Autoimmune Series Part 3: How Inflammatory Bowel Diseases can affect Oral Health

September 19, 2019

 

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

Image of the GI tract

IBD can affect any portion of the GI tract

 

There are a few differences between these two diseases, but both must be diagnosed by a physician. 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. Conversely, 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 etiology of IBD are not well known. Research points to environmental and genetic factors as 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 can be misdiagnosed. 

 

Symptoms:

-Persistent diarrhea

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

Kids and teens with IBD can feel different and might not be able to do the things their friends can do, especially during flare-ups. Some struggle with a poor self-image,depression, or anxiety. They may not take their medicine or follow their diet. It’s important to talk to your health care professional if you’re concerned about your child’s mood, behavior, or school performance.

IBD are different from IBS or Celiac disease. The similarity in symptoms can cause misdiagnosis which is why it’s important to seek a physician for correct diagnosis and treatment. 

IBD may cause aphthous ulcers in mouth.

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

Now that we know how IBD works, how can it affect our oral health? IBD can have several oral manifestations:

-Xerostomia (Dry Mouth): The salivary glands don’t produce enough saliva to keep the mouth moist and the pH of the oral cavity balanced. aliva in our mouths helps to wash away food debris and reduce plaque. As such, dry mouth can lead to severe tooth decay and gum disease if left untreated.

-Aphthous Ulcers: Canker sores, also called aphthous ulcers, are small, shallow lesions that develop on the soft tissues in your mouth or at the base of your gums. Unlike cold sores, canker sores don’t occur on the surface of your lips and they aren’t contagious. They can be painful, however, and can make eating, talking, and oral hygiene difficult.

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: Gingivitis is a reversible form of periodontal disease. Signs of gingivitis include red and puffy gums that bleed easily when the person brushes their teeth. Gingivitis often resolves with good oral hygiene, such as longer and more frequent brushing, and flossing. In addition, an antiseptic mouthwash may help.

Depending on which manifestations you’re experiencing your doctor and hygienist will tailor a treatment plan that best suits your needs. For example, if you’re experiencing frequent aphthous ulcers you may be prescribed a steroid cream to decrease length and frequency. Or if you suffer from xerostomia, we’ll discuss 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/

Mayo Clinic:

https://www.mayoclinic.org/diseases-conditions/canker-sore/symptoms-causes/syc-20370615

Medical News Today: 

https://www.medicalnewstoday.com/articles/241721.php

Kid’s Health:

https://kidshealth.org/en/parents/ibd.html

 


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