Inflammatory bowel diseases also known as IBD, are a group of autoimmune diseases that result in chronic inflammation in the gastrointestinal (GI) tract. The 2 main diseases identified with this group are Crohn’s Disease and Ulcerative Colitis. Due to the chronic inflammation eventually damaging the GI tract, the resulting symptoms are often painful.

Image of the GI tract

IBD can affect any portion of the GI tract

Although symptoms are similar, there are several differences between these two diseases. Both must be diagnosed by gastroenterologist to avoid misdiagnosis. Crohn’s disease can take place anywhere along the GI tract, from the mouth to the anus. The most common area targeted is in the small intestine, just before the colon (ileum). These areas affected show up as patches of irritation next to healthy tissue and the inflammation may reach through multiple wall layers within the intestine. Ulcerative Colitis is localized to the colon and rectum. Unlike the patchy areas seen in Crohn’s, the damaged areas in Colitis are seen in a continuous pattern, typically moving upward from the rectum to the colon. Colitis is also only found in the innermost wall of the colon as opposed to affecting multiple layers. 

Like most autoimmune diseases the cause(s) of IBD are not well known. Research points to environmental and genetic factors being the likely causes. The result is an immune response that when triggered by environmental factors attacks the cells in the GI tract. The symptoms of IBD are similar between both Crohn’s and Colitis and many times can be misdiagnosed. 

Common Symptoms:

-Persistent diarrhea
-Abdominal pain
-Rectal bleeding/bloody stools
-Weight loss
-Fatigue

IBD are different from, Irritable Bowel Syndrome and Celiac disease. The similarity in symptoms can cause misdiagnosis which is why it’s important to seek a physician are a correct diagnosis and treatment. Now that we know how IBD can make us feel, how can it affect our oral health? IBD can have several oral manifestations:

IBD may cause aphthous ulcers in mouth.

Painful aphthous ulcer on inner lip. These can be a result of IBD.

-Xerostomia (Dry Mouth): The salivary glands don’t produce enough saliva to keep the mouth moist and the pH of the oral cavity balanced. This can result in rampant decay.

-Aphthous Ulcers: Also known as canker sores. Individuals with IBD may present with frequent or multiple ulcers. These lesions can make oral care more uncomfortable.

Mucosal Tags: Similar to skin tags, these can be seen as a result of Crohn’s Disease. They may appear on the inner cheek, and can be visualized by your dentist or hygienist. 

-Gingivitis: Reversible form of periodontal disease, is treated with good home care and professional hygiene visits. 

Depending on which manifestations you’re experiencing your doctor and hygienist will tailor a treatment plan that best suits your dental needs. For example, if you’re experiencing frequent aphthous ulcers we may prescribe a steroid cream to decrease length and frequency of them for you. Or if you suffer from xerostomia, we’ll discuss the best options to balance pH and decrease your risk for decay. As with all autoimmune diseases, the healthier we can keep your mouth the less effect it will have on your immune response. If you would like to discuss the impact your IBD may be having on your oral health, please feel free to mention it at your next visit!

Image of GI tract affected by Crohn's Disease

Crohn’s Disease most commonly affects the end of the small intestine and the beginning of the colon.

 

References

CDC: 

https://www.cdc.gov/ibd/what-is-IBD.htm

Today’s RDH:

https://www.todaysrdh.com/crohns-disease-and-its-effects-on-the-oral-cavity/

 

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