ORIGINAL ARTICLE Dental Caries and Periodontal Disease in Children and Adolescents with Inflammatory Bowel Disease: A Case–Control Study Vassiliki Koutsochristou, DDS,* Aglaia Zellos, MD,* Konstantina Dimakou, MD,* Ioanna Panayotou, MD,* Sultana Siahanidou, MD,* Eleftheria Roma-Giannikou, MD,* and Alexandra Tsami, DDS † Background: Previous reports have demonstrated a higher prevalence of dental caries and periodontal disease in adults with inflammatory bowel disease (IBD), but similar data in children and adolescents do not exist. The aim of the study was to evaluate the status of dental caries, oral hygiene, gingival status and periodontal treatment needs of children with IBD. Methods: In this case–control study, 55 children on remission from a single outpatient IBD clinic, aged 4 to 18 years (12.27 6 3.67 yr) and 55 matched systemically healthy controls of a dental practice were assessed prospectively. The evaluation included medical history, dental questionnaire in both groups, and previous and current medical therapy of children with IBD. Additionally, the decayed, missing, and filled tooth (dmf-t or DMF-T), simplified gingival, plaque control record and community periodontal treatment needs indices were evaluated. Results: Children with IBD compared with controls had a statistically significant (P , 0.001) higher dmf-t (2.95 versus 0.91) or DMF-T (5.81 versus 2.04) index and a higher gingival inflammation (simplified gingival, 40% versus 24%) although the respectively dental plaque index showed no significant difference (plaque control record, 42% versus 41%). Also, the community periodontal treatment needs was significantly higher compared with controls (P , 0.001); most of the patients with IBD needed treatment of gingivitis (47% versus 4%), and none of them had healthy periodontium (0% versus 69%). Conclusions: The results of this case–control study demonstrate a higher frequency of dental caries, more clinical signs of gingival inflammation, and increased periodontal treatment needs in children and adolescents with IBD despite similar oral hygiene status. (Inflamm Bowel Dis 2015;21:1839–1846) Key Words: inflammatory bowel disease, children, adolescents, dental caries, gingival inflammation, periodontal treatment needs I nflammatory bowel disease (IBD) comprises 2 major disease entities: Crohn’s disease (CD) and ulcerative colitis (UC); they are characterized by chronic inflammatory involvement of the gastrointestinal tract evolving with a relapsing and remitting course. The etiology of these chronic intestinal disorders is not completely understood, but it is known that distinct immune abnormalities play a major role in the initiation and perpetuation of IBD, 1 and that genetic 2–4 and environmental factors 5–8 are involved in the pathogenesis. About 25% to 35% of patients with both forms of IBD develop at least 1 extraintestinal manifestation usually involving joints, eyes, skin, mouth, and liver. 9,10 One or more types of oral manifestations of IBD can precede, coincide, or follow the onset of the intestinal symptoms 11–13 and may occur at any time during disease process and in different forms in the same patient. 13–15 Common oral lesions in patients with CD include hypertrophy and nonspecific swellings of the mucosa and lips, gingival soft tissue swelling resembling epulis fissuratum, cobblestone appear- ance of the buccal mucosa or palate, and aphthous-like ulcerations or deep yellowish white ulcers within the vestibule and on the gingiva. 16–21 In patients with UC, pyostomatitis has been described as the main oral manifestation. 13,22 Most of these oral lesions are soft and friable and are detached easily from the underlying tissue, leaving an erythematous and ulcerated zone, while some of the smaller may coalesce to form larger ramifying areas of necrosis. Usually these lesions are painful and have been present for a few months, while the patient’s chief complaints are additional bleeding and swelling of gums. In adults with IBD, a higher prevalence of caries has been reported compared with healthy control subjects. 23–29 Data about prevalence and severity of periodontal disease in adult patients with IBD are limited. 28–33 However, data about prevalence and severity of caries and periodontal disease in children and adolescents with IBD are Received for publication March 2, 2015; Accepted March 24, 2015. From the *First Department of Pediatrics, University of Athens School of Med- icine, Athens, Greece; and † Department of Periodontology, University of Athens Dental School, Athens, Greece. The authors have no conflicts of interest to disclose. Reprints: Aglaia Zellos, MD, First Department of Pediatrics, University of Athens School of Medicine, Aghia Sofia Children’s Hospital, Thivon and Levadias Street, 11527 Athens, Greece (e-mail: eglie1@aol.com). Copyright © 2015 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000452 Published online 15 May 2015. Inflamm Bowel Dis  Volume 21, Number 8, August 2015 www.ibdjournal.org | 1839 Copyright © 2015 Crohn’s & Colitis Foundation of America, Inc. Unauthorized reproduction of this article is prohibited.