O What do dentists need to know about Crohn's disease?
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Published:
Jan 7, 2022
Keywords:
Periodontal disease, Inflammatory bowel disease, Crohn's disease, Oral manifestations, Inflammation
Main Article Content
Abstract
Crohn's disease is described as a highly complex inflammatory bowel disease, characterized by transmural lesions and inflammation that may involve any site of the gastrointestinal tract. Crohn's disease may present oral manifestations such as mucosal lesions, changes in saliva and periodontal involvement. For this review article, a literature search was performed in the PubMed, Scielo and academic Google databases, from 2010 to 2020, using keywords taken from health science descriptors. Oral lesions were described as affecting 46.75% of young patients and 22% of elderly patients with Crohn's disease. These lesions may be uncomfortable, persistent and difficult to treat. They may present several clinical aspects such as: linear or aphthous ulcerations, mucosal nodularities and granulomatous cheilitis. These lesions are directly related to the disease, however some injuries may appear as complications of Crohn's disease or as adverse effects of treatment. Oral manifestations may be the first symptoms of Crohn's disease. Thus, the recognition of their clinical aspects can contribute to the early diagnosis of the condition. Dentists should be able to recognize, diagnose and treat the oral manifestations of Crohn's disease, improving patient's prognosis.
Article Details
How to Cite
de Araújo Chagas, F. G., Thomé Leão, A. T., & Regina Torres, S. (2022). O What do dentists need to know about Crohn’s disease?. Naval Dental Jounal, 48(2). Retrieved from http://portaldeperiodicos.marinha.mil.br/index.php/odontoclinica/article/view/2176
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Literature Reviews
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
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Hullah EA, Escudier MP. The mouth in inflammatory bowel disease and aspects of orofacial granulomatosis. Periodontol 2000. 2019 Jun;80(1):61-76.
Lira-Junior R, Figueredo CM. Periodontal and inflammatory bowel diseases: Is there evidence of complex pathogenic interactions? World J Gastroenterol. 2016 Sep 21;22(35):7963-72.
Neurath MF. Cytokines in inflammatory bowel disease. Nat Rev Immunol. 2014 May;14(5):329-42.
Dutta AK, Chacko A. Influence of environmental factors on the onset and course of inflammatory bowel disease. World J Gastroenterol. 2016 Jan 21;22(3):1088-100.
Barta Z. Apical Periodontitis in Patients With Inflammatory Bowel Disease: A Puppet Master? Inflamm Bowel Dis. 2020 Jan 6;26(2):280-282.
Brito F, Zaltman C, Carvalho AT, Fischer RG, Persson R, Gustafsson A, Figueredo CM. Subgingival microflora in inflammatory bowel disease patients with untreated periodontitis. Eur J Gastroenterol Hepatol. 2013 Feb;25(2):239-45.
Muhvić-Urek M, Tomac-Stojmenović M, Mijandrušić-Sinčić B. Oral pathology in inflammatory bowel disease. World J Gastroenterol. 2016 Jul 7;22(25):5655-67.
Hovde Ø, Moum BA. Epidemiology and clinical course of Crohn's disease: results from observational studies. World J Gastroenterol. 2012 Apr 21;18(15):1723-31.
Rosen MJ, Dhawan A, Saeed SA. Inflammatory Bowel Disease in Children and Adolescents. JAMA Pediatr. 2015 Nov;169(11):1053-60.
Salek H, Balouch A, Sedghizadeh PP. Oral manifestation of Crohn's disease without concomitant gastrointestinal involvement. Odontology. 2014 Jul;102(2):336-8.
Rowland M, Fleming P, Bourke B. Looking in the mouth for Crohn's disease. Inflamm Bowel Dis. 2010 Feb;16(2):332-7.
Stein JM, Lammert F, Zimmer V, Granzow M, Reichert S, Schulz S, Ocklenburg C, Conrads G. Clinical periodontal and microbiologic parameters in patients with Crohn's disease with consideration of the CARD15 genotype. J Periodontol. 2010 Apr;81(4):535-45.
Mays JW, Sarmadi M, Moutsopoulos NM. Oral manifestations of systemic autoimmune and inflammatory diseases: diagnosis and clinical management. J Evid Based Dent Pract. 2012 Sep;12(3 Suppl):265-82
Woo VL. Case Report Oral Manifestations of Crohn’s Disease: A Case Report and Review of the Literature. Hindawi. 2015 Sep; Available from: http://dx.doi.org/10.1155/2015/830472.
