O que o cirurgião-dentista precisa saber sobre a doença de Crohn?
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Publicado:
Jan 7, 2022
Palavras-chave:
Doença periodontal, Doença inflamatória intestinal, Doença de Crohn, Manifestações orais, Inflamação
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Resumo
A doença de Crohn é descrita como uma doença inflamatória intestinal de alta complexidade, caracterizando-se por apresentar lesões e inflamações transmurais que podem acometer todo o trato gastrointestinal. A doença de Crohn pode apresentar manifestações bucais em forma de lesões de mucosa, alterações do fluxo salivar e envolvimento periodontal. Para este artigo de revisão foi realizada uma busca de literatura nas bases de dados PubMed, Scielo e academic Google, com espaço temporal de 2010 a 2020, utilizando palavras chaves obtidas de acordo com o descritor em ciência da saúde. Foi encontrado que as lesões bucais estão presentes em cerca de 46,75% dos pacientes jovens e 22% dos pacientes idosos com doença de Crohn, podendo ser bastante incômodas, persistentes e de difícil tratamento. Apresentam-se com diversos aspectos clínicos como: ulcerações lineares ou aftosas, nodularidades da mucosa e queilite granulomatosa. Essas lesões estão diretamente relacionadas com a doença, mas algumas lesões podem surgir de forma indireta, como complicação da doença de Crohn ou como efeitos adversos do tratamento. As manifestações bucais podem ser os primeiros sintomas da doença de Crohn, logo, o reconhecimento de seus aspectos clínicos pode contribuir para um diagnóstico precoce. Cabe ao cirurgião-dentista reconhecer, diagnosticar e tratar, junto a uma equipe multiprofissional, as manifestações bucais da doença de Crohn, promovendo melhorias no prognóstico do paciente.
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Como Citar
de Araújo Chagas, F. G., Thomé Leão, A. T., & Regina Torres, S. (2022). O que o cirurgião-dentista precisa saber sobre a doença de Crohn?. Revista Naval De Odontologia, 48(2). Recuperado de http://portaldeperiodicos.marinha.mil.br/index.php/odontoclinica/article/view/2176
Seção
Revisões de Literatura
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Referências
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Hullah EA, Escudier MP. The mouth in inflammatory bowel disease and aspects of orofacial granulomatosis. Periodontol 2000. 2019 Jun;80(1):61-76.
Lira-Junior R, Figueredo CM. Periodontal and inflammatory bowel diseases: Is there evidence of complex pathogenic interactions? World J Gastroenterol. 2016 Sep 21;22(35):7963-72.
Neurath MF. Cytokines in inflammatory bowel disease. Nat Rev Immunol. 2014 May;14(5):329-42.
Dutta AK, Chacko A. Influence of environmental factors on the onset and course of inflammatory bowel disease. World J Gastroenterol. 2016 Jan 21;22(3):1088-100.
Barta Z. Apical Periodontitis in Patients With Inflammatory Bowel Disease: A Puppet Master? Inflamm Bowel Dis. 2020 Jan 6;26(2):280-282.
Brito F, Zaltman C, Carvalho AT, Fischer RG, Persson R, Gustafsson A, Figueredo CM. Subgingival microflora in inflammatory bowel disease patients with untreated periodontitis. Eur J Gastroenterol Hepatol. 2013 Feb;25(2):239-45.
Muhvić-Urek M, Tomac-Stojmenović M, Mijandrušić-Sinčić B. Oral pathology in inflammatory bowel disease. World J Gastroenterol. 2016 Jul 7;22(25):5655-67.
Hovde Ø, Moum BA. Epidemiology and clinical course of Crohn's disease: results from observational studies. World J Gastroenterol. 2012 Apr 21;18(15):1723-31.
Rosen MJ, Dhawan A, Saeed SA. Inflammatory Bowel Disease in Children and Adolescents. JAMA Pediatr. 2015 Nov;169(11):1053-60.
Salek H, Balouch A, Sedghizadeh PP. Oral manifestation of Crohn's disease without concomitant gastrointestinal involvement. Odontology. 2014 Jul;102(2):336-8.
Rowland M, Fleming P, Bourke B. Looking in the mouth for Crohn's disease. Inflamm Bowel Dis. 2010 Feb;16(2):332-7.
Stein JM, Lammert F, Zimmer V, Granzow M, Reichert S, Schulz S, Ocklenburg C, Conrads G. Clinical periodontal and microbiologic parameters in patients with Crohn's disease with consideration of the CARD15 genotype. J Periodontol. 2010 Apr;81(4):535-45.
