Crohn’s Disease and Periodontal Manifestations: A Review of Current Evidence

Author(s): Chariklia Neophytou, Giorgos Michalopoulos, Avra Maria Neofytou, Themis Theofylaktidou, Nikoleta Kagioglou, Konstantinos Papadimitriou

Objective: Crohn's disease (CD) is a chronic inflammatory bowel condition of unknown cause, with rising prevalence. Oral manifestations, ranging from 0.5% to 80% of cases, are frequently associated with the disease. This review examines the association between CD and periodontal disease, underlying mechanisms, and therapeutic strategies to improve oral and systemic health.

Methods: A review was conducted using the keywords ((Crohn’s disease OR inflammatory bowel disease) AND periodontal) across multiple databases. Relevant studies were analyzed to investigate the relationship between CD and periodontal health and identify effective treatments.

Results: Evidence suggests a bidirectional relationship between CD and periodontal disease. CD patients exhibit microbial dysbiosis, with significant similarities between oral and intestinal microbiomes. Elevated levels of cytokines like TNF-α, IL-1β, and IL-10 in oral fluids are correlated with poor periodontal outcomes (e.g., pocket depth, attachment loss) and increased CD severity. CD patients are about three times more likely to develop periodontal disease [OR = 3.64 (95% CI: 2.33–5.67)] and nearly eight times more prone to early implant failure [OR = 7.95 (95% CI: 3.47– 18.24)]. These findings emphasize the need for further large-scale studies to elucidate these interactions and refine management.

Conclusions: Effective CD management requires a multidisciplinary approach, combining pharmacotherapy, nutrition, psychological support, and regular monitoring. Anti-TNF agents are effective but need careful supervision. Dentists play a critical role in identifying oral manifestations as early indicators of CD. Collaborative care between medical and dental professionals is vital for early diagnosis, timely intervention, and improved patient outcomes.