Inflammatory Bowel Disease

Question 1

Describe inflammatory bowel disease and talk about the pathogenesis, and which intestine is affected

Answer 1

• Inflammatory bowel diseases: a group of inflammatory diseases of the colon
• They affect the colon and small intestine
• The pathogenesis of Crohn’s disease (CD) and ulcerative colitis (UC) is still unclear, but both are immune-mediated phenomena

Question 2

List the oral signs and symptoms of inflammatory bowel diseases:
UC: 10
CD: 3

Answer 2

Ulcerative colitis:
• Aphthous ulcers
• Oedema/ swelling of lips
• Oral granulomatosis
• Xerostomia
• Inflammation/ abscess in salivary ducts 
• Erythema
• Gingivitis
• Cobblestone appearance 
• Mucosal tags 
• Corrugated buccal mucosa

Crohn’s disease:
• Aphthous ulcers
• Xerostomia
• Pyostomatitis vegetans

Question 3

Explain the dental management of inflammatory bowel disease (5)

Answer 3

• Evaluation of hypothalamic/pituitary/adrenal cortical function to determine if patient is able to undergo extensive dental procedures
• Avoid prescribing NSAID as they can trigger a flare-up. Recommend paracetamol instead
• Early diagnosis and treatment of oral infections to enhance the gastroenterologist’s ability to manage the IBD
• Diagnosis (biopsy if necessary) and treatment of oral inflammatory, infectious, or granulomatous oral lesions
• Frequent recalls to prevent destruction of hard tissues