Oral complications in Crohn's disease and their relation with medication

Objectives: It has been well established that oral complications occur more frequently in patients with Crohn's Disease (CD) than in control subjects. Since conflicting data have been presented about the possible correlation between medication and frequency of oral lesions, the aim of the present study was to obtain data on the prevalence of oral lesions in patients with CD. Methods: An oral health questionnaire was sent to 1000 patients with CD, randomly selected from the members of the Crohn's and Ulcerative Colitis Association in the Netherlands. Results: 654 patients wit CD returned the questionnaire. 52.4 % of the individuals reported oral complaints during the previous year: bleeding gums (23.3%), inflamed gums (21.4%), aphthous ulcers (15.9%), xerostomia (10.7%), swollen gums (10.3%), cheilitis angularis (6.7%), taste alterations (6.1%), glossitis (2.9%), white aspect of the oral mucosa (2.8%), red spots on oral mucosa (1.1%) and other – spontaneously reported -oral problems (13.2%).

Current medication was reported by 80.4% of the individuals: mesalazine (59.6%), sulfasalazine (6.6%), olsalazine (0.5%), corticosteroids (26.5%), immunosuppressives (28.6 %), infliximab (4.6%), metronidazol (1.1%) and other medication, including nutritional supplements (23.3%). Compared with the 19.6% patients without medication, patients using sulfasalazine had a significantly increased incidence of xerostomia (chi-square-test p < 0.012) and an almost significant increased incidence of inflamed gums (p < 0.060). Patients using metronidazol suffered significantly more frequent from aphthous ulcers (p < 0.041). A white aspect of the oral mucosa showed a near significant increased incidence in patients using corticosteroids (p < 0.064). Patients using nutritional supplements reported an increased incidence of swollen gums (p < 0.037) and glossitis (p < 0.004).

Conclusion: The medication may affect the incidence of oral complications in patients with CD. These oral complications, which occur in spite of an ordinary oral hygiene standard, need special attention of gastroenterologists, dentists and dental hygienists.