Padmavathi B, Sharma S, Astekar M, Rajan Y, Sowmya G. Oral Crohn's disease. J Oral Maxillofac Pathol. 2014 Sep;18(Suppl 1):S139-42
Law ST, Li KK. Age-related differences in the clinical course of Crohn's disease in an Asian population: a retrospective cohort review. Indian Pediatr. 2013 Dec;50(12):1148-52.
Docktor MJ, Paster BJ, Abramowicz S, Ingram J, Wang YE, Correll M, Jiang H, Cotton SL, Kokaras AS, Bousvaros A. Alterations in diversity of the oral microbiome in pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2012 May;18(5):935-42.
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Carolino F, Fernandes M, Plácido JL. Melkersson-Rosenthal syndrome - delay in the diagnosis of an early-onset oligosymptomatic variant. Porto Biomed J. 2016 Mar-Apr;1(1):43-45.
Lankarani KB, Sivandzadeh GR, Hassanpour S. Oral manifestation in inflammatory bowel disease: a review. World J Gastroenterol. 2013 Dec 14;19(46):8571-9.
Kim SK, Lee ES. Orofacial granulomatosis associated with Crohn's disease. Ann Dermatol. 2010 May;22(2):203-5.
Adegun OK, Zou L, Willis A, Fortune F. Facial biometrics: a novel technique for evaluation of morphological changes in orofacial Crohn's disease. BMJ Case Rep. 2013 Nov 20;2013:bcr2013010460.
Jennings VC, Williams L, Henson S. Orofacial granulomatosis as a presenting feature of Crohn's disease. BMJ Case Rep. 2015 Jan 9;2015:bcr2013203005.
Gale G, Ostman S, Saalman R, Telemo E, Jontell M, Hasséus B. Immunophenotype in orofacial granulomatosis with and without Crohn's disease. Med Oral Patol Oral Cir Bucal. 2014 Nov 1;19(6):e584-591.
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Trikudanathan G, Venkatesh PG, Navaneethan U. Diagnosis and therapeutic management of extra-intestinal manifestations of inflammatory bowel disease. Drugs. 2012 Dec 24;72(18):2333-49.
Nico MM, Hussein TP, Aoki V, Lourenço SV. Pyostomatitis vegetans and its relation to inflammatory bowel disease, pyoderma gangrenosum, pyodermatitis vegetans, and pemphigus. J Oral Pathol Med. 2012 Sep;41(8):584-8.
Gheisari M, Zerehpoosh FB, Zaresharifi S. Pyodermatitis-pyostomatitis vegetans: a case report and review of literature. Dermatol Online J. 2020 May 15;26(5).
Pereira MS, Munerato MC. Oral Manifestations of Inflammatory Bowel Diseases: Two Case Reports. Clin Med Res. 2016 Mar;14(1):46-52.
de Vries SAG, Tan CXW, Bouma G, Forouzanfar T, Brand HS, de Boer NK. Salivary Function and Oral Health Problems in Crohn's Disease Patients. Inflamm Bowel Dis. 2018 May 18;24(6):1361-1367.
Hopcraft MS, Tan C. Xerostomia: an update for clinicians. Aust Dent J. 2010 Sep;55(3):238-44.
Fernandez-Gutierrez MM, Imangaliyev S, Prodan A, Loos BG, Keijser BJF, Kleerebezem M. A salivary metabolite signature that reflects gingival host-microbe interactions: instability predicts gingivitis susceptibility. Sci Rep . 2020 Jan;10, 3008. https://doi.org/10.1038/s41598-020-59988-z
Singhal S, Dian D, Keshavarzian A, Fogg L, Fields JZ, Farhadi A. The role of oral hygiene in inflammatory bowel disease. Dig Dis Sci. 2011 Jan;56(1):170-5.
Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018 Jun;45 Suppl 20:S1-S8.
Hegab, M.M. and Abdelkawy, M. 2020. Classification of Periodontal Diseases – Old is Gold or New is Bold? A Survey Study in Egypt. Perio J. 2020 Jun;4, 1, 11–23.
Garlet GP. Destructive and protective roles of cytokines in periodontitis: a re-appraisal from host defense and tissue destruction viewpoints. J Dent Res. 2010 Dec;89(12):1349-63.
