Portal to Paunch: Dental/Medical Connections between the Mouth, Esophagus and Stomach

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1 The Gastrintestinal Tract One lng tube The upper GI tract Muth Esphagus Stmach Small intestine The lwer GI tract Cln Rectum Prtal t Paunch: Dental/Medical Cnnectins between the Muth, Esphagus and Stmach One Lng Tube Oral/Systemic health Muth as prtal t the tube Squamus cells vs. clumnar cells 70 millin+ experience GI difficulties GI and Systemic Wellness Immunity Prtective mucsal lining Fd-based antigens, pathgens and txins are managed Gut-Assciated Lymphid Tissue (GALT) largest lymphid rgan in the bdy! Immune system challenged = inflammatry respnse Chrnic = prblems! Sustenance Healthy micrflra a necessity! Prbitics Replaces gd bacteria and helps maintain needed balance t pull nutrients frm fd Fiber Sluble & insluble Allws slwing the breakdwn f carbhydrates and entry int the bldstream Regulates transit time Favrite fd f gd bacteria in the cln! Emtinal Well-being Enteric nervus system deeply cnnected t yur emtins (Little Brain) Small intestine has mre nerve endings than the spinal crd Manufactures up t 90% f sertnin Emtinal stress affects the GI system Fear accelerates gut mtility = diarrhea Anger stmach acids churn = queasiness, burning Sadness/happiness stimulates esphageal nerves = lump in the thrat GI Health Create a calm envirnment fr eating Allw plenty f time in yur day fr eliminatin Chse fiber rich fds Drink plenty f water Stay away frm fds that trigger allergy-like reactins r digestive after effects Take prbitics Epithelium 1

2 Lcated n the brders between internal and external surfaces Lines all internal bdy spaces that have sme cntact with external envirnment Tightly bund cells, n intercellular cnnective tissue Specialize cell membranes fr different tasks, prtective r metablic 3-curse meal 1 st curse Squamus cell bruschetta 2 nd curse Cmbinatin meal 3 rd curse = Take ut! 1 st curse bjectives Squamus epithelium Discver why the incidence f ral cancer in nn-tbacc users is increasing Discver interesting cnnectins between ral health and anal cancer 2 nd curse bjectives Squamus and clumnar epithelium Explre the acid reflux cnnectin t esphageal cancer 3 rd curse bjectives Squamus and Clumnar epithelium Investigate the ral cavity as a breeding reservir fr H. pylri Oral Cancers Histrically Tbacc Cigarettes, pipe, chew Alchl acts synergistically with tbacc Dehydratin, increased permeability f cell wall Chew- better fr lung cancer, prblematic fr pancreatic cancers and P. disease. Incidence: 45k new cases in 2015, ne death per day frm ral cancer 2

3 Tday HPV leads as cause f all head and neck cancers White, nn-smking males age 35 and 55 are mst at risk, 4 t 1 ver females. - Orpharyngeal specific areas up t 60% increase Base f tngue Incidence Tngue Flr f muth gingiva Tnsillar, Transitin between muth & thrat These areas are similar t the T-zne in the uterine cervix HPV Papillma viruses infect squamus epithelial cells Benign hyperplasia (warts r papillmas) Squamus cell cancer HPV subgrup 16 = high risk HPV 50% cervical cancers 100% ral cancer Increased dds 26 vaginal sex partners ral sex partners Sex partners with HPV angenital cancers and invasive cervical cancers Muth-t-muth transmissin pssible HPV-assciated rpharyngeal cancers have a BETTER prgnsis than HPV-negative cancers 6.2 millin new cases annually (all strains f HPV) Estimated 74% new cases in year lds Prphylactic vaccinatin with Gardasil Prtects against types 6, 11, 16, & 18 6 & 11 90% genital warts 16 & 18 70% cervical cancers, 100% OP cancers Wrks best befre cntact with HPV types listed 3 injectins initial, 2mnths & 6 mnths Nt a live virus Current recmmendatin by CDC vaccinatin schedule fr y females Male vaccinatin apprved in 2011 May prevent genital warts and rare cancers, such as penile and anal cancer Indirect health benefits fr girls/wmen Talking t Parents abut HPV- Anus Anatmy 1.5 inches lng pening between rectum and utside Functins as the gate t eliminatin Sphincters Internal invluntary cntrl External vluntary cntrl Anal cancer 7,270 new cases in 2014 females have higher incidence Early symptms Feeling f freign bdy in anus Bleeding and pain with bwel mvements Risk factrs In wmen, many anal cancers are preceded by ther genital cancers (cervical mst cmmn) 3

