Crohn’s Disease and its Effects on the Oral Cavity

What is Crohn’s Disease?

“Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract; this disease belongs to a group of conditions known as inflammatory bowel diseases (IBD).¹” This disease can be triggered by an autoimmune reaction in your body; what happens is the immune system might mistake the bacteria in your digestive tract and cause your body to attack healthy cells. Thus causing inflammation that leads to diarrhea, fatigue, cramping or stomach pains, and the body generally not feeling well.⁶

Crohn’s Disease Diagnosis

Crohn’s disease can be diagnosed after undergoing a multitude of testing²; some of these tests include, but are not limited to:

1. Full blood work
2. MRI
3. CT Scan
4. Colonoscopy
5. Endoscopy
6. Fecal samples

Crohn’s Disease Treatment

Crohn’s disease can be treated in a couple of different ways, but ultimately there is no cure for this disease. There are many different medications which can be prescribed for Crohn’s disease. However, the side effects of these medications do have their own risk factors. Some of the more common medications are Aminosalicylates, Corticosteroids, Immunomodulators, and Biologic therapies.³

Most people who take medication to help control Crohn’s disease, still end up needing surgery to help. There are three main surgeries doctors perform to help manage Crohn’s disease; these include subtotal colectomy, small bowel resection, and the most invasive is proctocolectomy (removes your whole colon and rectum).³

Research shows diet and nutrition help play a huge role in flare-ups of Crohn’s Disease. Being mindful of what patients put in their body is important to minimizing episodes.  Certain foods and drinks like high fat, carb, and sugar will create inflammation and diarrhea from constant use. Medication and surgery can only do so much for patients if they aren’t willing to alter their day to day dietary needs. Patients also can minimize episodes if they eat smaller meals, more times a day than eating three big meals a day.³

Oral Manifestations of Crohn’s Disease

There are many different oral manifestations this disease causes patients to experience whether directly related to the disease itself or from the medications they take to manage the disease.

• Aphthous ulcers are painful and can also be known as canker sores or aphthous stomatitis; usually found in the oral cavity on the moveable⁶
• Oral granulomatosis is swelling of the orofacial area, mainly the lips, this is not a common reaction.⁶
• Xerostomia is when the salivary glands in the oral cavity don’t produce enough saliva to keep the mouth moist. Xerostomia can increase the risk of dental caries, secondary decay, and halitosis.
• Inflammation or abscess of salivary glands can occur from xerostomia. The bacteria can cause the gland to become infected and create a painful lump in the gland.
• Erythema is characterized by when the gingival tissue appears irritated with general redness.
• Gingivitis is a type of periodontal disease that is nondestructive unless left untreated.
• Cobblestone appearance is when buccal mucosa has multiple bumps lining the tissue.
• Mucosal tags can also appear due to Crohn’s disease and appear like skin tags, but in the mouth, and usually found on the buccal mucosa, vestibule, or retromolar
• Deeply corrugated buccal or labial mucosa²

Treatment for Oral Manifestations

To treat these conditions listed above, doctors will prescribe a topical steroid, hydrocortisone ointments, vitamin supplements, recommend dry mouth products, and increased oral hygiene care.⁵ Fluoride rinses, at-home trays, and fluoride varnish treatments are great for root caries prevention as well. It is important to see your dentist and dental hygienist for exam and prophylaxis.

Usually, a 3-4 month recall for prophylaxis will be set up to help maintain the patient’s oral health and to help with early detection. Tightened recall schedules are important because if oral hygiene is poor, it may lead to periodontal issues if not addressed and their routine care isn’t altered.

Oral Health Care Instructions

I feel this is an area where the provider can tailor their oral hygiene instruction based on the patients’ needs and issues. Not every case of Crohn’s disease will present itself the same way, so it is important to treat the patient individually, and not solely based on their diagnosis. If periodontal issues are involved, recommend the use of interdental brushes based on embrasure space size, then combine that with mouthwash, and regular brushing twice a day. If the patient is suffering from dry mouth and caries; recommend a dry mouth product, fluoride varnish treatment and mouthwash to help increase saliva production and maximize enamel remineralization.

Baking soda-based toothpaste is another product I like to recommend to my patients when they have issues with plaque and tartar control, have a high caries risk, and low saliva production. The baking soda helps neutralize the pH of saliva and therefore minimizes bacteria production because the bacteria doesn’t have the ideal environment to colonize and grow.

Electric toothbrushes and water flossers are other products that can be utilized for patient compliance. However, the efficacy of an electric toothbrush depends on whether the patient will have the patience to leave the toothbrush in the same spot long enough for it to do its job. I have patients every day who say they never knew they shouldn’t be moving the brush quickly or that they struggle with being sedentary for that long. I find if a patient likes an electric toothbrush, they usually will also be compliant with a water flosser. Water flossers are great for patients who refuse to floss; I have had some really great success stories with patients using this product.

Crohn’s disease is a condition many people suffer from; it also is a condition that goes undiagnosed in patients for a long time. As dental providers, if we can detect one or more of these symptoms presenting in the mouth, and we can help build integrated care and enforce the oral-systemic connection by doing so. I encourage you to continue to make an impact on your patients’ lives by doing more than “just cleaning teeth!”

SEE ALSO: Medical History: Your Patient is Not Telling You Everything

DON’T MISS: Periodontal Inflmmation Linked to Vision Loss

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Resources

6. “Crohn’s & Colitis.” Crohn’s Treatment | IBD Treatment | Crohn’s Nutrition | Crohn’s & Colitis Foundation, www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-crohns-disease/.
7. Furgeson, Danielle. “Oral Manifestations of Crohn’s Disease.” Decisions in Dentistry, 1 May 2016, http://decisionsindentistry.com/article/oral-manifestations-crohns-disease/.
8. “Home – PMC – NCBI.” Advances in Pediatrics., U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pmc/.
9. IBSEN, OLGA A.C. Oral Pathology for the Dental Hygienist: With General Pathology Introductions. Elsevier Health Sciences, 2018.
10. Kim, Sue Kyung, and Eun-So Lee. Advances in Pediatrics., U.S. National Library of Medicine, May 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2883427/.
11. “Symptoms & Causes of Crohn’s Disease.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 Sept. 2017, www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/symptoms-causes.