Mays JW, Sarmadi M, Moutsopoulos NM. Oral manifestations of systemic autoimmune and inflammatory diseases: diagnosis and clinical management. J Evid Based Dent Pract. 2012 Sep;12(3 Suppl):265-82
Woo VL. Case Report Oral Manifestations of Crohn’s Disease: A Case Report and Review of the Literature. Hindawi. 2015 Sep; Available from: http://dx.doi.org/10.1155/2015/830472.
Padmavathi B, Sharma S, Astekar M, Rajan Y, Sowmya G. Oral Crohn's disease. J Oral Maxillofac Pathol. 2014 Sep;18(Suppl 1):S139-42
Law ST, Li KK. Age-related differences in the clinical course of Crohn's disease in an Asian population: a retrospective cohort review. Indian Pediatr. 2013 Dec;50(12):1148-52.
Docktor MJ, Paster BJ, Abramowicz S, Ingram J, Wang YE, Correll M, Jiang H, Cotton SL, Kokaras AS, Bousvaros A. Alterations in diversity of the oral microbiome in pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2012 May;18(5):935-42.
Ribaldone DG, Brigo S, Mangia M, Saracco GM, Astegiano M, Pellicano R. Oral Manifestations of Inflammatory Bowel Disease and the Role of Non-Invasive Surrogate Markers of Disease Activity. Medicines (Basel). 2020 Jun 16;7(6):33.
Carolino F, Fernandes M, Plácido JL. Melkersson-Rosenthal syndrome - delay in the diagnosis of an early-onset oligosymptomatic variant. Porto Biomed J. 2016 Mar-Apr;1(1):43-45.
Lankarani KB, Sivandzadeh GR, Hassanpour S. Oral manifestation in inflammatory bowel disease: a review. World J Gastroenterol. 2013 Dec 14;19(46):8571-9.
Kim SK, Lee ES. Orofacial granulomatosis associated with Crohn's disease. Ann Dermatol. 2010 May;22(2):203-5.
Adegun OK, Zou L, Willis A, Fortune F. Facial biometrics: a novel technique for evaluation of morphological changes in orofacial Crohn's disease. BMJ Case Rep. 2013 Nov 20;2013:bcr2013010460.
Jennings VC, Williams L, Henson S. Orofacial granulomatosis as a presenting feature of Crohn's disease. BMJ Case Rep. 2015 Jan 9;2015:bcr2013203005.
Gale G, Ostman S, Saalman R, Telemo E, Jontell M, Hasséus B. Immunophenotype in orofacial granulomatosis with and without Crohn's disease. Med Oral Patol Oral Cir Bucal. 2014 Nov 1;19(6):e584-591.
Antunes H, Patraquim C, Baptista V, Silva Monteiro L. Oral manifestations of Crohn's disease. BMJ Case Rep. 2015 Oct 28;2015:bcr2015212300. doi: 10.1136/bcr-2015-212300. Erratum in: BMJ Case Rep. 2015;2015. pii: bcr2015212300corr1. doi: 10.1136/bcr-2015-212300corr1. PMID: 26511994; PMCID: PMC4636709.
Trikudanathan G, Venkatesh PG, Navaneethan U. Diagnosis and therapeutic management of extra-intestinal manifestations of inflammatory bowel disease. Drugs. 2012 Dec 24;72(18):2333-49.
Nico MM, Hussein TP, Aoki V, Lourenço SV. Pyostomatitis vegetans and its relation to inflammatory bowel disease, pyoderma gangrenosum, pyodermatitis vegetans, and pemphigus. J Oral Pathol Med. 2012 Sep;41(8):584-8.
Gheisari M, Zerehpoosh FB, Zaresharifi S. Pyodermatitis-pyostomatitis vegetans: a case report and review of literature. Dermatol Online J. 2020 May 15;26(5).
Pereira MS, Munerato MC. Oral Manifestations of Inflammatory Bowel Diseases: Two Case Reports. Clin Med Res. 2016 Mar;14(1):46-52.
de Vries SAG, Tan CXW, Bouma G, Forouzanfar T, Brand HS, de Boer NK. Salivary Function and Oral Health Problems in Crohn's Disease Patients. Inflamm Bowel Dis. 2018 May 18;24(6):1361-1367.
Hopcraft MS, Tan C. Xerostomia: an update for clinicians. Aust Dent J. 2010 Sep;55(3):238-44.
Fernandez-Gutierrez MM, Imangaliyev S, Prodan A, Loos BG, Keijser BJF, Kleerebezem M. A salivary metabolite signature that reflects gingival host-microbe interactions: instability predicts gingivitis susceptibility. Sci Rep . 2020 Jan;10, 3008. https://doi.org/10.1038/s41598-020-59988-z
Singhal S, Dian D, Keshavarzian A, Fogg L, Fields JZ, Farhadi A. The role of oral hygiene in inflammatory bowel disease. Dig Dis Sci. 2011 Jan;56(1):170-5.
Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018 Jun;45 Suppl 20:S1-S8.
Hegab, M.M. and Abdelkawy, M. 2020. Classification of Periodontal Diseases – Old is Gold or New is Bold? A Survey Study in Egypt. Perio J. 2020 Jun;4, 1, 11–23.
Garlet GP. Destructive and protective roles of cytokines in periodontitis: a re-appraisal from host defense and tissue destruction viewpoints. J Dent Res. 2010 Dec;89(12):1349-63.
Gasner NS, Schure RS. Periodontal Disease. 2020 May 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 32119477.
Johannsen A, Fored MC, Håkansson J, Ekbom A, Gustafsson A. Consumption of dental treatment in patients with inflammatory bowel disease, a register study. PLoS One. 2015 Aug 12;10(8):e0134001.
Wisam Sbeit, Anas Kadah, Mahmud Mahamid, Hala Karayanni, Amir Mari, Shani Tali, Samer Srouji, Tawfik Khoury, Oral manifestations of inflammatory bowel disease: the neglected piece of the puzzle, European Journal of Gastroenterology & Hepatology. 2020, 32, 11, (1422-1431).
Hullah EA, Escudier MP. The mouth in inflammatory bowel disease and aspects of orofacial granulomatosis. Periodontol 2000. 2019 Jun;80(1):61-76.
Lira-Junior R, Figueredo CM. Periodontal and inflammatory bowel diseases: Is there evidence of complex pathogenic interactions? World J Gastroenterol. 2016 Sep 21;22(35):7963-72.
Neurath MF. Cytokines in inflammatory bowel disease. Nat Rev Immunol. 2014 May;14(5):329-42.
Dutta AK, Chacko A. Influence of environmental factors on the onset and course of inflammatory bowel disease. World J Gastroenterol. 2016 Jan 21;22(3):1088-100.
Barta Z. Apical Periodontitis in Patients With Inflammatory Bowel Disease: A Puppet Master? Inflamm Bowel Dis. 2020 Jan 6;26(2):280-282.
Brito F, Zaltman C, Carvalho AT, Fischer RG, Persson R, Gustafsson A, Figueredo CM. Subgingival microflora in inflammatory bowel disease patients with untreated periodontitis. Eur J Gastroenterol Hepatol. 2013 Feb;25(2):239-45.
Muhvić-Urek M, Tomac-Stojmenović M, Mijandrušić-Sinčić B. Oral pathology in inflammatory bowel disease. World J Gastroenterol. 2016 Jul 7;22(25):5655-67.
Hovde Ø, Moum BA. Epidemiology and clinical course of Crohn's disease: results from observational studies. World J Gastroenterol. 2012 Apr 21;18(15):1723-31.
Rosen MJ, Dhawan A, Saeed SA. Inflammatory Bowel Disease in Children and Adolescents. JAMA Pediatr. 2015 Nov;169(11):1053-60.
Salek H, Balouch A, Sedghizadeh PP. Oral manifestation of Crohn's disease without concomitant gastrointestinal involvement. Odontology. 2014 Jul;102(2):336-8.
Rowland M, Fleming P, Bourke B. Looking in the mouth for Crohn's disease. Inflamm Bowel Dis. 2010 Feb;16(2):332-7.
Stein JM, Lammert F, Zimmer V, Granzow M, Reichert S, Schulz S, Ocklenburg C, Conrads G. Clinical periodontal and microbiologic parameters in patients with Crohn's disease with consideration of the CARD15 genotype. J Periodontol. 2010 Apr;81(4):535-45.
Mays JW, Sarmadi M, Moutsopoulos NM. Oral manifestations of systemic autoimmune and inflammatory diseases: diagnosis and clinical management. J Evid Based Dent Pract. 2012 Sep;12(3 Suppl):265-82
Woo VL. Case Report Oral Manifestations of Crohn’s Disease: A Case Report and Review of the Literature. Hindawi. 2015 Sep; Available from: http://dx.doi.org/10.1155/2015/830472.
Padmavathi B, Sharma S, Astekar M, Rajan Y, Sowmya G. Oral Crohn's disease. J Oral Maxillofac Pathol. 2014 Sep;18(Suppl 1):S139-42
Law ST, Li KK. Age-related differences in the clinical course of Crohn's disease in an Asian population: a retrospective cohort review. Indian Pediatr. 2013 Dec;50(12):1148-52.
Docktor MJ, Paster BJ, Abramowicz S, Ingram J, Wang YE, Correll M, Jiang H, Cotton SL, Kokaras AS, Bousvaros A. Alterations in diversity of the oral microbiome in pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2012 May;18(5):935-42.