4 Sexual extrversin rather than sexual preference a factr Mst cases f anal cancers are a cnsequence f the HPV type assciated with cervical cancer Smking Lwered Immunity Gender and Race/Ethnicity Anus t ral HPV fund in genital tract, saliva, urine and semen Sexual transmissin thrugh ral, vaginal and anal sex Future f anal cancer Gardisil -On December 22, 2010, the FDA apprved Gardasil fr the preventin f anal cancer and precancer in men and wmen aged Anal self-exam? Pap smear fr the anus? Esphagus Physical prperties and functin Epithelium squamus cell Lwer esphageal sphincter is a band f muscle that keeps stmach cntents within the stmach Gastresphageal reflux disease (GERD) when acids leak back int the esphagus beynd nrmal limit causing symptms Typical heartburn, regurgitatin and dysphasia (difficulty swallwing) Atypical cughing, chest pain, damage t the lungs, vcal crds, ear and teeth Causes #1 Functinal prblem f the LES (t much relaxatin) #2 Certain fds, Medicatins, Hrmnes Cffee, alchl, citris, acids Medicatins calcium channel blckers, nitrates, beta-blckers Hrmnes prgesterne can decrease pressure n the LES #3 Obesity as a cntributing factr due t increased intra-abdminal pressure, 6% mre likely t develp esphageal cancer Reflux is nt nly stmach acid but als bile and pancreatic secretins Incidence 7% experience heartburn daily; f thse 20-40% have GERD Often under reprted due t OTC medicatins Esphagitis 50% f GERD patients Grade I erythema Grade II linear cnfluent ersins Grade III circular cnfluent ersins Grade IV stricture r Barrett s esphagus Barrett s Esphagus a disrder in which the lining f the esphagus is damaged by stmach acid. Cells exhibit dysplasia. Squamus cell epithelium is replaced by intestinal clumnar epithelium Risk factr fr adencarcinma f the esphagus 8-15% f GERD patients develp Barrett s Esphageal cancer adencarcinma (glandular) clumnar cell are glandular Ncturnal GERD 75% Time damages 4

5 Sleeping pills r aids mask GERD Cntribute t increased risk f further disease Oral Implicatins f GERD- Acid Wear Treatment f GERD Cntrl symptms, heal esphageal epithelium and prevent recurrence Lifestyle Avid trigger fds & large meals Wait 3 hurs after eating t lie dwn Elevate head f bed 8 inches Weight lss Pharmaclgic Mild antacids after eating and at bedtime can directly neutralize acids PPI Prtn Pump Inhibitr Prilsec, Prevacid, Prtnix H+ equals prtn Shut ff pumps that make the acid in the stmach Surgery Laparscpic Nissen Fundplicatin (wrap stmach arund the esphagus creating a new sphincter) Stmach Muscular rgan fr mixing Acid and pepsin fr initial breakdwn f fd Benign diseases Acid reflux, GERD H. pylri Gastritis Ulcers Malignant diseases Cancer Lymphma H. pylri What it is? Gram negative bacteria adapted t survive in the stmach Hw d we get it? Human-t-human cntact including mther-t-child Oral-fecal transmissin Incidence 10-60%. Appraching 100% in undevelped cuntries What des it d t us? Stmach ulcers & dudenal ulcers Chrnic, active inflammatin f gastric mucsa Testing: Bld, Breath, Stl, Stmach Treatment PPI Antibitics New strains emerging that are antibitic resistant Aut re-infectin Prphylactic vaccinatin in the future? H. pylri & the ral cavity Culprit in dental caries In children especially develping cuntries Risk factr fr dental caries Eradicatin may lead t lwered caries rates Pr ral hygiene is a risk factr Cntributes t halitsis as it resided in peri pckets Denture wearers are mre susceptible Remving appliances at night and brushing 2x daily has prven results in eradicating H. pylri Mre difficult t remve frm the muth than stmach (lwer levels f antibacterial drugs in saliva than in gastric juice) Can ccur in the ral cavity independently f the stmach clnizatin 5

6 D ral hygiene practices increase efficacy f eradicatin frm the stmach? Research is incnclusive. Vitamin E prtects the mucsal epithelium frm H. pylri 101 patients studied with upper endscpy and exam f peri pckets H. pylri cultured frm dental plaque and stmach H. pylri Peri Patients Nn-Peri Patients Dental plaque 79 % 43 % Stmach 60 % 33 % Dental Plaque & Stmach 78 % 30 % The ral cavity appears t be a reservir and a pssible surce fr reinfectin. Canadian J Gastrenterlgy 2009, Al Asqah Kelli Swansn Jaecks, MA, RDH kelli@verbalimpact.rg Take Hme Messages 6

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