Uma visão geral das manifestações orais de doenças gastrointestinais.
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Palavras-chave

Alterações da cavidade oral, Doença celíaca, Doença de Crohn, Doença do refluxo gastroesofágico, Doenças gastrointestinais, Colite ulcerativa.

Como Citar

Junqueira , A. H. . (2021). Uma visão geral das manifestações orais de doenças gastrointestinais. Brazilian Journal of Implantology and Health Sciences, 3(7), 11–25. https://doi.org/10.36557/2674-8169.2021v3n7p11-25

Resumo

A cavidade oral faz parte do sistema gastrointestinal e, como tal, a presença de alterações nesta região pode ser o primeiro sinal de doenças sistémicas e gastrointestinais. Como essas alterações são muito comuns, principalmente em crianças, é importante que o dentista saiba quando elas são expressão de um quadro gastrointestinal. O objetivo desta revisão é fornecer ao dentista dados úteis para o diagnóstico, tratamento e manejo das condições mais comuns, como doença de Crohn, colite ulcerativa, doença do refluxo gastroesofágico e doença celíaca. Uma das alterações orais mais comuns é a erosão dentária, com perda de esmalte e aumento do risco de cárie dentária, que tem sido relatada em crianças e adolescentes com refluxo gastroesofágico. Hipoplasia do esmalte dentário e úlceras aftosas são mais comuns em crianças com doença celíaca do que na população em geral. Outra alteração oral muito comum é a gengivite, que afeta 9-95% das crianças na Europa e na América do Norte e mais de 60% dos adolescentes. Pioestomatite vegetante pode ser um sinal de colite ulcerosa e doença de Crohn, esta última também foi relacionada a edema difuso da mucosa, mucosa de paralelepípedo, muco-gengivite localizada, ulceração linear profunda, marcas de tecido fibroso, pólipos, nódulos e úlceras aftosas. O reconhecimento imediato de doenças sistêmicas e gastrointestinais por meio de um exame cuidadoso da cavidade oral pode ser o primeiro passo para novas investigações que podem levar a um diagnóstico precoce e tratamento oportuno.

https://doi.org/10.36557/2674-8169.2021v3n7p11-25
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Referências

Italian Ministry of Health, Guidelines. Linee guida nazionali per la promozione della salute orale e la prevenzione delle patologie orali in età evolutiva, 2014 Ministero del lavoro, della Salute e delle Politiche Sociali. 2013.

Chi AC, Neville BW, Krayer JW, Gonsalves WC. Oral manifestations of systemic disease. Am Fam Physician 2010 Dec 1;82(11):1381-8.

Majorana A, Bardellini E, Flocchini P, Amadori F, Conti G, Campus G. Oral mucosal lesions in children from 0 to 12 years old: ten years’ experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010 Jul;110(1):e13-8. doi: 10.1016/j.tripleo.2010.02.025. Epub 2010 May 10.

US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health: 2000; 1–308.

Pastore L, Campisi G, Compilato D, Lo Muzio L. Orally based diagnosis of celiac disease: current perspectives. J Dent Res 2008; 87(12): 1100-7.

Pastore L, Carroccio A, Compilato D, Panzarella V, Serpico R, Lo Muzio L. Oral manifestations of celiac disease. J Clin Gastroenterol 2008;42(3):224-32.

Tolia V. Evaluation and management of pediatric gastroesophageal reflux. Fam Pract Recert 1997;19:35-57.

Bishop RP, Brewster AC, Antonioli DA. Crohn’s disease of the mouth. Gastroenterology 1972;62:302-6.

Bishop K, Briggs P, Kelleher M. The aetiology and management of localized anterior tooth wear in the young adult [review]. Dent Update 1994;21:153-60.

Schroeder P, Filler S, Ramirez B, Lazarchik D, Vaezi M, Richter J. Dental erosion and acid reflux disease. Ann Intern Med 1995;122:809-15.

Smith CH1, Materna A2, Martig L3, Lussi A4. Gastro-oesophageal reflux is common in oligosymptomatic patients with dental erosion: A pH-impedance and endoscopic study. United European Gastroenterol J 2015 Apr;3(2):174-81.

Mulic A, Tveit AB, Skaare AB. Prevalence and severity of dental erosive wear among a group of Norwegian 18-year-olds. Acta Odontol Scand 2013;71:475-481.

