Gastroenterology and nutritional disorders dentally relevant questions

Question 1

What inflammatory bowel disease affects the oral cavity?

Answer 1

Crohn’s disease

Question 2

What concern would you have if patient presents with lumpy lesions like cobblestones in mouth?

Answer 2

Think something wrong in bowels

Question 3

What are the presentations of crohns?

Answer 3

Pain, diarrhoea, intestine obstruction, inflammation, transmural process, fistula
Other complications - ulcers, uveitis, arthritis

Question 4

What test shows someone has crohns?

Answer 4

Increased serum ACE levels = sarcoidosis (granulomatous disease)

Question 5

What symptoms appear in a child with crohns?

Answer 5

Fever, anaemia, arthritis, failure of growth and development

Question 6

What is Barret’s oesophagus?

Answer 6

Epithelial cells undergo dysplastic change = produce mucus

Question 7

What is in saliva to neutralise acid?

Answer 7

Bicarbonate

Question 8

What drug treatment is given for someone with GORD?

Answer 8

Protein pump inhibitors –> omeprazole/ lansoprazole

Question 9

What treatment is given for peptic ulcers?

Answer 9

Histamine blockers (cimetidine), long term antacid, proton pump inhibitors

Question 10

What is diverticular disease?

Answer 10

Inflamed out-pouching of large bowel

Question 11

How many pairs of teeth are needed for a functioning occlusion?

Answer 11

> 5 pairs

Question 12

What is the difference between 1.parenteral and 2.enteral feeding?

Answer 12

1. IV nutrition

2. Feed directly into the gut via tube

Question 13

What drugs should be avoided in peptic ulcers?

Answer 13

NSAIDs and corticosteroids

Question 14

What causes peptic ulcers?

Answer 14

H.pylori infection, stress/smoke/alcohol, NSAIDs/corticosteroids
Gastric acid, pepsin

Question 15

What natural offers protection for peptic ulcers in the stomach?

Answer 15

Prostaglandins
Mucus
HCO3 (Bicarbonate)

Question 16

How do H2-receptor antagonists work in peptic ulcer management? and give an example.

Answer 16

Decrease acid secretion

Cimetidine and ranitidine

Question 17

How do proton pump inhibitors work in peptic ulcer management? and give an example.

Answer 17

Final step in acid production is action of H+/K+ aptase (proton pump), therefore PPIs inhibits enzyme
Active only in an acidic environment
Example - end in -azoles

Question 18

How do antacids work in peptic ulcer management? and give an example.

Answer 18

Increase gastric pH, therefore inhibiting pepsin

E.g. Al and Mg salts (milk of Mg)

Question 19

How do chelates and complexes work in peptic ulcer management? and give an example.

Answer 19

Physical barrier and coats mucosa
Stimulates bicarbonate and mucous and inhibits pepsin
E.g. sucralfate, bismuth chelates

Question 20

How is H.pylori infection eliminated?

Answer 20

Triple therapy:

1. PPIs
2. Clarithromycin
3. Metronidazole/amoxicillin

Question 21

What are the dental side effects of ranitidine?

Answer 21

Erythema multiforme, tongue staining

Question 22

What are the dental side effects of omeprazole/sucralfate?

Answer 22

Xerostomia

Question 23

What are the dental side effects of H2 receptor antagonists?

Answer 23

Pain and swelling of salivary glands

Question 24

What is the drug interaction of antacids and tetracyclines?

Answer 24

Decreased absorption of tetracyclines as chelate formed

Question 25

What drug interactions occur between omeprazole and 1.anti-fungals, 2.diazepam, 3.warfarin?

Answer 25

1. Inhibits absorption of some anti-fungals
2. Inhibits diazepam metabolism - may over sedate
3. Increases warfarin effect

Question 26

Why would a patient on high dose prednisolone be prescribed proton pump inhibitors?

Answer 26

To decrease acid secretion as steroids are bad for producing ulcers