Gasner NS, Schure RS. Periodontal Disease. 2020 May 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 32119477.
Johannsen A, Fored MC, Håkansson J, Ekbom A, Gustafsson A. Consumption of dental treatment in patients with inflammatory bowel disease, a register study. PLoS One. 2015 Aug 12;10(8):e0134001.
Wisam Sbeit, Anas Kadah, Mahmud Mahamid, Hala Karayanni, Amir Mari, Shani Tali, Samer Srouji, Tawfik Khoury, Oral manifestations of inflammatory bowel disease: the neglected piece of the puzzle, European Journal of Gastroenterology & Hepatology. 2020, 32, 11, (1422-1431).
Hullah EA, Escudier MP. The mouth in inflammatory bowel disease and aspects of orofacial granulomatosis. Periodontol 2000. 2019 Jun;80(1):61-76.
Lira-Junior R, Figueredo CM. Periodontal and inflammatory bowel diseases: Is there evidence of complex pathogenic interactions? World J Gastroenterol. 2016 Sep 21;22(35):7963-72.
Neurath MF. Cytokines in inflammatory bowel disease. Nat Rev Immunol. 2014 May;14(5):329-42.
Dutta AK, Chacko A. Influence of environmental factors on the onset and course of inflammatory bowel disease. World J Gastroenterol. 2016 Jan 21;22(3):1088-100.
Barta Z. Apical Periodontitis in Patients With Inflammatory Bowel Disease: A Puppet Master? Inflamm Bowel Dis. 2020 Jan 6;26(2):280-282.
Brito F, Zaltman C, Carvalho AT, Fischer RG, Persson R, Gustafsson A, Figueredo CM. Subgingival microflora in inflammatory bowel disease patients with untreated periodontitis. Eur J Gastroenterol Hepatol. 2013 Feb;25(2):239-45.
Muhvić-Urek M, Tomac-Stojmenović M, Mijandrušić-Sinčić B. Oral pathology in inflammatory bowel disease. World J Gastroenterol. 2016 Jul 7;22(25):5655-67.
Hovde Ø, Moum BA. Epidemiology and clinical course of Crohn's disease: results from observational studies. World J Gastroenterol. 2012 Apr 21;18(15):1723-31.
Rosen MJ, Dhawan A, Saeed SA. Inflammatory Bowel Disease in Children and Adolescents. JAMA Pediatr. 2015 Nov;169(11):1053-60.
Salek H, Balouch A, Sedghizadeh PP. Oral manifestation of Crohn's disease without concomitant gastrointestinal involvement. Odontology. 2014 Jul;102(2):336-8.
Rowland M, Fleming P, Bourke B. Looking in the mouth for Crohn's disease. Inflamm Bowel Dis. 2010 Feb;16(2):332-7.
Stein JM, Lammert F, Zimmer V, Granzow M, Reichert S, Schulz S, Ocklenburg C, Conrads G. Clinical periodontal and microbiologic parameters in patients with Crohn's disease with consideration of the CARD15 genotype. J Periodontol. 2010 Apr;81(4):535-45.
Mays JW, Sarmadi M, Moutsopoulos NM. Oral manifestations of systemic autoimmune and inflammatory diseases: diagnosis and clinical management. J Evid Based Dent Pract. 2012 Sep;12(3 Suppl):265-82
Woo VL. Case Report Oral Manifestations of Crohn’s Disease: A Case Report and Review of the Literature. Hindawi. 2015 Sep; Available from: http://dx.doi.org/10.1155/2015/830472.
Padmavathi B, Sharma S, Astekar M, Rajan Y, Sowmya G. Oral Crohn's disease. J Oral Maxillofac Pathol. 2014 Sep;18(Suppl 1):S139-42
Law ST, Li KK. Age-related differences in the clinical course of Crohn's disease in an Asian population: a retrospective cohort review. Indian Pediatr. 2013 Dec;50(12):1148-52.
Docktor MJ, Paster BJ, Abramowicz S, Ingram J, Wang YE, Correll M, Jiang H, Cotton SL, Kokaras AS, Bousvaros A. Alterations in diversity of the oral microbiome in pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2012 May;18(5):935-42.
Ribaldone DG, Brigo S, Mangia M, Saracco GM, Astegiano M, Pellicano R. Oral Manifestations of Inflammatory Bowel Disease and the Role of Non-Invasive Surrogate Markers of Disease Activity. Medicines (Basel). 2020 Jun 16;7(6):33.