Ribaldone DG, Brigo S, Mangia M, Saracco GM, Astegiano M, Pellicano R. Oral Manifestations of Inflammatory Bowel Disease and the Role of Non-Invasive Surrogate Markers of Disease Activity. Medicines (Basel). 2020 Jun 16;7(6):33.
Carolino F, Fernandes M, Plácido JL. Melkersson-Rosenthal syndrome - delay in the diagnosis of an early-onset oligosymptomatic variant. Porto Biomed J. 2016 Mar-Apr;1(1):43-45.
Lankarani KB, Sivandzadeh GR, Hassanpour S. Oral manifestation in inflammatory bowel disease: a review. World J Gastroenterol. 2013 Dec 14;19(46):8571-9.
Kim SK, Lee ES. Orofacial granulomatosis associated with Crohn's disease. Ann Dermatol. 2010 May;22(2):203-5.
Adegun OK, Zou L, Willis A, Fortune F. Facial biometrics: a novel technique for evaluation of morphological changes in orofacial Crohn's disease. BMJ Case Rep. 2013 Nov 20;2013:bcr2013010460.
Jennings VC, Williams L, Henson S. Orofacial granulomatosis as a presenting feature of Crohn's disease. BMJ Case Rep. 2015 Jan 9;2015:bcr2013203005.
Gale G, Ostman S, Saalman R, Telemo E, Jontell M, Hasséus B. Immunophenotype in orofacial granulomatosis with and without Crohn's disease. Med Oral Patol Oral Cir Bucal. 2014 Nov 1;19(6):e584-591.
Antunes H, Patraquim C, Baptista V, Silva Monteiro L. Oral manifestations of Crohn's disease. BMJ Case Rep. 2015 Oct 28;2015:bcr2015212300. doi: 10.1136/bcr-2015-212300. Erratum in: BMJ Case Rep. 2015;2015. pii: bcr2015212300corr1. doi: 10.1136/bcr-2015-212300corr1. PMID: 26511994; PMCID: PMC4636709.
Trikudanathan G, Venkatesh PG, Navaneethan U. Diagnosis and therapeutic management of extra-intestinal manifestations of inflammatory bowel disease. Drugs. 2012 Dec 24;72(18):2333-49.
Nico MM, Hussein TP, Aoki V, Lourenço SV. Pyostomatitis vegetans and its relation to inflammatory bowel disease, pyoderma gangrenosum, pyodermatitis vegetans, and pemphigus. J Oral Pathol Med. 2012 Sep;41(8):584-8.
Gheisari M, Zerehpoosh FB, Zaresharifi S. Pyodermatitis-pyostomatitis vegetans: a case report and review of literature. Dermatol Online J. 2020 May 15;26(5).
Pereira MS, Munerato MC. Oral Manifestations of Inflammatory Bowel Diseases: Two Case Reports. Clin Med Res. 2016 Mar;14(1):46-52.
de Vries SAG, Tan CXW, Bouma G, Forouzanfar T, Brand HS, de Boer NK. Salivary Function and Oral Health Problems in Crohn's Disease Patients. Inflamm Bowel Dis. 2018 May 18;24(6):1361-1367.
Hopcraft MS, Tan C. Xerostomia: an update for clinicians. Aust Dent J. 2010 Sep;55(3):238-44.
Fernandez-Gutierrez MM, Imangaliyev S, Prodan A, Loos BG, Keijser BJF, Kleerebezem M. A salivary metabolite signature that reflects gingival host-microbe interactions: instability predicts gingivitis susceptibility. Sci Rep . 2020 Jan;10, 3008. https://doi.org/10.1038/s41598-020-59988-z
Singhal S, Dian D, Keshavarzian A, Fogg L, Fields JZ, Farhadi A. The role of oral hygiene in inflammatory bowel disease. Dig Dis Sci. 2011 Jan;56(1):170-5.
Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018 Jun;45 Suppl 20:S1-S8.
Hegab, M.M. and Abdelkawy, M. 2020. Classification of Periodontal Diseases – Old is Gold or New is Bold? A Survey Study in Egypt. Perio J. 2020 Jun;4, 1, 11–23.
Garlet GP. Destructive and protective roles of cytokines in periodontitis: a re-appraisal from host defense and tissue destruction viewpoints. J Dent Res. 2010 Dec;89(12):1349-63.
Gasner NS, Schure RS. Periodontal Disease. 2020 May 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 32119477.
Johannsen A, Fored MC, Håkansson J, Ekbom A, Gustafsson A. Consumption of dental treatment in patients with inflammatory bowel disease, a register study. PLoS One. 2015 Aug 12;10(8):e0134001.