The mouth in inflammatory bowel disease and aspects of orofacial granulomatosis

Abstract

Inflammatory bowel disease has a wide range of possible oral manifestations, many of which overlap with those seen in other conditions, including orofacial granulomatosis. The precise etiology remains unclear, as is the exact relationship between orofacial granulomatosis and Crohn's disease. Overall, there is growing evidence that orofacial granulomatosis and oral Crohn's disease are distinct clinical disorders with optimal management requiring a multidisciplinary approach with input from appropriate specialists in oral medicine, gastroenterology, allergy, dietetics, and clinical psychology. This review details the etiopathogenesis, clinical presentation, epidemiology, extra‐intestinal, and oral manifestations of inflammatory bowel disease and orofacial granulomatosis. It also assesses the current role of investigations in the diagnosis of orofacial granulomatosis and critically reviews the available evidence in relation to medical and surgical interventions for the condition, and its relationship to Crohn's disease.

Painless lip swelling in a child

“…Crohn's disease is a systemic inflammatory condition that most commonly affects the small bowel and colon, typically presenting with abdominal pain, diarrhea, weight loss, and poor appetite 1 . Additionally, Crohn's disease can have various oral findings including cobblestoning of mucosa, mucosal tags, deep linear ulcerations, and labial swelling 2 . Clinically, labial enlargement during the early course of the disease can occur as recurrent episodes lasting a few days or weeks, which over time, becomes persistently firm and indurated 3 .…”

Nonneoplastic diseases and disorders of the oral mucosa: A contemporary overview

“…It is therefore no surprise that diseases which primarily affect other parts of the gut often involve the oral mucosa. Hulla and Escudier describe inflammatory bowel diseases and their oral manifestations in great detail, including epidemiology, oral manifestations, diagnosis and management. Crohn's disease and ulcerative colitis have significant oral manifestations which may be the first to appear: hence dentists may initiate the diagnostic process and are called upon for treatment in symptomatic cases.…”

Orofacial granulomatosis: a questionnaire study among Norwegian dental clinicians

“…It is not possible to distinguish between OFG and oral CD either clinically or histopathologically. However immunological differences are though reported (Freysdottir et al 2007 ; Zbar et al 2012 ), and recent findings showed that there may be similar phenotypic characteristics despite different genetic characteristics and a different composition of the inflammatory infiltrate (Gale et al 2014 ; Gale et al 2015 ; Hullah and Escudier 2019 ).…”

“…The aetiology of OFG and CD is still unknown, but studies indicate a multifactorial origin (Tilakaratne et al 2008 ; Grave et al 2009 ; Al-Hamad et al 2015 ; Gale et al 2015 ; Hullah and Escudier 2019 ). In OFG, allergy or hypersensitivity may be a causative factor, since both atopy and contact hypersensitivity are observed in several OFG patients (James et al 1986 ; Armstrong et al 1997 ; Wray et al 2000 ; Fitzpatrick et al 2011 ; Campbell et al 2013 ; Patel et al 2013 ).…”

“…In CD, although the aetiology is not known, it probably occurs as an inappropriate immune response to an environmental stimulus in a genetically susceptible person (Hullah and Escudier 2019 ). Intestinal microbial dysbiosis may also play a role where the gut immune response may be altered by both antibiotic use and dietary changes (Ananthakrishnan 2015 ; Bernstein 2017 ).…”