Oral manifestation in inflammatory bowel disease: A review

Table 1 Summary of specific and non-specific oral lesions in Crohn’s disease

	Lesion	Relation with CD	Frequency	Treatment options
		activity
Specific oral lesions	Indurated tag-like lesions	No specific direct association reported	Common in OCD patients	See general points on the treatment of OCD in the text
	Cobblestoning	No specific direct association reported	Common in OCD patients	Topical steroids for less severe cases and systemic steroids for others
	Mucogingivitis	No specific direct association reported	Common in OCD patients	See general points on the treatment of OCD in the text
	Others:
	Lip swelling with vertical fissures	No specific direct association reported		Topical tacrolimus, intra-lesional injection of steroids, immunosuppressive agents
	Deep linear ulcerations			Topical analgesics, 5-ASA, or steroids, intra-lesional steroids, topical tacrolimus, other medications used in PV treatment
Non-specific oral lesions	Aphthous stomatitis	No specific direct association reported	10% of patients with UC and 20%-30% of those with CD	Topical agents (lidocaine 2%, triamcinolone 0.1%, dexamethasone elixir), non-steroidal anti-inflammatory pastes, systemic steroids, intra-lesional steroids
	Pyostomatitis vegetans	Associated with active CD	Rare	Antiseptic mouthwashes/topical steroids (though less effective), systemic steroids, azathioprine and sulfamethoxypyridazine, dapsone, cyclosporine A, injections of infliximab pursued by maintenance therapy with MTX, adalimumab, surgical colectomy in UC
	Others:
	Angular cheilitis	No specific direct association reported	Unknown	5-ASA mouthwashes, topical steroids (1% hydrocortisone), vitamin supplements, intra-lesional steroids
	Persistent submandibular lymphadenopathy			See general points on the treatment of OCD in the text
	Recurrent buccal abscesses			Antibiotics, infliximab, methotrexate, thalidomide
	Perioral erythema with scaling
	Glossitis

CD: Crohn’s disease; OCD: Oral Crohn’s disease; MTX: Methotrexate; UC: Ulcerative colitis.