Complications of Crohn’s disease can include gum inflammation and sometimes cavities, but the most common are mouth sores — the same aphthous ulcers, or canker sores, that many people get every now and then, explains Paul Casamassimo, DDS, a member of the section of dentistry at Nationwide Children’s Hospital in Columbus, Ohio. Common trouble spots are between the lower lip and gums, under or on the edges or base of the tongue, and inside the cheeks. A number of factors can trigger the development of canker sores, including certain toothpastes, foods containing lactose, and acidic fruits and vegetables, Dr. Casamassimo says. “Stress and hormonal changes can trigger sores for some people,” he continues. “Gastroesophageal reflux disease, or GERD, is another reported association. Injury to the soft tissue in the mouth, from aggressive tooth brushing or cheek biting, can also manifest as an ulcer.” Mouth sores are also associated with a number of serious diseases, including Crohn’s. According to a 2015 review published in the journal Alimentary Pharmacology and Therapeutics, as many as 50 percent of people living with Crohn’s develop oral lesions, with canker sores being the most common type. Experts say there are several reasons for this. “Crohn’s disease itself could involve the oral cavity, including the gums or the pharynx, in addition to the lips,” says Ghassan T. Wahbeh, MD, director of the inflammatory bowel disease center at Seattle Children’s Hospital and an associate professor of pediatrics and gastroenterology at the University of Washington School of Medicine in Seattle. “There are also certain medications that could lead to oral ulcerations — for example, methotrexate — if given without adequate folic acid supplementation.” Immunity problems and infections are other likely reasons. With Crohn’s disease, mouth sores are typically at their worst during a severe flare-up. Sometimes the sores may be the only sign of the disease. The good news? Once other Crohn’s symptoms subside, so do the mouth ulcers. Gum problems, such as swollen or bleeding gums, can be another complication of Crohn’s and may be the result of poor nutrition. Bleeding gums may also be a sign of abnormal blood counts, which in rare cases may be a side effect of certain medications, Dr. Wahbeh says. Getting the right vitamins and minerals in your diet is crucial to good overall health and oral health, but the combination of Crohn’s and mouth problems can leave you with little appetite or interest in eating. You might need to work harder on the quality of your diet because the consequences of Crohn’s can prevent your body from taking advantage of all the nutrients in the foods you eat. Instead, food is moved through your system without being fully digested. If you have persistent canker sores, your dentist and gastroenterologist can work together to help you manage the symptoms with relatively simple treatment options. “These might include oral rinses aimed at preventing bacterial superinfection or local anesthetics to temporarily stop pain and allow eating,” Casamassimo says. “Even ice water can temporarily ease pain and facilitate eating or just provide comfort.” Besides seeking immediate relief, look at the big picture, too. Working to control Crohn’s— to prevent flares and, in turn, mouth problems — should be your ultimate goal. Stick to your Crohn’s treatment plan and a diet that focuses on balanced nutrition, says Wahbeh. If you’re not sure you’re getting the most nutrition from the foods you normally eat, talk to a dietitian, a key member of an inflammatory bowel disease medical team, he says. Finally, as part of living a healthy Crohn’s lifestyle, drink plenty of water throughout the day to stay hydrated, avoid greasy and fried foods, and eat smaller meals more often if that makes you feel better. If mouth problems persist, ask your doctor if vitamin supplements will help you get all the nutrients your body and mouth need to stay healthy. Additional reporting by Ashley Welch.
