Unique to You

About gastrointestinal disorders

An estimated 70 million Americans face diseases and conditions of the gastrointestinal (GI) tract.¹ The effects of these disorders can range from temporary and mild to chronic and life-threatening.

The causes of GI disorders are not fully understood, but genetics, family history, nerve conditions, food allergies, stress, anxiety, depression, bacterial imbalances, or viral infection are all known to be contributing factors.² There is also emerging research suggesting there may be a link between poor oral health and certain GI disorders.³

Some of the more common GI disorders include:

• Acid reflux and its more severe, chronic form Gastroesophageal reflux disease (GERD). These conditions are commonly referred to as "heartburn," but this is actually just a symptom.
• Inflammatory Bowel Disease (IBD), which includes Ulcerative Colitis (UC) and Crohn's Disease (CD), and others.
• Irritable Bowel Syndrome (IBS)
• Peptic ulcers
• Lactose intolerance
• Celiac disease, an autoimmune disorder causing a reaction to eating gluten.
• Colorectal cancer

Symptoms of GI conditions vary for each person and condition. Common symptoms can include²:

• Heartburn
• Chest pain
• Reduced appetite and weight loss
• Difficulty swallowing
• Persistent abdominal pain
• Vomiting
• Diarrhea or constipation
• Gas, cramping or bloating
• Bloody or black stool
• Rectal bleeding
• Anemia from an iron deficiency
• Fatigue
• Oral health issues as described below

GI disorders and your oral health

GI disorders can affect your oral health in a variety of ways. In fact, the first signs of an emerging GI condition are often in your mouth. Because of this, your dentist may be the first healthcare provider to identify that you have a GI disorder.

Two of the most common oral symptoms of a possible GI disorder are:

• Ulcers or mouth sores: These are usually firm, pink, and painless, but ulcers or mouth sores may hurt if you eat acidic or spicy foods. People with Inflammatory Bowel Disease (IBD) often get temporary mouth sores that disappear in a week or two. These sores may return if your IBD is not well controlled. Individuals with Crohn's disease may also experience a specific type of mouth sore called an aphthous ulcer, which usually looks off-white, oval-shaped, and surrounded by inflamed, red tissue.⁴
• Enamel erosion: Chronic acid reflux, GERD, or frequent vomiting causes stomach acid to repeatedly flow over the teeth. This strong acid breaks down the tooth's enamel over time, leading to tooth sensitivity, discoloration, chipped or cracked teeth, and missing teeth. The erosion caused by these conditions is typically most significant on the non-visible side of the front upper teeth. If enough enamel has eroded, the tooth pulp can be exposed, leading to an infection that requires invasive treatment like root canal therapy. More commonly, teeth become thin, weak, and brittle. As a result, they can more easily chip or fracture.⁵ Acid reflux is especially damaging when you're asleep since your mouth produces less saliva and you swallow less often. Enamel erosion of molars, particularly when it occurs on one side of your mouth, may be a sign that stomach acid is entering your mouth during sleep. This can be caused by certain types of hernias or disorders of the muscles that seal off the esophagus from your stomach.
• Other symptoms may include:
  • A black or yellowish coating on the tongue is associated with peptic ulcers.
  • Yellow or white pustules which are closely associated with both UC and CD.⁴
  • Receding gums
  • Loss of taste
  • Bad breath

Inform your dentist:

• Inform your dentist or hygienist that you are being treated for a GI disorder or have a family history of GI conditions when they conduct a health history and current health status.
• Tell your dentist about all medications you are taking. This includes any supplements or natural remedies. Some medications taken for GI disorders can cause oral conditions such as dry mouth and enlarged salivary glands.⁴
• Let your dentist know if you've noticed mouth sores, white or red rashes in your mouth, dry mouth, tooth sensitivity, or swollen or bleeding gums.
• Provide your dentist and physician with each other's contact information. This is important if they need to discuss your condition, oral health status, or medications.

Make oral health a priority:

Your dentist can help identify many GI conditions, so it's important to visit the dentist regularly. Early intervention can help you avoid future problems. If your dentist suspects that your oral issues may be related to a GI disorder, they will discuss it with you and most likely suggest you contact your physician for further evaluation.

If you do have a GI disorder, make your oral health a priority. Maintain a good oral hygiene regimen at home and see a dentist regularly based on their recommended schedule. These simple actions can make a big difference. This includes:

• Brushing at least twice a day with a soft-bristled brush and fluoride toothpaste. If your gums bleed, don't stop brushing your teeth. Bleeding gums may be a sign of inflammation or plaque build-up below your gum line, which requires more attention, not less.
• Flossing at least once a day, which helps remove plaque between teeth where brushes do not reach.
• If your enamel is eroding, your dentist may suggest desensitizing and/or remineralizing toothpaste or prescriptions.
• If you have dry mouth, special toothpaste is available to reduce the symptoms. Some types may require a prescription.
• Use mouthwash frequently to kill germs and reduce bad breath.
• If you are frequently vomiting, rinse your mouth with clean water as soon as possible to wash away stomach acid and bacteria. It's also recommended not to brush for at least an hour after vomiting to avoid embedding stomach acid deeper into the tooth enamel.⁵
• Drink plenty of water to keep your mouth moist, increase your saliva flow, and keep yourself hydrated.
• Avoid sugary, acidic, or spicy foods and drinks.
• Reduce your alcohol and tobacco use.

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen are often prescribed for pain management following dental procedures. Prolonged use of these drugs can negatively affect your GI tract and produce nausea, heartburn, abdominal pain, bleeding, and other symptoms.
• Some medications that are prescribed to people with Inflammatory Bowel Disease (IBD) can suppress their immune system. This can lead to a fungal infection in the mouth (thrush). Antibiotics or steroids are also used to treat IBD and can also lead to thrush.
• If you have a peptic ulcer, your doctor may recommend that you take bismuth subsalicylate (such as Pepto-Bismol®) to eliminate the bacteria that leads to these ulcers. This can temporarily and harmlessly cause the surface of your tongue to turn black.

Women: Estrogen replacement therapy (ERT), often used to treat osteoporosis, can have a positive effect on your oral health by increasing jaw bone density, alveolar resorption, and tooth loss.⁶ However, ERT can increase your risk for Irritable Bowel Syndrome (IBS).² Be sure to tell your dentist if you are undergoing ERT so they can look for signs of IBS in its early stages.

Infants and toddlers: It is strongly recommended that mothers with acid reflux or GERD not taste or chew their child's food before feeding them. This simple act can transfer harmful bacteria to your child, increasing their risk of certain GI disorders.⁷