Oral manifestations of patients with inflammatory bowel disease

Authors Flora Zervou, A. Gikas, E. Merikas, G. Peros, Maria Sklavaina, J. Loukopoulos, J.K. Triantafillidis.


Background: CrohnÂ’s disease (CD) is considered to be a
disease involving the whole gastrointestinal tract, while
ulcerative colitis (UC) is a disease exclusively located in
the large bowel. The aim of this study was to examine whether
patients with either CD or UC are at increased risk for
developing oral manifestations. Patients-Methods: A wide
spectrum of oral lesions was carefully sought by the same
oral dentist in a consecutive series of 30 patients with inflammatory
bowel disease (IBD) (15 with CD and 15 with
UC). Forty-seven healthy individuals (matched for age and
sex), attendants of our dental clinic served as controls. Results:
93% of UC and 87% of the CD group had at least one
lesion compared to 55% of the control group (P<0.005).
Significantly more patients with CD had mandibula lymphadenopathy
(P<0.0001), ulcers (P=0.011), angular
cheilitis (P<0.0001), hair tongue (P=0.011), periodontitis
(P=0.011), gingival bleeding (P<0.0001), gingivitis
(P=0.002), cobblestone appearance of the mucosa
(P=0.002), polypoid tags (P=0.002), buccal trauma
(P<0.0001) and lip swelling (P=0.002) as compared to
healthy controls. Ulcerative colitis patients had in a significantly
higher proportion of involvement of salivary glands
(P<0.0001), as well as lymphadenopathy (P=0.002), buccal
trauma (P<0.0001) and angular cheilitis (P<0.0001),
compared to healthy controls. Significantly more patients
with CD or UC had concurrently 3 or more oral manifestations
as compared to normal controls (P<0.0001). On multivariate analysis, age and IBD were the only factors significantly
related to the existence of oral lesions (OR 1.07, 95%
CI: 1.02 – 1.13, P=0.009). No correlation between activity
and duration of disease, sex and smoking habit, with the
presence of oral manifestations, was noticed. No significant
differences between patients and controls in the incidence
of other lesions, including leukoplakia, and aphthouslike
ulcers were found. No cases of pyostomatitis vegetans
in either patients with IBD or controls were found. Conclusion:
Although the number of patients included in the study
is small we can conclude that oral manifestations in patients
with IBD (especially in those with CD), is a frequent
and underestimated event that needs further clinical validation.
Key words: Inflammatory bowel disease, Crohn's disease,
Ulcerative colitis, Oral manifestations
Original Articles