Bartlett DW, Lussi A, West NX, Bouchard P, Sanz M, Bourgeois D. Prevalence of tooth wear on buccal and lingual surfaces and possible risk factors in young European adults. J Dent 2013;41:1007-1013.

Stankler L, Ewen SWB, Kerr NW. Crohn’s disease of the mouth. Br J Dermatol 1972;87:501-4.

Van Dyke TE, Dowell VR Jr, Offenbacher S, Snyder W, Hersh T. Potential role of microorganisms isolated from periodontal lesions in the pathogenesis of inflammatory bowel disease. Infect Immun 1986;53:671-7.

Katsanos KH, Torres J, Roda G, Brygo A, Delaporte E, Colombel JF. Review article: non-malignant oral manifestations in inflammatory bowel diseases. Aliment Pharmacol Ther 2015 Jul; 42(1): 40-60.

Harty S, Fleming P, Rowland M et al. A prospective study of the oral manifestations of Crohn’s disease. Clinical Gastroenterology Hepatology 2005; 3 (9): 886–891.

› Pittock S, Drumm B, Fleming P et al.The oral cavity in Crohn's disease. J. Pediatr 2001; 138: 767–771.

Campbell H, Escudier M, Patel P et al. Distinguishing orofacial granulomatosis from Crohn's disease: two separate disease entities? Inflamm Bowel Dis 2011; 17: 2109–2115.

Lankarani KB, Sivandzadeh GR, Hassanpour S. Oral manifestation in inflammatory bowel disease: a review. World J Gastroenterol 2013; 19: 8571–8579.

Hovde Ø, Moum BA. Epidemiology and clinical course of Crohn's disease: Results from observational studies. World J Gastroenterol. 2012 Apr 21; 18(15): 1723–1731.

Yapp TR, Stenson R, Thomas GA, Lawrie BW, Williams GT, Hawthorne AB. Crohn’s disease incidence in Cardiff from 1930: an update for 1991-1995. Eur J Gastroenterol Hepatol. 2000;12:907–911.

Gheorghe C, Pascu O, Gheorghe L, Iacob R, Dumitru E, Tantau M, Vadan R, Goldis A, Balan G, Iacob S, et al. Epidemiology of inflammatory bowel disease in adults who refer to gastroenterology care in Romania: a multicentre study. Eur J Gastroenterol Hepatol 2004;16:1153–1159.

Crippa R, Zuccotti GV, Mantegazza C. Oral manifestations of gastrointestinal diseases in children. Part 2: Crohn’s disease. Eur J Paediatr Dent 2016;17(2):164-166.

Daley TD, Armstrong JE. Oral manifestations of gastrointestinal diseases. Can J Gastroenterol 2007; 21: 241-244.

Hussey S, Fleming P, Rowland M, Harty S, Chan L, Broderick A et al. Disease outcome for children who present with oral manifestation of Crohn’s disease. Eur Arch Paediatr Dent 2011; 12:167–9.

Boirivant M, Cossu A. Inflammatory bowel disease. Oral Diseases 2012; 18 (1): 1–15.

Kalmar JR. Crohn’s disease: orofacial considerations and disease pathogenesis. Periodontology 2000 1994; 6: 101–115.

Zbar AP, Ben-Horin S, Beer-Gabel M, Eliakim R. Oral Crohn’s Disease: is it a separable disease from orofacial granulomatosis? J Crohns Colitis 2012;6:134–42.

Fatahzadeh M, Schwartz RA, Kapila R, Rochford C. Orofacial Crohn’s disease: an oral enigma. Acta Dermatovenerol Croat 2009;17:289–300.

Jacobs A, Cavill I. The oral lesions of iron deficiency anaemia: pyridoxine and riboflavin status. Br J Haematol 1968;14:291-5.

Lehner T. Cell-mediated immune response in oral disease: a review. J Oral Pathol 1972;1:39-58.

Basu MK. Oral manifestations of Crohn’s disease: studies in the pathogenesis. Proc R Soc Med 1976;69:765-6.

Mahid SS, Mulhall AM, Gholson RD et al. Inflammatory bowel disease and African Americans: a systematic review. Inflamm Bowel Dis 2008;14: 960–

Laube R, Liu K, Schifter M, Yang JL, Suen MK, Leong RW. Oral and upper gastrointestinal Crohn's disease. J Gastroenterol Hepatol 2018 Feb;33(2):355-364.

