FEATURES OF THE DENTAL STATUS OF PATIENTS WITH INFLAMMATORY BOWEL DISEASES

Аннотация

The problem of development of dental diseases in inflammatory bowel diseases (IBD) has been poorly studied. Apparently, this is due to the lack of a clear understanding of the etiology and pathogenesis of IBD. Analysis of foreign and domestic publications shows that oral lesions are considered in more detail in CD than in UC. Severe recurrent course ofIBD and close relationship of different levels of the digestive system create prerequisites for development of oral lesions. It should be taken into account that data on the frequency of dental diseases presented by ECCO are limited to aphthous stomatitis, considered as an extraintestinal manifestation ofIBD. Key words: Intestine, stomatitis, Crohn's disease (CD), ulcerative colitis (UC), ECCO - The European Organization ofCrohn's andColitis. However, numerous studies indicate a more extensive symptomatology of oral manifestations of IBD than just aphthous lesions of the oral mucosa. Several hundred cases of lesions of the maxillofacial organs in CD havebeen described intheworld literature. It should be taken into account that the gastroenterologist's attention during the clinical examination of the patient is focused on the most accessible areas of the oral cavity. Therefore, the ECCO data on the 40% prevalence of extraintestinal manifestations of IBD in the oral cavity need to be clarified. CD is considered a systemic chronic disease involving any part of the digestive tract. Intestinal symptoms are predominant, but extraintestinal manifestations may occur during the disease process, including in the oral cavity. In most cases, oral lesions follow intestinal inflammation, aremore common in CDthan inUC, and are morecommon in young people and in men. It has been established that the prevalence of dental diseases is higher with inflammation of the proximal sections of the gastrointestinal tract and perianal region than with damage to the distal sections. The appearance of symptoms at a younger age in individuals with proximal localization ofpathological processes is noted. In the study by M. Garamszegi et al., lesions of the maxillofacial region in CD were systematized. Skin lesions, perioral erythema, median fissure of the lip, diffuse swelling of the lips, gingivitis, stomatitis, polypoid lesions on the vestibular side and in the retromolar fossa, ulcerations in the oral cavity in the form of aphthae with hyperplastic edges, localized areas of mucosal hyperplasia resembling a "cobblestone pavement", and lymphadenopathy were identified. Oral lesions are more often observed in patients with a long history, but sometimes they are detected in theabsence ofbowel diseases. Chronic stomatitis in CD is described as generalized erythema of the mucous membrane with chronic ulcerations. Biopsy of the palatal mucosa revealed noncaseating granulomas. In some cases, oral lesions precede intestinalsymptoms byseveral years. Among the histological manifestations of CD in the maxillofacial area, tuberculoid follicles are noted, represented by epithelioid and multinucleated giant cells without caseous necrosis. 87 Volume 4, issue 4, 2025 Considering tuberculoid follicles to be non-specific for CD, they are regarded as characteristic if the patient has aphthous ulcers, glossitis, cheilitis, peeling of the skin around the mouth, stomatitis and thickening of the lips. Researchers note the formation of granulomas in the vestibule of the oral cavity, suggesting the presence of CD in the patient, with subsequent confirmation ofthediagnosis based ontheresults ofendoscopy. Inflammation of the larynx observed in patients with active CD, despite its high frequency, is characterizedbymoderate severity. A.J. Williams et al. describe swelling of the lips, lesions of the mucous membrane of the cheeks in the form of a "cobblestone pavement", linear ulcers, swellings, which can often occur in parallel with intestinal symptoms. According to them, in 35% of cases, patients do not need specific dental treatment; in a number of cases, it was successful only with the appointment of corticosteroid drugs. Other studies have found that the mucous membrane of the cheek, vestibule of the oral cavity and lips are most often affected. Less often, the inflammatory process spreads to the mucous membrane of the alveolar process and palate with the development of multiple ulcers ofthe aphthous type. According to researchers, the most common oral disease in IBD is aphthous stomatitis. In the general population, the frequency of this disease is 20-30%, with UC the prevalence increases to 20%, with CD - up to 40%. The association of the activity of the underlying disease and aphthous stomatitis is not completely clear, in some cases there was no correlation. It was noted thatpatients withother extraintestinaldisorders moreoften suffer from stomatitis. Another non-specific oral lesion is vegetative purulent stomatitis (Pyostomatitis vegetans), but this disease is more common in UC than in CD. Vegetative purulent