Mouth Sores and Other Oral Symptoms

Although the primary location of inflammation is the intestinal tract, inflammatory bowel diseases like Crohn’s disease and ulcerative colitis can cause mouth sores and other oral problems. Signs of oral inflammatory bowel disease (IBD) include lesions, white tags, cracks, graininess, swelling, and redness.1 These changes can occur anywhere in the mouth, including the lips, cheeks, and gums. Sometimes the mouth sores look a lot like the damage to the intestinal lining. These kinds of sores are rare.

Malnutrition and medications can cause oral symptoms in people with IBD. A severe deficiency of B vitamins can cause inflammation or soreness in the mouth and tongue.2 Budesonide, a corticosteroid used to treat IBD, can cause the tongue to swell.2 Inflammation of the mouth is a side effect of mesalamine, sulfasalazine, and methotrexate.

The sores may or may not be painful. For some people, they interfere with eating and drinking. Acidic, spicy, or hot foods may be particularly difficult to eat.3 Sores come and go. Interestingly, oral flares do not necessarily happen at the same time as intestinal flares.4 Mouth sores affect up to 30% of people with inactive IBD.1

What other conditions can cause mouth sores?

Mouth sores are one of the main symptoms of Behçet’s disease.5 Behçet’s disease is a rare autoimmune disease that causes inflammation of the blood vessels. This disorder affects various different parts of the body.5

Other causes of mouth sores are:3,6

  • Viral infection
  • Other autoimmune diseases
  • Blood disorders
  • Cancerous growths

How common are mouth sores?

No one knows how common mouth sores are in people with IBD. Studies report estimates ranging from 20% to 50% of patients. Mouth sores are more common in people with Crohn’s disease than ulcerative colitis, and children are more likely to have mouth sores than adults. Men and boys are more likely to have them than girls and women.1 Mouth sores are more likely if you also have inflammation in your esophagus or around your anus.4

How are mouth sores evaluated?

For about 5% to 10% of people with IBD, mouth sores are the first symptom that they notice.1

A tissue sample (biopsy) may be taken from affected areas. It will be examined for signs of inflammation and infection. Some mouth sores form when inflammatory cells collect in one spot. These are called “granulomas.” Having a granuloma is sign that the ulcer has been caused by Crohn’s disease.1

How are mouth sores treated?

Mouth sores are not always painful. Many times, the medications that you take to treat inflammation in the intestine will also treat mouth sores.1 However, if the mouth sores bother you, there are also medications that treat them directly.1 Some medications come as topical creams that are applied right to the ulcer. Others are “swish and spit” solutions.6

Written by: Sarah O'Brien and Emily Downward | Last Reviewed: January 2018.
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