Rowland M, Fleming P, Bourke B. Looking in the mouth for Crohn's disease. Bowel Dis.2010; 16: 332–337.

Tilakaratne WM, Freysdottir J, Fortune F. Orofacial granulomatosis: review on etiology and pathogenesis. J Oral Pathol Med 2008; 37: 191–195.

Kolho KL, Heiskanen K, Verkasalo M, Pitkäranta A. Orofacial granulomatosis in children- a challenge for diagnosis and treatment. Int J Pediatr Otorhinolaryngol 2011 Jun; 75(6): 864-7.

Wiesenfeld D, Ferguson MM, Mitchell DN et al. Oro-facial granulomatosis – a clinical and pathological analysis. Q J Med 1985; 54: 101–113.

Van der Waal RIF, Schulten EAJM, van der Meij EH et al. Cheilitis granulomatosa: overview of 13 patients with long-term follow-up – results of management. Int J Dermatol 2002; 41: 225–229.

Plauth M, Jenss H, Meyle J. Oral manifestations of Crohn’s disease, an analysis of 79 cases. J Clin Gastroenterol 1991; 13: 29–37.

Bogenrieder T, Rogler G, Vogt T et al. Orofacial granulomatosis as the initial presentation of Crohn’s disease in an adolescent. Dermatology 2003;206: 273–278.

Allen CM, Camisa C, Hamzeh S, Stephens L. Cheilitis granulomatosa: report of six cases and review of the literature. J Am Acad Dermatol 1990; 23: 444–50.

Friedrich W, Timmermann J Miescher’s granulomatous cheilitis. Diagnostic and therapeutic aspects.Laryngorhinootologie 1990; 69: 564–8.

Alawi F. Granulomatous diseases of the oral tissues: differential diagnosis and update. Dent Clin North Am 2005; 49: 203–21.

Ayangco L, Rogers RS 3rd, Sheridan PJ. Pyostomatitis vegetans as an early sign of reactivation of Crohn’s disease: a case report. J Periodontol 2002; 73: 1512–6.

Delaporte E, Viget N, Pasturel-Michon U, Catteau B, Hachulla E, Piette F. Pyostomatitis-pyodermatitis vegetans uncovering a case of Crohn disease. Ann Dermatol Venereol 1998;125: 331–4.

Hansen LS, Silverman S Jr, Daniels TE. The differential diagnosis of pyostomatitis vegetans and its relation to bowel disease. Oral Surg Oral Med Oral Pathol 1983; 55: 363–73.

Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn’s disease and ulcerative colitis: a study of 700 patients. Medicine (Baltimore) 1976; 55: 401–12.

Lisciandrano D, Ranzi T, Carrassi A et al. Prevalence of oral lesions in inflammatory bowel disease. Am J Gastroenterol 1996; 91: 7–10.

Field EA, Tyldesley WR. Oral Crohn’s disease revisited–a 10-year review. Br J Oral Maxillofac Surg 1989; 27: 114–23.

Colella G, Riegler G, Lanza A, Tartaro GP, Russo MI, Tartaglione M. Changes in the mouth mucosa in patients with chronic inflammatory intestinal diseases. Minerva Stomatol 1999; 48: 367–71.

Lourenço SV, Hussein TP, Bologna SB, Sipahi AM, Nico MM. Oral manifestations of inflammatory bowel disease: a review based on the observation of six cases. J Eur Acad Dermatol Venereol 2010; 24: 204–7.

Correll RW, Wescott WB, Jensen JL. Recurring, painful oral ulcers. J Am Dent Assoc 1981; 103: 497–8.

Gargiulo AV, Ladone JA, Toto PD, Logiudice J. Crohn’s disease: early detection by gingival biopsy. Periodontal Case Rep 1989; 11: 20–2.

Ciantar M, Adlam DM. Treatment with infliximab: implications in oral surgery? A case report. Br J Oral Maxillofac Surg 2007; 45: 507–10.

Roseth AG, Schmidt PN, Fagerhol MK. Correlation between faecal excretion of indium-111-labelled granulocytes and calprotectin, a granylocyte marker protein, in patients with inflammatory bowel disease. Scand J Gastroenterol 1999; 34: 50–54.

