Crohn’s Disease Mouth Ulcers: Causes, Symptoms, and Treatment

Mouth Ulcers

Small, painful lumps referred to as mouth ulcers or canker sores (the name for a wide variety of mouth lesions) are the most common oral symptom of Crohn’s disease.

These sores are usually round or oval-shaped with a clear boundary and a gray or yellow center, surrounded by a reddish ring.

Canker sores from Crohn’s might at first appear similar to other mouth lesions like cold sores, and they can both be painful. But cold sores have a different cause — herpes simplex virus type 1 — and vary in the following ways:

Canker sores are not contagious; cold sores are.
Canker sores only appear inside the mouth; cold sores can also develop outside the mouth.
Canker sores show as a single, rounded sore; cold sores can also appear in clusters.

Some Crohn’s disease mouth ulcers don’t cause discomfort, while others may be painful enough to affect day-to-day life.

If you have canker sores without a Crohn’s diagnosis (for example, if they’re the first symptom you have), a physician may request a complete blood count, anemia testing, and screening to rule out celiac disease, or any other diseases.

Other Mouth Symptoms of Crohn’s Disease

Besides ulcers, changes in and around the mouth that may be due to Crohn’s include:

Angular cheilitis, which is cracked, red, sore skin at the corners of the mouth
Gingivitis, or gum inflammation that can lead to bleeding, swelling, and redness (one of the most common mouth symptoms of Crohn’s disease in children)
Foul-smelling breath
Abscesses, or pus-filled lumps, that keep growing back
Dental decay due to repeated vomiting
Red, scaly skin around the lips
Glossitis, or a swollen, inflamed tongue

Although these are the most common mouth symptoms of Crohn’s disease, a gastroenterologist might find it difficult to rely on them for a definitive diagnosis as they are signs of numerous conditions, not just Crohn’s.

Oral symptoms that are specific to Crohn’s disease include:

Inflammation and redness in the groove between the cheeks and gums, an area known as the sulcus
Long, narrow ulcers that often form straight lines in the gum, sulcus, and the insides of the cheeks
Scar tissue on the lining of the mouth, sometimes also including small, fleshy lumps in the mouth called mucosal tags

People with Crohn’s disease are likely to have oral symptoms at the back of the throat, as well as a higher risk of lip swelling. Identifying these two symptoms together could point towards a Crohn’s diagnosis.

These symptoms may sometimes occur along with raised levels of an inflammatory protein called C-reactive protein, which suggests high levels of gut inflammation characteristic of Crohn’s disease.

Causes and Risk Factors for Crohn’s Mouth Symptoms

A number of risk factors make a person more likely to experience oral symptoms of Crohn’s disease.

Age

Oral symptoms of Crohn’s disease are much more common in children than adults. Fewer than 1 percent of adults with Crohn’s develop mouth lesions; in children, the percentage is between 50 and 80 percent. In around 42 percent of children with Crohn’s disease, severe GI symptoms develop only after the appearance of mouth ulcers.

Certain Crohn’s Disease Medications

Crohn’s disease medications like methotrexate may cause mouth ulcers as a side effect. Taking folic acid supplements along with these medications may lower the risk of mouth ulcers.

Disease Flare-Ups

With Crohn’s, mouth sores typically develop during severe flare-ups.

They tend to improve with typical Crohn’s treatments.

How to Manage Crohn’s Disease Mouth Symptoms

Preventing and coping with mouth ulcers and other oral symptoms of Crohn’s disease can involve everything from prescription drugs to twice-a-day tooth-brushing.

Crohn’s Disease Medications

Crohn’s disease medications that help alleviate flares can also help relieve mouth symptoms.

?A gastroenterologist will put together a treatment plan for you that typically involves a range of medications, including:

Drugs that suppress immune activity, such as biologics
Steroids to reduce inflammation during flares
Pain medications

Treatments will vary from person to person, depending on symptoms.

Make sure you discuss any oral symptoms with your gastroenterologist so they can provide the appropriate care.

Medications and Home Treatments for Pain and Inflammation

Anyone with mouth ulcers that persist after three weeks should consider seeing a dentist or ear, nose, and throat doctor, who can then coordinate treatment with a gastroenterologist.

A dentist might prescribe the following:

Pain-relieving mouth rinses like lidocaine
Corticosteroid mouth rinses like dexamethasone to relieve inflammation and pain
Topical products like benzocaine (Anbesol, Kank-A, Orabase), fluocinonide (Lidex, Vanos), and hydrogen peroxide (Orajel Antiseptic Mouth Sore Rinse, Peroxyl) for applying to a canker sore as soon as it appears

Home remedies may also help relieve pain from mouth ulcers. These include:

Mouth rinse: Dissolve one teaspoon of baking soda in a half-cup of warm water or use salt water to rinse the mouth.
Milk of magnesia: Apply to the sore a few times every day.
Ice water: Hold some ice chips in your mouth on your sores to numb them.

Steer clear of spicy, acidic, or salty foods to reduce irritation on the mouth sores.

Everyday Oral Hygiene

Staying on top of oral hygiene is key for a healthy mouth, but people with Crohn’s disease mouth symptoms may have to take extra measures to keep their teeth and gums healthy.

This might include:

Brush twice a day using fluoride toothpaste.?Choose products that don’t contain sodium lauryl sulfate. A higher-fluoride toothpaste might be necessary to manage dental health, particularly if dry mouth is a common Crohn’s disease symptom for you.
Clean between the teeth daily.?Use floss, tape, or interdental brushes. Crohn’s disease can affect the joints, so people with joint issues or limited finger movement may want to try using a water flosser, which shoots mouthwash or water between the teeth to get rid of debris and plaque.
Quit or avoid smoking.?Smoking damages teeth and gums. Plus it can trigger Crohn’s flares and contribute to mouth cancer lesions, which might be mistaken for Crohn’s disease mouth ulcers.
Smoking might also reduce the effectiveness of some medications for Crohn’s disease by around half.

Yuying Luo, MD

Medical Reviewer

Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City.?She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

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Adam Felman

Author

Adam is a freelance writer and editor based in Sussex, England. He loves creating content that helps people and animals feel better. His credits include Medical News Today, Greatist, ZOE, MyLifeforce, and Rover, and he also spent a stint as senior updates editor for Screen Rant.

As a hearing aid user and hearing loss advocate, Adam greatly values content that illuminates invisible disabilities. (He's also a music producer and loves the opportunity to explore the junction at which hearing loss and music collide head-on.)

In his spare time, Adam enjoys running along Worthing seafront, hanging out with his rescue dog, Maggie, and performing loop artistry for disgruntled-looking rooms of 10 people or less.

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Canker sore. Mayo Clinic. April 3, 2018.
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