Gingival manifestation of Crohn’s disease in a paediatric patient: A case report

Abstract

Crohn's disease (CD) is a complex multisystemic inflammatory disorder and part of the inflammatory bowel diseases (IBDs). About 20% of the subjects affected by IBDs are paediatric patients and 21% of them present extraintestinal manifestations. Among the extraintestinal manifestations of CD, oral manifestations are rather frequent (20–50% of affected people) and can be difficult to identify, being frequently aspecific and not pathognomonic. Their early diagnosis by the dentist is extremely important, because extraintestinal manifestations can precede intestinal symptoms, in all patients but especially in children. The aim of this paper is to report the case of a CD adolescent patient that presented a gingival manifestation.

Oral Manifestations of Crohn’s Disease: A Systematic Review

“…Microscopically, we find chronic patchy and transmural inflammation, with an increase in plasma cells and lymphocytes, discontinuous irregularity of the crypts, but without rupture of the crypts, and the presence of non-caseating granulomas in the lamina propria. In oral biopsies of the reported cases, plasma cell and lymphocyte infiltrate and the presence of non-caseating granulomas of the lamina propria and submucosa were found in most of them [6,10,12,[14][15][16][17]19,20,22,23,25,28,30,34].…”

“…It is vitally important to know about them and the prevalence in which they occur. In the adult population, lesions are found in around 0-9%, while in children, they appear in around 50-80% of patients and may precede severe intestinal involvement in up to 42% of the latter [23,28,30,31]. Rarely have cases been reported where oral involvement was unique and unaccompanied by intestinal disease [14].…”

“…Periodontitis and vegetating pyostomatitis are non-specific manifestations that only some articles classify as such [23,27,30]. CD is one of the systemic conditions affecting the periodontium.…”

“…Regarding the location of the lesions mentioned, there is a predominance of lesions on the mucosa, especially on the lower lips and gums. Lesions are present in other less common locations, such as the soft palate, uvula, tongue, and pillars of the fauces [10][11][12][13][14][15][16][17][19][20][21][22][23][24][25][26][27][28]30,31].…”

“…The quality of the studies was medium, as many of them did not meet items 8b, 9c, 10c, 10d, and 12 referring to therapeutic intervention, follow-up, outcomes, and patient perspective. Only items 6-8 referring to timing, clinical findings, and diagnostic assessment were fulfilled by all items [10,12,14,17,23,25,28,30,31].…”