| Popis: |
This chapter emphasizes the importance of oral disease in the context of systemic disease. Oral disease may be the first sign of an underlying systemic disorder, which should trigger further investigations or referral to a medical or specialist practitioner, expediting early diagnosis and appropriate clinical care. In those patients with known illnesses, dental healthcare professionals should have an appreciation of the effects of these diseases on the oro- facial complex; patients can then benefit from the supportive care of the dental team. Coeliac disease (gluten-induced enteropathy) is a genetically determined inflammatory small bowel disease that is induced by gluten in the diet. Gluten is present in wheat, rye, and barley. The inflammatory reaction results in malabsorption due to morphological abnormalities in the small intestinal mucosa. It was once thought of as a rare disease of childhood, but now it is understood to be a common disease that can be diagnosed at any age. Studies undertaken since the advent of serological screening indicate a prevalence of 0.5–1% in the population, with adult presentations now more frequent than childhood ones. This new appreciation has led to the concept of the ‘coeliac iceberg’. At the tip of the iceberg are those with overt disease, with the lower groups classified in order as: silent coeliac disease, latent coeliac disease, and healthy individuals with genetic susceptibility. Severe presentations in childhood classically were of diarrhoea, failure to thrive, and weakness. However, it is now understood that patients with coeliac disease may have minimal gastrointestinal symptoms of malabsorption at presentation and experience other rather non-specific symptoms of the disease. The increasing recognition of the disease is attributed to several factors, including new serological assays, advances in flexible endoscopy allowing clinicians to take duodenal biopsies more easily, and an increased index of suspicion in looking for the disease. The disease is associated with an increased rate of osteoporosis, infertility, autoimmune diseases, and malignancy, especially lymphoma. Treatment should involve a gluten-free diet, which is a major undertaking and for which dietetic advice is essential. |
