WHAT IF YOU CANNOT EAT WHEAT OR WHEAT CONTAINING FOOD?

 

Many of the people around us are intolerant to wheat or any of the products that contain wheat inside it or made of it. As they consume such foods, they develop gastrointestinal problems or oral health issues.

Such people are considered to have permanent intolerance to a protein which is found in gluten food. This protein is called “Gliadin”. In addition to wheat, it is also present in rye, barley and possibly oats as well. This condition is known as Coeliac Disease or also known as Gluten-sensitive enteropathy.

Background & History:

This condition was first described in detail in 1887. It was previously known as Coeliac Sprue. This word “Sprue” is from the Dutch word meaning aphthous ulcers which are typically found in the mouth. It means that oral ulceration is an important feature of Coeliac disease.

Signs & Symptoms:

a)      Diarrhea

b)      Abdominal pain

c)       Loss of appetite

d)      Bloating

e)      Anemia due to malabsorption.

ORAL FEATURES:

a)      Oral Ulcers

b)      Glossitis

c)       Angular chielitis

d)      Enamel defects on permanent teeth.

HOW TO DIAGNOSE COELIAC DISEASE?

There are two types of investigations can be conducted to confirm coeliac disease.

a)      Biopsy of the small bowel

b)      Blood tests (auto-antibodies: IgA anti-gliadin, IgA anti-reticulin, IgA-endomysial)

HOW TO TREAT COELIAC DISEASE?

a)      Lifelong adherence to gluten-free diet

b)      Use Multi-vitamins and dietary supplements to prevent deficiencies

WHAT TO DO IF DIAGNOSED WITH COELIAC DISEASE?

a)      Physician follow-up… at time of diagnosis, 3–6-month visit,12-month visit, annual thereafter

b)      Dietician follow-up… at the time of diagnosis, 2–4-week visit, 6–12-month visit, 24-month visit.

LESION IN THE MID OF THE TONGUE?

What if you found a depapillated rhomboid patch on the top surface of the tongue in the midline? Is it dangerous or you do not get worried about it? Should you get a consultation from a dentist?

Let's answer the questions one by one.

                                                        Fig: Median Rhomboid Glossitis

This picture is showing a depapillated red, erythematous patch on the dorsum of the tongue having a rhomboidal shape. This condition is known as "Median Rhomboid Glossitis", or it is also known as central papillary atrophy.

Mostly males are affected with an age range of 30-50 years.

What are the Clinical features?

According to European Dental Journal,2-3 cm red patch is found on the posterior midline dorsal side of the tongue with loss of papillae or taste buds there.

What are the Causes?

a) Vit B12 deficiency
b) Niacin deficiency
c) Riboflavin deficiency
d) Iron deficiency
e) Ill-fitting denture
f) burns
g) Syphilis rarely.

Any associated medical condition?

This condition is mostly seen in patients with Diabetes mellitus or Oral candidiasis.

Treatment:

Anti-fungal therapy is indicated for its management.
Topical anti-fungal.
a) Nystatin pastilles
b) Amphotericin B lozenges

Systemic anti-fungal.
a) Fluconazole
b) Itraconazole.

What If you have a patchy Tongue?

 

Fig: Dorsum of the tongue showing erythematous patches having white borders.

This condition giving a patchy appearance to your tongue is known as" Geographic Tongue". It is also known as benign migratory glossitis due to the ability of the lesion to migrate from on site to another on tongue over time.

It is a benign condition typically found on the lateral sides, tip and dorsum (top) side of the tongue. It is not a pre-cancerous lesion or condition. Moreover, it's not a contagious condition so you cannot get it if you pass by or eat with a person having this condition.

GEOGRAPHIC TONGUE SIGNS & SYMPTOMS:

It is usually an asymptomatic condition with only 1 in 1o patients have mild burning sensations on having spicy food or acidic food.

The signs of geographic tongue are patches on the dorsum side of tongue. These patches may have,

a) light pink or white color border
b) variation in size and shape.

c) no raised or nodular appearance.

Mostly this condition is an accidental finding by the patient while looking at the tongue in front of a mirror or a dentist spots it during a clinical examination.

GEOGRAPHIC TONGUE CAUSES:

Exact cause of geographic tongue is still unknown but it has seen running in families with a positive family history so it might be the genes responsible for that.

It has also seen in patients with auto-immune disorders like Psoriasis.

It is mostly seen in younger adults and females are found to be more affected.

GEOGRAPHIC TONGUE TREATMENT:

The burning sensation will mostly go on its own but if you have a constant and severe pain, your dentist or doctor may prescribe,

a) pain killers

b) anti- inflammatory drugs

c) anesthetic mouth rinses

d) Topical steroids

e) zinc supplements.

Angular Chielitis

Angular chielitis is a dental condition characterized by red patches and cracking at the corner of the lips. This condition is also known as Perleche. Cracking can occur on both sides of the lips at the same time as well. This condition can happen to people of any age and group.

SYMPTOMS OF ANGULAR CHIELITIS:

It is a painful condition and can range from red patches to blisters formation at the angle of the lips. The following symptoms are seen at the angle of the lips.

a) Swelling

b) Cracking

c) Blistering

d) Crusting

e) Pain

WHO CAN GET ANGULAR CHIELITIS:

Although any of the individual can get this condition but there are certain predisposing factors that can make people more prone to this condition. These factors include,

a) Candidal infection (most common cause)

b) Diabetes mellitus

c) Xerostomia (Dry Mouth)

d) Iron deficiency anemia

e) Vit B12 deficiency

f) Wearing dentures

g) Low vertical facial height

h) Licking lips

i) Sjogren's Syndrome

j) Smoking

HOW TO DIAGNOSE ANGULAR CHIELITIS:

Angular chielitis is mostly a self-diagnosed condition but it should be consulted with dental practitioner or dermatologist for better diagnosis and quick management.

It is diagnosed as,

a) Physical Examination of lips and medical history.

b) Sample of the affected area for microbiological finding.

HOW TO TREAT ANGULAR CHIELITIS:

A) Eliminate the pre-disposing factors.

B) Correct nutritional deficiencies.

C) Medications (Anti-fungals, fusidic acid cream)

HOW TO PREVENT ANGULAR CHIELITIS:

It is very easy to prevent angular chielitis and it can save you from oral health discomfort and complications. Some of the best measures to prevent angular chielitis include,

a) Maintain good oral hygiene

b) Avoid smoking

c) Nutritional supplements

d) Correcting dentures.

e) Using lip balm, moisturizer etc.

f) Stop licking the lips.

  
 

Fig: Angular Chielitis

Ramsay Hunt Syndrome

Varicella zoster virus (Type III herpes) often present with complications like post-herpetic neuralgia or Ramsay Hunt Syndrome. Any patient who got chicken pox can develop these complications.

Patients who got this Ramsay Hunt Syndrome as a complication develop multiple complaints like,

1) Facial Weakness (Bell's Palsy)

2) Loss of taste sensation

3) Dizziness

4)Unilateral vesicles on ear

5)vesicles on palate and oral mucosa

                                                                

Fig: Pictorial illustration of Ramsay Hunt Syndrome

HOW TO TREAT?

Treated with corticosteroids and Anti-viral. Better results are achieved when anti-virals are given within three days of onset of disease.

Depending on other symptoms, further treatment may be required like analgesics and vertigo suppressants. 

Patients with facial palsy should be careful about their cornea.

THE BOTTOM LINE.

Ramsay Hunt Syndrome can lead to permanent facial palsy or deafness. So, early diagnosis and treatment is crucial for better prognosis.