Carolino F, Fernandes M, Plácido JL. Melkersson-Rosenthal syndrome - delay in the diagnosis of an early-onset oligosymptomatic variant. Porto Biomed J. 2016 Mar-Apr;1(1):43-45.
Lankarani KB, Sivandzadeh GR, Hassanpour S. Oral manifestation in inflammatory bowel disease: a review. World J Gastroenterol. 2013 Dec 14;19(46):8571-9.
Kim SK, Lee ES. Orofacial granulomatosis associated with Crohn's disease. Ann Dermatol. 2010 May;22(2):203-5.
Adegun OK, Zou L, Willis A, Fortune F. Facial biometrics: a novel technique for evaluation of morphological changes in orofacial Crohn's disease. BMJ Case Rep. 2013 Nov 20;2013:bcr2013010460.
Jennings VC, Williams L, Henson S. Orofacial granulomatosis as a presenting feature of Crohn's disease. BMJ Case Rep. 2015 Jan 9;2015:bcr2013203005.
Gale G, Ostman S, Saalman R, Telemo E, Jontell M, Hasséus B. Immunophenotype in orofacial granulomatosis with and without Crohn's disease. Med Oral Patol Oral Cir Bucal. 2014 Nov 1;19(6):e584-591.
Antunes H, Patraquim C, Baptista V, Silva Monteiro L. Oral manifestations of Crohn's disease. BMJ Case Rep. 2015 Oct 28;2015:bcr2015212300. doi: 10.1136/bcr-2015-212300. Erratum in: BMJ Case Rep. 2015;2015. pii: bcr2015212300corr1. doi: 10.1136/bcr-2015-212300corr1. PMID: 26511994; PMCID: PMC4636709.
Trikudanathan G, Venkatesh PG, Navaneethan U. Diagnosis and therapeutic management of extra-intestinal manifestations of inflammatory bowel disease. Drugs. 2012 Dec 24;72(18):2333-49.
Nico MM, Hussein TP, Aoki V, Lourenço SV. Pyostomatitis vegetans and its relation to inflammatory bowel disease, pyoderma gangrenosum, pyodermatitis vegetans, and pemphigus. J Oral Pathol Med. 2012 Sep;41(8):584-8.
Gheisari M, Zerehpoosh FB, Zaresharifi S. Pyodermatitis-pyostomatitis vegetans: a case report and review of literature. Dermatol Online J. 2020 May 15;26(5).
Pereira MS, Munerato MC. Oral Manifestations of Inflammatory Bowel Diseases: Two Case Reports. Clin Med Res. 2016 Mar;14(1):46-52.
de Vries SAG, Tan CXW, Bouma G, Forouzanfar T, Brand HS, de Boer NK. Salivary Function and Oral Health Problems in Crohn's Disease Patients. Inflamm Bowel Dis. 2018 May 18;24(6):1361-1367.
Hopcraft MS, Tan C. Xerostomia: an update for clinicians. Aust Dent J. 2010 Sep;55(3):238-44.
Fernandez-Gutierrez MM, Imangaliyev S, Prodan A, Loos BG, Keijser BJF, Kleerebezem M. A salivary metabolite signature that reflects gingival host-microbe interactions: instability predicts gingivitis susceptibility. Sci Rep . 2020 Jan;10, 3008. https://doi.org/10.1038/s41598-020-59988-z
Singhal S, Dian D, Keshavarzian A, Fogg L, Fields JZ, Farhadi A. The role of oral hygiene in inflammatory bowel disease. Dig Dis Sci. 2011 Jan;56(1):170-5.
Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018 Jun;45 Suppl 20:S1-S8.
Hegab, M.M. and Abdelkawy, M. 2020. Classification of Periodontal Diseases – Old is Gold or New is Bold? A Survey Study in Egypt. Perio J. 2020 Jun;4, 1, 11–23.
Garlet GP. Destructive and protective roles of cytokines in periodontitis: a re-appraisal from host defense and tissue destruction viewpoints. J Dent Res. 2010 Dec;89(12):1349-63.
Gasner NS, Schure RS. Periodontal Disease. 2020 May 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 32119477.
Johannsen A, Fored MC, Håkansson J, Ekbom A, Gustafsson A. Consumption of dental treatment in patients with inflammatory bowel disease, a register study. PLoS One. 2015 Aug 12;10(8):e0134001.