A rare case of pediatric Crohn’s disease and alveolar bone loss: a report and review

Abstract

Crohn's disease (CD) is a granulomatous inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract, but its etiology is still unclear. CD patients usually have extraintestinal manifestations including oral manifestations, and this can also occasionally appear in children. Oral manifestations, including aphthous stomatitis, typically develop on the mucocutaneous tissue. As pediatric CD is not common, there have been no reports concerning alveolar bone resorption for these kinds of patients. An 11-year-old Chinese girl was referred to our hospital because of reoccurring painful oral ulcers, with a 2.5-year history of CD and recurrent oral ulcers. Clinical examinations revealed intestinal lesions, oral ulcers, and alveolar bone loss. CD and its related periodontitis were diagnosed. After comprehensive therapy, including periodontal scaling and anti-inflammatory treatment, the oral ulcers gradually healed. One year later, follow-up visit showed the anterior alveolar bone to be stable and new alveolar bone regenerating around the mandibular anterior teeth at some sites. It is rare for CD children to have periodontitis, especially with severe alveolar bone loss. This case suggests that when treating periodontitis in children, the possibility of systemic disease, such as CD, should be considered and attended to. Early diagnosis and symptomatic treatment and care are crucial.

Oral Manifestations of Crohn’s Disease: A Systematic Review

“…These include aphthous ulcers, angular cheilitis, and glossitis. It should be noted that these ulcers are sometimes not part of the disease process but are secondary to nutritional deficiencies caused by the course of the disease [10,11,15,17,20,24,27,28,31].…”

“…Periodontitis and vegetating pyostomatitis are non-specific manifestations that only some articles classify as such [23,27,30]. CD is one of the systemic conditions affecting the periodontium.…”

“…CD is one of the systemic conditions affecting the periodontium. Recent studies have speculated that CD is likely to induce periodontitis by changing its oral microbiota and subsequent inflammatory response [27,29].…”

“…One year later, a case-control study conducted by Dr. Stephan Vavircka et al [13] affirms the previous findings and provides that, in addition to the higher prevalence, the disease behaves with greater severity and extension, both in the adult population. Recently, the first case of a girl with CD presenting with periodontal disease and advanced bone loss has been described [11,27].…”

“…Regarding the location of the lesions mentioned, there is a predominance of lesions on the mucosa, especially on the lower lips and gums. Lesions are present in other less common locations, such as the soft palate, uvula, tongue, and pillars of the fauces [10][11][12][13][14][15][16][17][19][20][21][22][23][24][25][26][27][28]30,31].…”