Sipponen T, Savilahti E, Kolho KL, Nuutinen H, Turunen U, Fa¨rlkkila¨ M. Crohn’s disease activity assessed by fecal calprotectin and lactoferrin: corrleation with Crohn’s disease activity index and endoscopic findings. Inflamm Bowel Dis 2008; 14: 40–46.

Harikishan G, Reddy NR, Prasad H, Anitha S. Oral Crohn’s disease without intestinal manifestations. J Pharm Bioallied Sci 2012;4:S431–4.

Peitsch WK, Kemmler N, Goerdt S, Goebler M. Infliximab: a novel treatment option for refractory orofacial granulomatosis. Acta Dermatol Venereol 2007; 87: 265–266.

Mantegazza C, Angiero F, Zuccotti GV. Oral manifestations of gastrointestinal diseases in children. Part 3: Ulcerative colitis and gastro-oesophageal reflux disease. Eur J Paediatr Dent 2016a;17(3):248-250.

Seo JK, Yeon KM, Chi JG. Inflammatory bowel disease in children--clinical, endoscopic, radiologic and histopathologic investigation. J Korean Med Sci 1992 Sep; 7(3):221-35.

Alstead EM, Wilson AG, Farthing MJ. Lichen planus and mesalazine. J Clin Gastroenterol 1991;13:335–37.

Calobrisi SD, Mutasim DF, McDonald JS. Pyostomatitis vegetans associated with ulcerative colitis. Temporary clearance with fluocinonide gel and complete remission after colectomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995 Apr; 79(4):452-4.

O'Loughlin S, Perry HO. A diffuse pustular eruption associated with ulcerative colitis. Arch Dermatol 1978 Jul; 114(7):1061-4.

Davies PT, Shadforth MF. Sulphasalazine induced oral lichen planus. Br Med J 1984;288:194.

Parvinen T, Parvinen I, Larmas M. Stimulated salivary flow rate, pH, and lactobacillus and yeast concentrations in medicated persons. Scand J Dent Res 1984;92:524–32.

Sreebny LM, Schwartz SS. A reference guide to drugs and dry mouth. Gerodontology 1986;5:75–99.

Mijandrusi-Sinci B, Licul V, Gorup L, Brnci N, Glazar I, Lucin K. Pyostomatitis vegetans associated with inflammatory bowel disease-report of two cases. Coll Antropol 2010; 34 Suppl 2:279-82.

Folashade AJ, Melvin B. Heymant extraintestinal manifestations of inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2008 Feb; 46(2): 124-133.

Lekovi Z, Radlovi N, Brdar R, Vuleti B, Jani N, Risti D, Stojsi Z, Radlovi V, Simi D, Nikoli D. Clinical characteristics of idiopathic ulcerative colitis in children. Srp Arh Celok Lek 2011 Mar-Apr;139(3-4):170-3.

Krebs KT. Case study: aphthous ulcers in a 14-year-old girl. Pediatr Nurs 2011 May-Jun;37(3):115-8.

Kugathasan S, Judd RH, Hoffmann RG et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study. J Pediatr 2003;143:525-31.

Bentsen BS, Moum B, Ekbom A. Incidence of inflammatory bowel disease in children in southeastern Norway: a prospective popula- tion-based study 1990 – 94. Scand J Gastroenterol 2002; 37:540-5.

Elahi M, Telkabadi M, Samadi V, Vakili H. Association of oral manifestations with ulcerative colitis. Gastroenterol Hepatol Bed Bench 2012 Summer; 5(3): 155–160.

Pace F, Pallotta S, Tonini M, Vakil N, Bianchi Porro G. Systematic review: gastro-oesophageal reflux disease and dental lesions. Aliment Pharmacol Ther 2008 Jun;27(12):1179-86.

Vandenplas Y, Colin DR. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Committee Members: Di Lorenzo C, Hassall E, Liptak G, Mazur L, Sondheimer J, Staiano A, Thomson M, Veereman-Wauters G, Wenzl TG. J Pediatric Gastroenterology Nutrition 2009; 49:498-547.

Pindborg JJ. Chemical and physical injuries. In: Pindborg JJ ed. Pathology of the dental hard tissues. Philadelphia: Saunders; 1970. p 312-325.

Dahshan A, Patel H, Delaney J, Wuerth A, Thomas R, Tolia V. Gastroesophageal reflux disease and dental erosion in children. J Pediatr. 2002 Apr;140(4):474-8.

