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Relação entre a diversidade da microbiota oral e doença de Crohn: revisão integrativa
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A doença de Crohn é uma condição multifatorial cuja causa exata permanece desconhecida. Caracteriza-se por períodos de atividade que alternam com remissões, afetando principalmente a porção terminal do íleo e o início do cólon. Pode causar complicações tanto intestinais quanto extra-intestinais. Entre estas últimas, destacam-se as manifestações na cavidade oral, que podem ocorrer antes ou depois do diagnóstico da doença de Crohn. O diagnóstico deve ser realizado por um gastroenterologista, que se baseará numa história clínica detalhada, num exame físico minucioso e em vários exames complementares. Estes incluem a colonoscopia, exames de imagem, análises laboratoriais e histopatologia. O cirurgião-dentista também desempenha um papel crucial na deteção, prevenção e tratamento das manifestações orais da doença de Crohn. Pode ser um elemento fundamental no diagnóstico precoce, especialmente quando os primeiros sintomas aparecem na cavidade oral. Além disso, o dentista contribui com informações e conselhos ao paciente, visando melhorar a sua qualidade de vida.
A doença de Crohn manifesta-se através de uma ampla gama de sintomas, que variam de pessoa para pessoa, exigindo assim uma abordagem personalizada e multidisciplinar. Entre as manifestações orais mais comuns associadas à doença de Crohn estão a estomatite aftosa, as úlceras profundas e lineares, a mucogengivite, o aspeto de empedrado (cobblestoning), a queilite granulomatosa e as lesões polipóides. Estas manifestações devem ser observadas e diagnosticadas cuidadosamente pelo cirurgião-dentista, permitindo assim um diagnóstico precoce e um tratamento adequado e atempado.
A relação entre a diversidade da microbiota oral e as doenças sistémicas, em particular a doença de Crohn, representa um campo de investigação emergente e promissor que destaca a interconexão entre a saúde oral e o bem-estar geral do organismo. A microbiota oral, composta por uma grande variedade de bactérias, vírus, fungos e outros micro-organismos, forma um ecossistema complexo e essencial, desempenhando um papel fundamental na manutenção da homeostase oral e sistémica. A diversidade deste ecossistema é crucial, pois garante resiliência e estabilidade, fatores importantes para evitar a disbiose, que pode levar a doenças locais e sistémicas.
Os resultados desta pesquisa revelam uma alteração significativa da microbiota oral em pacientes com doença de Crohn, caracterizada por uma redução na diversidade microbiana e uma predominância de certas estirpes patogénicas. Esta disbiose, associada a distúrbios inflamatórios e imunológicos sistémicos comuns na doença de Crohn, evidencia uma relação bidirecional entre a inflamação intestinal e as alterações na microbiota oral. Por outras palavras, a inflamação crónica e sistémica característica da doença de Crohn parece influenciar diretamente a composição da microbiota oral, criando um ambiente favorável ao desenvolvimento de doenças periodontais e outras infeções orais. Além disso, o oposto também parece ser verdadeiro: a disbiose oral pode influenciar negativamente a microbiota intestinal através da circulação sistémica, agravando a inflamação e intensificando os sintomas da doença de Crohn.
Esta hipótese sugere novas perspetivas para o tratamento preventivo e curativo das condições orais em pacientes com doenças inflamatórias intestinais crónicas. Uma abordagem terapêutica integrada, que leve em conta a saúde oral, pode desempenhar um papel crucial na gestão global da doença de Crohn. Este estudo, portanto, destaca a importância de uma visão holística da saúde, na qual a componente oral não deve mais ser vista como um elemento isolado, mas como uma parte essencial do equilíbrio sistémico do corpo. O controlo da disbiose oral, particularmente através de intervenções direcionadas à microbiota, como o uso de probióticos ou a modulação da higiene oral, pode representar uma estratégia promissora para melhorar a qualidade de vida dos pacientes com doença de Crohn e, possivelmente, outras doenças sistémicas relacionadas a desequilíbrios na microbiota oral. Nesse contexto, torna-se fundamental incluir a dimensão oral no acompanhamento e tratamento de doenças sistémicas, revelando uma interdependência ainda maior entre as diferentes disciplinas médicas.
