Crohn’s disease is a chronic inflammatory condition primarily known for affecting the digestive tract, causing symptoms like abdominal pain and diarrhea. However, this inflammation is systemic, meaning it can manifest in other areas of the body, including the mouth. Oral symptoms are common, affecting up to 60% of patients. These mouth sores and ulcers often serve as a visible indicator of inflammatory activity elsewhere in the body. In some cases, the presence of oral lesions can even precede the diagnosis of intestinal Crohn’s disease, particularly in children.
Specific Appearance of Oral Sores
The most common oral manifestation of Crohn’s disease is an aphthous-like ulcer. These closely resemble typical canker sores but often present with greater severity. They are typically oval or round, featuring a distinct gray or yellowish center surrounded by a raised red border. They vary in size, sometimes appearing as small lesions or coalescing into larger, more extensive ulcers.
A more specific presentation is the appearance of deep, linear ulcers, which are distinct from the usual rounded sores. These long, narrow lesions are frequently found in the fold where the cheek meets the gum (the vestibule or sulcus). Another characteristic feature is a “cobblestone” appearance on the inside of the cheeks. This describes raised, swollen, bump-like areas caused by chronic inflammation and tissue overgrowth.
A rarer, more severe form of oral inflammation is pyostomatitis vegetans. This condition presents as multiple yellow or white pustules set on a red base, which can rupture to form lesions sometimes described as “snail-track” ulcerations. The sores most often appear in clusters on the inside of the lips, cheeks, and on the tongue. Their presence usually correlates with a heightened state of disease activity.
How They Differ from Common Mouth Ulcers
While Crohn’s-related ulcers may initially look like standard canker sores, their underlying nature and clinical course set them apart. Common minor aphthous ulcers are usually shallow and heal relatively quickly, typically resolving within one to two weeks. Crohn’s-associated sores, however, are often larger, deeper, and cause more significant pain, interfering with eating and speaking.
A major distinguishing factor is the persistence and recurrence of the lesions, which coincide directly with inflammatory flares of the intestinal disease. While a common canker sore might be triggered by stress or minor trauma, Crohn’s mouth sores often signal increasing systemic disease activity. Furthermore, the location can be telling; standard canker sores rarely appear in the specific linear patterns or on the tongue characteristic of Crohn’s-related inflammation.
The Underlying Cause of Oral Symptoms
The appearance of these lesions is a direct consequence of the systemic inflammatory process that defines Crohn’s disease. The mouth sores are not localized infections but are considered extraintestinal manifestations. They are caused by the same overactive immune response that targets the gastrointestinal tract, mistakenly attacking the mucous membranes lining the mouth and leading to ulcers.
The body’s constant inflammatory state leads to a breakdown of the oral mucosa, making it a sensitive target for ulceration. Malabsorption is also a secondary mechanism contributing to the problem. Crohn’s disease can impair the body’s ability to absorb essential micronutrients, particularly iron, zinc, folate, and B vitamins. Deficiencies in these vitamins and minerals can independently contribute to the development of oral lesions, worsening the inflammatory damage.
Treatment and When to Consult a Doctor
Treatment for Crohn’s mouth sores involves a two-pronged approach addressing both local relief and the systemic cause. For immediate symptom management, topical treatments are commonly used, including prescription corticosteroid gels or analgesic rinses like lidocaine or dexamethasone elixir. These local therapies reduce pain and inflammation directly at the site of the ulcer, promoting faster healing.
For long-term resolution, the most effective treatment is managing the underlying Crohn’s disease activity with systemic therapy. Medications such as immunosuppressants or biologic drugs that control intestinal inflammation typically lead to the clearing of the oral ulcers. If the sores are suspected to be caused by a nutrient deficiency, a doctor may recommend specific supplements, such as iron or zinc, to address malabsorption.
It is important to consult a healthcare provider, such as a gastroenterologist or an oral medicine specialist, if the sores are persistent (lasting longer than three weeks) or if they significantly interfere with daily functions like eating and drinking. Medical advice is also warranted if the mouth sores are accompanied by other signs of increased disease activity, such as fever, abdominal pain, or weight loss. Consistent, painful, or unusual oral lesions may signal a need to adjust the current treatment regimen for the underlying Crohn’s disease.