We write to comment on the December JADA articles by Dr. Junu Ojha and colleagues and Dr. Scott De Rossi and colleagues regarding patients with Crohn disease and ulcerative colitis.1,2 Both articles recommended appropriate local treatment for patients with moderate oral symptoms. We believe that it may be appropriate for the dentist to make clinical recommendations regarding the use of more appropriate current systemic pharmaceuticals to patients with severe oral manifestations of multisystem diseases.
We have been much more aggressive in our patient education and referral discussions with patients who have severe oral manifestations of multisystem diseases. This is because we have had several family members and good friends who have presented with severe oral manifestations associated with diagnosed rheumatoid arthritis, Crohn disease, ulcerative colitis and vasculitis.
These are patients who were severely disabled and barred from daily pursuits owing to severe oral, systemic and other organ symptoms. They are not interested in palliation of any symptoms. Rather, they are highly motivated and wish to pursue aggressive treatment to get back to healthy lifestyles immediately.
One of our mentioned patients became severely disabled in a short period of time from oral, systemic and gastrointestinal symptoms related to ulcerative colitis and vasculitis. After a discussion with the dentist and her two physicians, the patient was brought to a remission by treatment with Remicade (Centocor, Horsham, Pa.). Our personal and professional experience with this group informs us that many patients can benefit from the dentist’s leading aggressive, informed and clear discussion between the patient and physicians.
Accordingly, we advise all of our patients who present in this way of the availability and possible benefits of the most up-to-date systemic pharmaceuticals to treat their conditions, specifically naming the biological response modifier drugs by brand name such as Enbrel (Immunex, Thousand Oaks, Calif.) Remicade and Humira (Abbott Laboratories, Abbott Park, Ill).
For those patients whose physician has already mentioned or recommended the appropriate drug, we have only reinforced the prescription. For patients whose physicians have not, it may be appropriate for the patients to seek referrals to physicians proficient in such treatments.
Both of the JADA articles and the medical and dental literature mention how oral manifestations of these immune-related or inflammatory multi-system diseases improve as the diseases remit and exacerbate as the diseases flare. Therefore, it is in the dentists’ and patients’ interest to push the systemic disease into remission with the most aggressive systemic pharmaceutical treatment in order to control severe oral manifestations along with the disease itself.
Just as a gastroenterologist or primary physician may treat the intestine pharmaceutically in order to remit gastrointestinal symptoms and, thereby, remit other systemic symptoms including oral symptoms, an appropriately trained dentist should be able to recommend aggressive systemic pharmaceutical treatment in order to remit severe oral symptoms along with remission of systemic and other local organ symptoms.
Therefore, for now, we are recommending clear, equal communication among dentist, patient and physicians and more active participation by the dentist in the overall treatment plan.
TOP
REFERENCES
