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Inflammatory Bowel Disease

Risks to the dental patient

Management During Treatment

Questions to Ask 

  • Not usually required.

Clinical Findings 

Prevention 

  • Immunosuppressors cause an increased risk for lymphoma and infection

    • Presence of fever without obvious causative illness mandates prompt referral to the physician

    • Regular head and neck examinations for abnormal swellings

  • Minimize the use of clindamycin which has been linked to overgrowth of Clostridium difficile

  • Patients taking corticosteroids may be at risk for suppression of adrenal function which may reduce the ability of the patient to withstand stress.

    • Current recommendations:  

      • Patient should take the usual daily dose of corticosteroid before the dental appointment and the dentist should provide adequate pain and anxiety control.​

      • Supplemental corticosteroids may be required in rare circumstances; if the patient's health is poor, infection is present, the patient is more fearful and when major surgery is being performed.

  • Pain control

    • Aspirin and other NSAIDs which irritate the GI mucosa should be avoided​

      • ​Cotherapy of a COX-2 inhibitor (celecoxib) and a proton pump inhibitor to protect the GI mucosa

    • Acetaminophen may be used alone or in combination with opioids​

      • Take care in prescribing acetaminophen or opioids due to the possibility of overdose if patient is already taking one or a combination for pain​

  • Patients on sulfasalazine are at risk for hematologic abnormalities (leukopenia and thrombocytopenia). Medical consultation is advised for these patients for extensive surgical procedures.

References

Dental Management of the Medically Compromised Patient.  Little, Falace, Miller and Rhodus. 8th Edition

Medical Consultation Recommended 

  • What type of inflammatory bowel disease do you have?

  • What medications are you taking?

  • How stressful do you find dental treatment?

  • Are you taking your medications as directed?

  • How often do you see your physician?

Introduction

This term encompasses two idiopathic diseases of the gastrointestinal tract

​Ulcerative colitis  

  • Mucosal disease limited to the large intestine and rectum

  • Three prominent symptoms:

    • Attacks of diarrhea

    • Rectal bleeding or bloody diarrhea

    • Abdominal cramps

  • Chronic intermittent course- characterized by remissions and exacerbations

    • Less than 5% remain symptom-free over 

    • About 50% experience a relapse in any given year

Crohn's disease

  • Transmural process involving the entire thickness of the bowel wall, producing patching ulcerations at any point along the alimentary canal from the mouth to the anus bum most commonly involves the terminal ileum.

  • Initial manifestations 

    • Recurrent or persistent diarrhea - often without blood

    • Abdominal pain or cramping

    • Anorexia

    • Weight loss

    • Unexplained fever, malaise

  • Intestinal complications are common

    • Fibrosis, intestinal fissuring , formation of fistulas or abscesses, malabsorption

    • 70-80% require surgery within their lifetime

​

  • Antiinflammatory drugs

  • ​Corticosteroids

  • Immunomodulators

  • Opioids for pain

  • Negative reaction to medications used and/or prescribed by dentist

  • Inability to handle stress from dental procedures

  • Delayed healing

  • Increased risk of infection

Medical Management

  • Aphthous-like lesion in 20% of patients with ulcerative colitis

  • Pyostomatitis vegetans

  • Sulfasalazine can cause bald tongue

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