Oral Manifestations of Inflammatory Bowel Diseases: Two Case Reports

Abstract

Inflammatory bowel diseases (IBD) are known as chronic inflammatory disorders of the digestive tract, represented mainly by Crohn's disease (CD) and ulcerative colitis (UC). Among the main oral manifestations of IBD are cobblestoning of the oral mucosa, labial swellings with vertical fissures, pyostomatitis vegetans, angular cheilitis, perioral erythema, and glossitis. In this sense, understanding these nosological entities by dentists would help reach early and differential diagnosis. Thus, two case reports are presented and discussed based on theoretical references obtained by a literature review. The first case report refers to an adult patient whose IBD diagnosis was established after stomatological assessment. The second case was a patient with CD diagnosed in childhood with characteristic oral lesions.

Oral ulcers in children- a clinical narrative overview

“…Typically, Coeliac disease can present with multiple small ulcers with circumscribed margins and yellow/gray floors [ 26 ], additionally the child might complain about abdominal pain, bloating or diarrhea. The same manifestations or angular cheilitis, perioral erythema and labial swelling can be induced by an inflammatory bowel disease (Crohn’s disease, ulcerative colitis or undefined colitis) [ 27 ].…”

Oral manifestations of autoinflammatory and autoimmune diseases

“…Inflammatory bowel disease is a chronic inflammatory condition that consists of two main subsets; namely, Crohn's disease (CD) and ulcerative colitis. This review discusses CD (37). CD is a multifactorial condition with still insufficiently clear connections between genetic susceptibility, autoimmunity, and environmental triggers (2).…”

“…However, despite various studies, it is not yet clear why oral lesions occur only in some patients, although it seems that extraintestinal manifestations occur because of sharing common epitopes with inflamed intestinal mucosa (2,38). Oral changes can precede intestinal involvement or occur simultaneously, but they generally appear after intestinal involvement (37,38). Patients can develop changes specific to CD; for example, painless swollen lips, fissuring of the tongue and lips, cobblestone appearance of hyperplastic mucosa, deep linear ulcers mainly in the buccal vestibule, mucogingivitis, and, due to fibrosis, mucosal tags, nodules, or polyps (2,12,38).…”

“…Patients can develop changes specific to CD; for example, painless swollen lips, fissuring of the tongue and lips, cobblestone appearance of hyperplastic mucosa, deep linear ulcers mainly in the buccal vestibule, mucogingivitis, and, due to fibrosis, mucosal tags, nodules, or polyps (2,12,38). Although these alterations are characteristic of CD, they do not coincide with its dynamics (37). It should be emphasized that non-specific changes due to complications caused by nutritional deficiencies, side effects of prescribed drugs, and chronic inflammation are also possible (38).…”

“…It should be emphasized that non-specific changes due to complications caused by nutritional deficiencies, side effects of prescribed drugs, and chronic inflammation are also possible (38). Among other things, in the group of non-specific lesions there are aphthous ulcers, angular cheilitis, pyostomatitis vegetans, persistent submandibular lymphadenopathy, lichenoid reactions, EM, SJS, glossitis, depapillation of the tongue, halitosis, dental erosion and caries, periodontal disease, spontaneous bleeding, oppor- tunistic infections, mucosal atrophy, perioral erythema, pale mucosa, gingival hyperplasia, stomatitis, erosions, and ulcerations, whereas symptoms sometimes described include odynophagia, dysphagia, tongue pain, taste disturbances, and a burning sensation (37,38). Moreover, xerostomia often occurs secondary to the involvement of minor salivary glands, or chronic inflammation may cause obstruction of the salivary ducts with subsequent consequences (38).…”