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THE NEXTDDS Student Ambassador Blogs

Oral Manifestations of Gastrointestinal Abnormalities

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    They often say that the dentist is the first person to diagnose a severe clinical finding like oral cancer. Since we are the experts of the oral cavity, this makes total sense and seems like a no-brainer as to why we would be the first to diagnose such a severe condition. However, oral cancer is not the only severe finding that the dentist can diagnose and be the first to find. Gastrointestinal (GI) abnormalities can often be first detected in the oral cavity because the GI system technically originates and is continuous with the oral cavity. Here are a few GI abnormalities with oral manifestations that I recently learned in my general pathology course. 

            One gastrointestinal abnormality that has an oral manifestation is GI reflux. Gastric acid enamel erosion can be seen in patients with chronic gastric reflux including GERD (gastric esophageal reflux disease), hiatal hernia, chronic alcoholism, and bulimia. Enamel loss often affects the lingual/palatal surfaces of teeth and the extent of loss may reflect reflux duration or frequency. The mouth is not equipped to handle acids that are commonly found in the stomach and enamel is especially prone to degradation due to these acids that have a severely low pH compared to that of saliva.

            Another GI abnormality that has an oral manifestation is malabsorption. Malabsorption consists of a wide range of issues all of which deal with the GI system not being able to absorb critical nutrients that the body needs. One of the most critical malabsorption problems is iron malabsorption which can lead to iron deficiency anemia, vitamin B12 malabsorption, and pernicious anemia. If severe, the initial oral sign can be atrophic glossitis—a bald or reddish tongue. This can be seen clinically as rough patches on the tongue or can involve the entire dorsum of the tongue. Overt tongue lesions are usually tender and patients often complain of a burning sensation, or glossopyrosis. These findings can revert back to normal if the patient is treated with the correct vitamins and nutrients needed.

            Familial adenomatous polyposis (FAP) also can be seen clinically arising in the oral cavity. This is an inherited capability of developing polyps/adenomas within the bowel and if these polyps are left untreated lead to a 100% risk of cancer. The reason for this risk is because with FAP, a patient can develop hundreds of polyps and any one of them can undergo malignant transformation, thus leading to cancer. Gardner syndrome is often associated with FAP in which a patient can develop epidermoid cysts, jaw osteomas, supernumerary and/or unerupted teeth, and increased odontomas. These can be seen both clinically and radiographically. These oral manifestations can contribute to early recognition of the condition and allows for appropriate screening for bowel disease and other potential neoplasms.

            These gastrointestinal abnormalities are just a few pathological findings that can arise in the oral cavity. When in doubt, if something looks out of place or looks abnormal, the best advice is to take a biopsy and send it off to a pathologist who can better diagnose your findings. Although it may not be oral cancer, it can still be a serious condition in which you could potentially save a patient’s life.