The impact of IBD on teeth

Current research suggests that people with Crohn's disease and ulcerative colitis are more likely to undergo dental procedures than a healthy person. This includes; dentures, front teeth fillings, fillings in the canines and incisors, and endodontic treatment (generally involving root canal treatment).

These associations mainly appear to be related to the development of tooth decay, gum disease, and other loosely related conditions through other risk factors associated with the development of IBD.


Here’s how IBD might contribute:

Malnutrition

Malnutrition is pretty common in people with Crohn’s disease or ulcerative colitis. The inflammatory process or scarring in the intestine often means that we have higher nutritional requirements – due to malabsorption.
 
Restrictive diets, malabsorption, and surgery, often result in vitamin deficiencies. The most common being B12, magnesium, potassium, vitamin D, selenium, and zinc. These deficiencies can lead to oral health issues such as oral lesions, glossitis (inflammation of the tongue) and stomatitis (inflammation of the mouth and lips).
 
Vitamin A deficiency causes tooth brittleness, and a lack of vitamin D results in poor absorption of minerals like calcium and phosphorus, which is vital for enamel strength. These deficiencies might cause teeth to chip more easily.

Dietary limitations and aiming to maintain weight often mean that we lean towards a high sugar diet, which obviously also impacts our teeth.

Treatments

Medications usually work on preventing the immune system from attacking itself, subsequently reducing the body's ability to fight infection, which is an important consideration in an oral health context.

Prolonged use of prednisone can cause osteoporosis, which can lead to loss of the bone that supports your teeth. It may also reduce the calcium in your teeth which can ultimately lead to tooth decay.

Symptoms

Dehydration and periods of vomiting whilst in a flare can cause acid damage, leading to enamel erosion and brittle teeth.

Acid reflux can also be an issue for people with IBD, resulting in an extra acidic mouth. This will also contribute to enamel erosion (as do acidic drinks; fruit juice, carbonated drinks, and lemon water). An acidic mouth also creates the perfect environment for plaque, which can cause gum disease and gingivitis. If gingivitis isn’t treated, a condition called periodontitis can develop. This affects the tissues that support teeth and hold them in place. If periodontitis is not treated, the bone in your jaw may be damaged and small spaces can open up between the gum and teeth. The teeth can become loose and may eventually fall out. It can also cause painful abscesses and receding gums.

Medications and pain can result in the grinding or clenching or teeth, both of which can cause the enamel to wear away.

Fatigue, pain, and depression, might additionally, impact how well we look after our teeth.

Research concludes that it’s reasonable to assume that the inflammatory response is the leading factor for the increased risk for periodontitis in people with IBD, but it’s also been linked to the oral microbiota.