Olga Raptis, DMD      Date: 01/31/17 

Article Title: An update of the etiology and management of xerostomia
Author(s): D. R. Porter, MD, PhD, FDS RCS, FDS RCSE, et al.
Journal: Oral Surg Oral Med Oral Pathol Radiol Endod
Date: January 2004
Major TopicXerostomia
Type of Article: Literature review
Main Purpose: To update the etiology and management of xerostomia

-       Xerostomia, or dry mouth, is an abnormal reduction of saliva and can be a symptom of certain diseases of be an adverse effect of certain medications. 

-       Causes of long-standing xerostomia:
·       Drugs (synergistic effects – patient that are on multiple medications)
·       Anticholinergic or sympathomimetic, tricyclic antidepressants, antipsychotics, benzodiazepines, atropinics, Beta blockers, and antihistamines, omeprazole, tramadol, and others)
·       Local radiation (single dose of 20Gy can cause salivary dysfunction, 52Gy (severe), treatment of oral carcinoma involves the administration of a dose of 60-70Gy) – radioactive iodine for thyroid disease may also cause salivary damage
·       Chemotherapy (more drugs taken more discomfort, medications can also make saliva thicker, causing mouth to feel dry)
·       Chronic graft-versus-host disease (well know complication, fibrosis of gland and alteration of chemical composition)
-       Disease of the salivary glands
·       Sjogren’s syndrome
·       Sarcoidosis
·       HIV disease
·       Hepatitis C virus infection
·       Primary biliary cirrhosis
·       Cystic Fibrosis
·       Diabetes mellitus
·       Other
-       Rare causes
·       Amyloidosis
·       Hemochromatosis
·       Wegener’s disease
·       Salivary gland agenesis (with or without ectodermal dysplasia)
·       Triple A syndrome
·       others

Occasionally, xerostomia may be subjective, with no evidence of altered salivary flow – most often associated with psychological factors.

   Clinical Consequences of Xerostomia
·       Increased frequency of caries (cervical)
·       Proclivity toward acute gingivitis
·       Dysarthria
·       Dysphagia
·       Dysgeusia
·       Proclivity toward candidal infection (eg. Acute pseudomembranous candidiasis, median rhomboid glossitis, denature-associated stomatitis, angular cheilitis)
·       Burning tongue/depapillation of tongue
·       Oral mucosal soreness
·       Dry, sore, cracked lips
·       Salivary gland enlargement

Summary of oral care in patients with xerostomia:
·       Oral hygiene – plaque control, OHI, dietary advice, chlorhexidine mouthwash or fluoride mouthwash daily (0.05%) to minimize the risk of caries
·       Dentures – should fit well, implant-retained.  Provide instructions on denture hygiene.
·       Antifungals – nystatin pastilles, amphotericin lozenges, miconazole gel
·       Topical saliva substitutes – sugar-free gum and candies; oral moisturizers
·       Systemic therapies – Pilocarpine and others
-       Some topical therapies for xerostomia
·       Sugar-free gum, candies, and liquids
·       Lubricating gels, mouthwashes. Lozenges, and toothpaste
·       Salivary stimulant pastilles
·       Mucin spray
·       Humidifiers
·       Saliva substitute placed in intraoral device

As people live longer with infections/medical issues that cause them to take medications, more people will suffer with long standing signs and symptoms of xerostomia.  At present, anticholinergic agents would seem to hold promise and are appropriate for the treatment of xerostomia associated with radiation and Sjorgen’s.