Wilder-Smith CH, Wilder-Smith P, Kawakami-Wong H, Voronets J, Osann K, Lussi A. Quantification of dental erosions in patients with GERD using optical coherence tomography before and after double-blind, randomized treatment with esomeprazole or placebo. Am J Gastroenterol 2009;104:2788-2795.

Di Fede O, Di Liberto C, Occhipinti G, Vigneri S, Lo Russo F, Fedele S, Lo Muzio S, Campisi G. Oral manifestations in patients with gastro-oesophageal reflux disease: a single-center case–control study. J Oral Pathol Med 2008;37: 336-340.

Silva MA, Damante JH, Stipp AC, Tolentino MM, Carlotto PR, Fleury RN. Gastroesophageal reflux disease: new oral findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 91: 301–10.

Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900-1920.

Barker JM, Liu Celiac Disease: Pathophysiology, clinical manifestations and associated autoimmune conditions. Adv Pediatr 2008; 55: 349–365.

Mantegazza C, Paglia M, Angiero F, Crippa R. Oral manifestations of gastrointestinal diseases in children. Part 4: Coeliac disease. Eur J Paediatr Dent 2016b;17(4):332-334.

Lionetti E, Catassi C. Co-localization of gluten consumption and HLA-DQ2 and -DQ8 genotypes, a clue to the history of celiac disease. Dig Liver Dis 2014;46(12):1057e63.

Rashid M, Zarkadas M, Anca A, Limeback H. Oral manifestations of celiac disease: a clinical guide for dentists. J Can Dent Assoc 2011;77:b39

Tack GJ, Verbeek WHM, Schreurs MWJ, Mulder CJJ. The spectrum of celiac disease: epidemiology, clinical aspects and treatment. Nat Rev Gastroenterol Hepatol 2010; 7(4): 204-213.

Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005;40(1):1-19.

Aine L, Mäki M, Collin P, Keyriläinen O. Dental enamel defects in celiac disease. J Oral Pathol Med 1990 Jul;19(6):241-5.

Campisi G, Di Liberto C, Carroccio A, Compilato D, Iacono G, Procaccini M et al. Coeliac disease: oral ulcer prevalence, assessment of risk and association with gluten-free diet in children. Dig Liver Dis 2008 Feb;40(2):104-7. Epub 2007 Dec 11.

Condò R, Costacurta M, Maturo P, Docimo R. The dental age in the child with coeliac disease. Eur J Paediatr Dent 2011 Sep;12(3):184-8.

Sedghizadeh PP, Shuler CF, Allen CM, Beck FM, Kalmar JR. Celiac disease and recurrent aphthous stomatitis: a report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002 Oct;94(4):474-8.

Trandafir LM, Anton-Paduraru DT, Rusu D, Burlea M. Oral manifestations in celiac disease children. Romanian Journal of Oral Rehabilitation 2014 January - March; 6(1): 33-37.

Lähteenoja H, Toivanen A, Viander M, Mäki M, Irjala K, Räihä I et al. Oral mucosal changes in coeliac patients on a gluten-free diet. Eur J Oral Sci 1998; 106(5): 899-906.

Shetyer E, Berson T, Lachmanovitz O, Hidas A, Wilschanski M, Meneachem M, Shachar E, Shapira J, Steinberg D, Moskovitz M. Oral health status and salivary properties in relation to gluten free diet in children with celiac disease. J Pediatr Gastroenterol Nutr 2013, 57, 1, 49–52.

Benkebil F, Combescure C, Anghel SI, Besson Duvanel C, Schäppi MG. Diagnostic accuracy of a new point-of-care screening assayfor celiac disease. World J Gastroenterol 2013;19:5111-7.

Ertekin V, Selimoglu MA, Kardas F, Aktas¸ E. Prevalence of CD in Turkish children. J Clin Gastroenterol 2005; 39: 689–691.

Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A,Shamir R et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012;54:136-60.

Mantegazza C, Crippa R, Zuccotti GV. Oral manifestations of gastrointestinal diseases in children. Part 1: General introduction. Eur J Paediatr Dent 2016a;17(1):80-82.

Mantegazza, C., et al. "An overview on oral manifestations of gastrointestinal diseases." Ital J Dent Med 5 (2020)

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