Key takeaways

  • Ulcerative colitis, an inflammatory bowel disease, can cause inflammation throughout the whole body, increasing the chance of oral health issues like mouth sores and gum disease.
  • In addition to inflammation, the gut-gum axis theory suggests that imbalances and dysfunction in a person’s gut microbiome can trigger inflammation that impairs the gum microbiome and vice versa.
  • Managing ulcerative colitis with medication may help alleviate related oral health conditions, and treatments like mouth rinses can provide relief.

UC and Crohn’s disease are the two primary types of IBD. UC is a chronic condition featuring persistent inflammation and the development of sores or ulcers along the lining of the large intestine.

Even though UC is a condition focused on the digestive tract, it can put the body in a state of systemic inflammation that may cause extraintestinal manifestations. These refer to UC-related symptoms in parts of the body outside the gastrointestinal system.

The mouth is one common place for extraintestinal manifestations, though not everyone with UC will develop oral issues.

UC may increase a person’s likelihood of experiencing certain oral health challenges.

Experts believe this happens because UC and oral health are linked through two interconnected mechanisms: systemic inflammation and the gut-gum axis.

Systemic inflammation

As a chronic condition, UC can keep the body in a regular state of elevated inflammation. Even though this reaction may start in the large intestine, the immune cells and inflammatory substances from UC can travel throughout the body by entering the bloodstream. This creates what’s known as systemic, or body-wide, inflammation.

Extraintestinal manifestations happen when other tissues and organ systems are affected by UC-related inflammation or when the medications used to treat UC cause side effects outside the gastrointestinal system. The mouth and many other parts of the body can be affected.

The gut-gum axis

Direct exposure to inflammatory substances is just one part of the UC-oral health relationship. Another theory involves the gum-gut axis, a bidirectional communication pathway between the microbiome of the mouth and the microbiome of the gut.

Both the mouth and the intestines have a microbiome, a community of microorganisms that support the function and health of these body parts. Each microbiome has specific functions based on its location, but they collectively play a role in jobs such as:

  • keeping harmful bacteria in check
  • aiding in the digestive process
  • facilitating immune cells

According to the gut-gum axis theory, imbalances and dysfunction (dysbiosis) in a person’s gut microbiome can trigger inflammation that impairs the gum microbiome and vice versa. If the mouth microbiome is unbalanced, inflammatory substances can travel to the gut and disrupt the balance of the intestinal microbiome.

Is the gut-gum axis the same as the gut-brain axis?

When researchers refer to an “axis” in the body, they are typically referring to a two-way relationship between organ systems or body parts. “Bidirectional” means changes to one part of the body can affect the other and vice versa.
The gut-brain axis is not the same as the gum-gut axis. The gut-brain axis refers to the neurological, hormonal, and immune signaling pathways shared between your brain and your gut. The gut-brain axis focuses on shared neurological processes and networks.

Not everyone living with UC will develop oral health challenges, and it is not clear why some people do and some people do not. Genetics, environmental factors, and underlying health conditions can affect a person’s individual risk.

Certain oral health issues are prevalent among people who do experience this type of extraintestinal manifestation. According to studies from 2021 and 2022, UC is commonly associated with:

When oral health conditions are directly related to UC, treating UC as the underlying condition is important to find symptom relief. By managing UC and controlling chronic inflammation, the body-wide effects of UC can improve.

Doctors primarily treat UC with medications that help reduce inflammation in the large intestine, such as:

  • Aminosalicylates:
    • mesalamine
    • sulfasalazine
    • olsalazine
  • Immunosuppressants:
    • azathioprine
    • mercaptopurine
    • cyclosporine
  • Corticosteroids:
    • prednisone
    • hydrocortisone
    • methylprednisolone
  • Biologics:
    • infliximab (Remicade)
    • adalimumab (Humira)
    • golimumab (Simponi)
    • ustekinumab (Stelara)
    • vedolizumab (Entyvio)

For many people, medication can help improve symptoms enough to bring on and maintain remission, a period of time when clinical signs of UC have disappeared.

If medications aren’t effective enough for controlling UC, or if a person experiences severe complications like toxic megacolon, doctors may recommend surgery. Surgical treatment of UC involves removing the colon and rectum and altering how the body passes solid waste.

Focusing on treating UC does not mean ignoring mouth symptoms. Oral extraintestinal manifestations can be treated for prompt relief using:

  • topical anti-inflammatory and pain medications
  • antiseptic mouth rinses
  • corticosteroid mouthwash
  • oral corticosteroids and antibiotics
  • antifungal medications
  • saliva substitutes or oral moisturizers
  • sialogogues (saliva-stimulating medications)
  • dental cleaning procedures

UC is a chronic (long-term) condition, but it does not affect a person’s overall life expectancy compared with the larger population.

Serious complications are rare, but approximately 5% of people with a UC diagnosis develop colon cancer. Cancer risk increases the longer a person lives with UC.

Oral challenges from UC can improve or disappear with treatment. Like other symptoms in UC, they may improve for periods of time and then worsen in what is known as a relapsing-remitting pattern.

Ulcerative colitis (UC) is one of two primary types of inflammatory bowel disease (IBD). It is a condition featuring chronic inflammation and ulceration of the large intestine.

For many people, UC causes extraintestinal manifestations, which are symptoms in areas of the body outside of the gastrointestinal system. One common place to experience UC extraintestinal manifestations is in the mouth. Bad breath, dry mouth, oral sores, and gum disease are common symptoms.

Managing extraintestinal manifestations in UC begins by treating UC with medications or surgery, if necessary. In addition to addressing the underlying condition, medications and oral rinses can directly treat oral challenges in UC.