Crohn's disease is a multifactorial condition with an unknown exact cause. It is characterized by periods of activity alternating with remission, primarily affecting the terminal part of the ileum and the beginning of the colon. The disease can lead to both intestinal and extra-intestinal complications. Among these extra-intestinal complications, manifestations in the oral cavity are notable and can occur either before or after the diagnosis of Crohn's disease. The diagnosis should be made by a gastroenterologist, who will rely on a detailed medical history, a thorough physical examination, and various complementary tests. These include colonoscopy, imaging tests, laboratory analyses, and histopathology. The dentist also plays a crucial role in the detection, prevention, and treatment of oral manifestations of Crohn's disease. They can be essential in early diagnosis, especially when the first symptoms appear in the oral cavity. Additionally, the dentist provides information and guidance to the patient, aiming to improve their quality of life. Crohn's disease presents with a wide range of symptoms that vary from person to person, thus requiring a personalized and multidisciplinary approach. Common oral manifestations associated with Crohn's disease include aphthous stomatitis, deep and linear ulcers, mucogingivitis, cobblestoning, granulomatous cheilitis, and polypoid lesions. These manifestations should be carefully observed and diagnosed by the dentist, enabling early diagnosis and timely, appropriate treatment. The relationship between oral microbiota diversity and systemic diseases, particularly Crohn's disease, represents an emerging and promising field of research that highlights the interconnection between oral health and overall well-being. The oral microbiota, composed of a vast range of bacteria, viruses, fungi, and other microorganisms, forms a complex and essential ecosystem, playing a fundamental role in maintaining both oral and systemic homeostasis. The diversity of this ecosystem is crucial as it provides resilience and stability, important factors in preventing dysbiosis, which can lead to both local and systemic diseases. The findings of this research reveal a significant alteration in the oral microbiota of patients with Crohn's disease, characterized by a reduction in microbial diversity and an overrepresentation of certain pathogenic strains. This dysbiosis, linked to the systemic inflammatory and immune disorders common in Crohn's disease, underscores a bidirectional relationship between intestinal inflammation and alterations in the oral microbiota. In other words, the chronic and systemic inflammation characteristic of Crohn's disease appears to directly influence the composition of the oral microbiota, creating an environment conducive to periodontal diseases and other oral infections. Moreover, the reverse also seems to be true: oral dysbiosis could negatively impact intestinal microbiota through systemic circulation, worsening inflammation and intensifying Crohn's disease symptoms. This hypothesis suggests new perspectives for the preventive and curative treatment of oral conditions in patients with chronic inflammatory bowel diseases. An integrated therapeutic approach that takes oral health into account could play a crucial role in the overall management of Crohn's disease. Therefore, this study highlights the importance of a holistic view of health, where the oral component should no longer be seen as an isolated element, but as an essential part of the body's systemic balance. Controlling oral dysbiosis, particularly through targeted microbiota interventions, such as the use of probiotics or the modulation of oral hygiene, may represent a promising strategy to improve the quality of life of patients with Crohn's disease and potentially other systemic diseases related to oral microbiota imbalances. In this context, it becomes essential to include the oral dimension in the monitoring and treatment of systemic diseases, revealing an even greater interdependence among various medical disciplines.
Crohn's disease is a multifactorial condition with an unknown exact cause. It is characterized by periods of activity alternating with remission, primarily affecting the terminal part of the ileum and the beginning of the colon. The disease can lead to both intestinal and extra-intestinal complications. Among these extra-intestinal complications, manifestations in the oral cavity are notable and can occur either before or after the diagnosis of Crohn's disease. The diagnosis should be made by a gastroenterologist, who will rely on a detailed medical history, a thorough physical examination, and various complementary tests. These include colonoscopy, imaging tests, laboratory analyses, and histopathology. The dentist also plays a crucial role in the detection, prevention, and treatment of oral manifestations of Crohn's disease. They can be essential in early diagnosis, especially when the first symptoms appear in the oral cavity. Additionally, the dentist provides information and guidance to the patient, aiming to improve their quality of life. Crohn's disease presents with a wide range of symptoms that vary from person to person, thus requiring a personalized and multidisciplinary approach. Common oral manifestations associated with Crohn's disease include aphthous stomatitis, deep and linear ulcers, mucogingivitis, cobblestoning, granulomatous cheilitis, and polypoid lesions. These manifestations should be carefully observed and diagnosed by the dentist, enabling early diagnosis and timely, appropriate treatment. The relationship between oral microbiota diversity and systemic diseases, particularly Crohn's disease, represents an emerging and promising field of research that highlights the interconnection between oral health and overall well-being. The oral microbiota, composed of a vast range of bacteria, viruses, fungi, and other microorganisms, forms a complex and essential ecosystem, playing a fundamental role in maintaining both oral and systemic homeostasis. The diversity of this ecosystem is crucial as it provides resilience and stability, important factors in preventing dysbiosis, which can lead to both local and systemic diseases. The findings of this research reveal a significant alteration in the oral microbiota of patients with Crohn's disease, characterized by a reduction in microbial diversity and an overrepresentation of certain pathogenic strains. This dysbiosis, linked to the systemic inflammatory and immune disorders common in Crohn's disease, underscores a bidirectional relationship between intestinal inflammation and alterations in the oral microbiota. In other words, the chronic and systemic inflammation characteristic of Crohn's disease appears to directly influence the composition of the oral microbiota, creating an environment conducive to periodontal diseases and other oral infections. Moreover, the reverse also seems to be true: oral dysbiosis could negatively impact intestinal microbiota through systemic circulation, worsening inflammation and intensifying Crohn's disease symptoms. This hypothesis suggests new perspectives for the preventive and curative treatment of oral conditions in patients with chronic inflammatory bowel diseases. An integrated therapeutic approach that takes oral health into account could play a crucial role in the overall management of Crohn's disease. Therefore, this study highlights the importance of a holistic view of health, where the oral component should no longer be seen as an isolated element, but as an essential part of the body's systemic balance. Controlling oral dysbiosis, particularly through targeted microbiota interventions, such as the use of probiotics or the modulation of oral hygiene, may represent a promising strategy to improve the quality of life of patients with Crohn's disease and potentially other systemic diseases related to oral microbiota imbalances. In this context, it becomes essential to include the oral dimension in the monitoring and treatment of systemic diseases, revealing an even greater interdependence among various medical disciplines.
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Keywords
Microbiota oral Doença de Crohn Doenças sistémicas Manifestações orais da doença de Crohn Oral microbiota Crohn's disease Systemic diseases Oral manifestations of Crohn's disease