Sir, an increased incidence of dental conditions with inflammatory bowel disease (IBD) patients1 suggests that dentists should play an active role in the multidisciplinary team managing them through recognising the associated oral conditions and screening for malnutrition and medication side effects.
Oral disease appears to be more prevalent in the benign and particularly active IBD population compared to a healthy population.1 The association between caries and the IBD population is well documented with children having statistically significantly higher rates of dmft compared to healthy controls.2 With periodontal disease, incidence of clinical attachment loss was doubled in an IBD population versus control so surveillance could identify these conditions before they precipitate disease.3
IBD presents in the oral cavity as non-specific, recurrent, long lasting aphthous ulcers, which are treated through control of intestinal disease. Dentists should be aware of severe manifestations of IBD including cobble stoning of the lips and abscesses of the buccal mucosa. Routine dental appointments could identify signs of early flare activity that can be treated earlier to improve prognosis. It is theorised that oral inflammation may precede intestinal manifestations of IBD.4
Malnutrition, a cause of non-specific oral lesions, is extremely prevalent within the IBD cohort. Community outpatient appointment checks have identified one in four patients as being in a state of malnutrition.5 Deficiencies of iron, B12 and folate manifest with characteristic features identified during dental screenings. IBD medications are generally potent immunosuppressant agents; methotrexate can cause ulcerative stomatitis and gingival ulceration, and purine analogues, such as azathioprine or 6-mercaptopurine, can lead to an increased risk of presentations of lymphoma6 which can be identified in a simple head and neck examination. Dentists can play a vital role in tailoring appropriate medication by recognising side effects on oral examination improving patient outcomes.
Dentists with IBD patients should liaise with general physicians and hospital gastroenterology services regarding concerns within the oral cavity, while doctors should encourage patients to attend oral check-ups.
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Thomas, T., Chandan, J. Multidisciplinary management: Inflammatory bowel disease. Br Dent J 222, 4–5 (2017). https://doi.org/10.1038/sj.bdj.2017.9
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DOI: https://doi.org/10.1038/sj.bdj.2017.9