An oral manifestation of IBD: Pyostomatitis vegetant, about two cases

Dental problems and oral microbiome alterations in ulcerative colitis

Ulcerative colitis is a chronic disease that has not well-established etiology. The role of microbial dysregulation in its pathogenesis has been recently highlighted. Overall, microbiome alterations concern the reduction of bacterial abundance and diversity, resulting in gut microbiome imbalance negatively affecting immunological aspects. There is a link between ulcerative colitis and the oral microbiome. The changes of oral microbiome are found at many levels, from gently dysbiotic composition to the presence of the main periodontal microbes. The analysis of oral microbiome can be a part of personalized medicine due to the fact that it is a potential biomarker. Patients with ulcerative colitis may manifest dental symptoms/problems, such as periodontitis (strongly related to the red-complex pathogens-Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and bacteria belonging to the other complexes, such as Fusobacterium nucleatum and Aggregatibacter actinomycetecomitans), dental caries, oral ulcerations, leukoplakia, halitosis, and others. Notably, the DMFT (Decayed, Missing, Filled Teeth) index is higher in these patients compared to healthy subjects. According to some data, oral lichen planus (which is a disease with an immunological background) can also be observed in ulcerative colitis patients. It seems that deep understanding of ulcerative colitis in association with oral microbiome, immunology, and dental manifestations may be crucial to provide complex treatment from a dental point of view.

How Oral Specialists Can Help Diagnose and Manage Extra-Digestive Inflammatory Bowel Disease Complications

Identification of extra-digestive manifestations of inflammatory bowel disease (IBD) is essential. The oral cavity is a preferential site in which gingival enlargement may be one of these manifestations. We present, in this article, two original cases and a concept map that highlights the need for a close collaboration between the dental surgeon or oral specialist, the dermatologist, and the gastroenterologist. In the first case, the strictly local management of a systemic IBD oral complication, can relieve and answer the patient's complaint without modifying or disrupting the systemic treatment already implemented by the gastroenterologists. In the second case, the dental surgeon's diagnosis of gingival enlargement turns out to be the inaugural manifestation of Crohn's disease and allows early treatment of the intestinal pathology. These two cases illustrate the close link between the oral cavity and IBD. Knowledge and multidisciplinary management of these manifestations such as proposed in the concept map are essential for clinicians for the early diagnosis and the improvement of the oral and general quality of life of patients suffering from IBD.