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Title: Changes in oral cavity in relation to chosen cytokines in saliva from patients with Crohn’s disease


Crohn’s disease (CD) is a chronic inflammatory disease affecting all of the layers of the gastro-intestinal tract (GIT), that spreads locally, and is usually separated by non-changed parts of mucosa. The pathologic changes can be located in every part of GIT, from the oral cavity to the anus. CD is characterized by the remission and exacerbation periods. The changes in oral cavity may be found in every period of the disease, preceding other GIT changes for several years, coexisting with them from the initial diagnosis or fallow the GIT changes. Several pathologic changes have been described in CD, and were initially characterized in 1991 by Malins. The aim of the study was to examine in CD patients, both in the remission and exacerbation of the disease: 1) the frequency and character of pathologic changes in the oral cavity mucosa and dental status in clinical examination, 2) the amount of saliva production and characteristic of chosen inflammatory cytokines: IL-1beta, IL-6, IL-10; 3) the correlation of these cytokines with the activity of CD. The studied group consisted of 69 subjects. In this group 37 patients suffered from CD (aged 20-48 years) and 32 were healthy volunteers and were treated as a control group (HC; aged 18-45 years). Among many other tests, the general medical status, BMI, whole blood count, and biochemical parameters were analyzed. The CD patients were divided into two groups based on the Crohn’s disease activity index (CDAI). The active disease cut point was CDAI>150 points and the rest were treated as remission. In all subjects dental examination, including medical interview, and the assessment of DMF ( d-decayed, m-missing, f- filling) index was performed. Special precautions were undertaken to assess the pathologic changes previously described in CD. The saliva production was measured, and the production of cytokines IL-1beta, IL-6, IL-10 i TNF-alfa was estimated using the ELISA method. Statistical analysis was implemented based on the normality of the data distribution, and adequate statistical tests were used. In patients with active CD when compared to healthy controls (HC), there were statistically higher levels of leucocytes count, CRP, fibrinogen, and lower levels of erythrocytes, haemoglobin (Hgb), haematocrit (HCT) and albumins. The biochemical biomarkers typical for chronic inflammatory disease (ie. CRP, fibrinogen, albumin), the blood count parameters including platelets, statistically differed from patients with CD in remission. No differences were observed between groups in DMF, which means no increase tendency to caries was found in CD. The amount of sensitive changes in oral cavity, according to Malins et. al, was as follows: in 2 (5%) a diffused labial and buccal sweelings was observed, in 1 (3%) focal areas of mucosal inflammatory hyperplasia and fissuring (cobblestoning). Unsensitive changes were: in 3 ( 8%) unhealed oral ulcerations , in 3 (8%) aphtous ulcerations, in 4 ( 11%) gingivitis, in 4 ( 11%) midline lip fissuring, in 5 ( 13,5%) angular cheilitis , in 1 ( 3%) inflammation of the tongue and in 12 ( 32%) paleness of oral mucosa. The amount of saliva production in CD patients was 0,40 + 0,16 ml/min and did not differ depending on the activity of the disease nor to the HC group (0,36 + 0,14). The IL-6 in saliva of the CD patients was higher than in HC (12,09 + 9,33 i 4,41 + 4,79 pg/ml respectively; p=0,034) and was also increased in CD patients in exacerbation, when compared to CD in remission (13,85 + 9,26 vs 7,23 + 7,16 pg/ml respectively; p =0,047). The IL-10 in the saliva was lower in CD patients when compared to HC group ( 9,35 + 13,81 vs 23,70 + 16,50 pg/ml respectively; p=0,007) and did not differ inside CD group, when activity of the disease was taken into account. The TNF-alfa level in saliva of the CD patients was higher, when compared to HC (30,56 + 21,28 vs 6,80 + 1,80 pg/ml respectively; p=0,018). ; A statistical positive correlation between the BMI, HgB, HCT, CRP, fibrinogen, platelet count and albumins level and pathological changes in the oral cavity of the CD patients was observed. No association between the CDAI and pathological changes in oral cavity in CD patients was found. Obtained results show clear interaction of the increased IL-6 level in the saliva with the oral cavity pathological changes, and this correlation was also true for TNF-alfa, however not so obvious (positive Pearson and tau-Kendall correlations). No correlation was observed between the saliva production, DMF and oral cavity pathological changes in patients with CD. In summary, a special attention should be paid in clinical examination of the oral cavity in CD patients, while 3-5% of these adult patients (and even more according to other authors) may have pathological findings. These changes may precede the typical GIT manifestation of the disease, and if accurately diagnosed may help in establishing the diagnosis and starting the proper treatment, and therefore to prevent concomitant exacerbations of the disease. In this performed study on CD patients, both in exacerbation and in clinical remission some important clinical outcomes were found, namely: 1) the oral cavity pathological changes were found in CD patients, and among them the non specific changes were more common; 2) the saliva production did not differ among the CD patients and HC. No differences were neither observed, when the CD patients were divided according to the disease activity; 3) the proinflammatory cytokines: IL-6 and TNF-alfa were increase in the CD patients when compared to HC, and IL-6 level was higher in the active phase of the CD when compared to remission. The IL-10 level in CD patients both in remission and exacerbation was lower than in HC; 4) statistical correlation was observed between the pathological changes in oral cavity in CD patients and: HgB, HCt, blood platelet count, CRP, fibrinogen, BMI, albumins and icreased levels of IL-6 and TNF-alfa in saliva. No correlation was observed between oral cavity pathological changes and DMF, CDAI, saliva production and levels of IL-1 beta and IL-10.

Level of degree:

2 - studia doktoranckie

Degree discipline:

choroby układu trawiennego

Degree grantor:

Wydział Lekarski


Jan Zapała

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tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego - Collegium Medicum

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Last modified:

Oct 15, 2019

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Nov 21, 2012

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Edition name Date
ZB-113855 Oct 15, 2019


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