Crohn’s Disease May Present With Oral Manifestations

Oral involvement occurs in up to 37% of patients with Crohn’s disease (CD), including up to 90% of pediatric patients according to a systematic review published online in the Journal of Clinical Medicine.

“The oral cavity is recognized as a useful part of the gastrointestinal tract in the diagnostic procedure for CD,” wrote corresponding author Julia Guerrero-Gironés DDS, PhD, and study coauthors from the University of Murcia in Spain. “Thus, dentists play an important role in the early diagnosis of the disease and subsequent improvement in both quality of life and prognosis, especially in the pediatric population, with a major impact on growth, puberty, and emotional development.”

The review included 19 articles published between 2012 and 2023 reporting oral manifestations in patients with CD. The most common oral manifestations of CD are ulcers, gingivitis, and angular cheilitis, the authors stated. From 50% to 80% of pediatric patients and up to 9% of adult patients present with such symptoms.

In some patients, lesions go unnoticed, while others experience incapacitating pain sometimes accompanied by gastrointestinal symptoms. The most prevalent locations of oral manifestations are the lower lips, mucosa, and gums.

Mucogingivitis (especially in the pediatric population), angular cheilitis, serpiginous and linear ulcers, and cobblestone-like mucous membranes are the most characteristic oral manifestations of CD, the review suggested. Periodontitis and vegetative pyostomatitis are less frequent.

Limitations of the review included a low number of patients and a lack of patient follow-up.

“Most of the proposed articles are clinical case reports of a single patient. In the case of observational studies, the number of patients reaches a maximum of 113, but only 69 of them had CD,” researchers wrote. “Even in one of them, the oral examination was not performed by dentists. Moreover, in most of them, the follow-up of the patient after the healing of the lesions was not described.”

Reference:
Pecci-Lloret MP, Ramirez-Santisteban E, Hergueta-Castillo A, Guerrero-Gironés J, Oñate-Sánchez RE. Oral manifestations of Crohn’s disease: a systematic review. Journal of Clinical Medicine. 2023;12(20):6450. https://doi.org/10.3390/jcm12206450