Gastrointestinal
Dental Management of Patients with Inflammatory bowel disease (Crohn's / ulcerative colitis)
Important — second opinion only. DentiCision provides an evidence-based second opinion to assist the dentist. It does not replace the treating dentist's professional clinical judgment or consultation with the patient's physician. The treating dentist retains full clinical, scientific and legal responsibility. Always verify drugs and doses against current guidelines.
Is the IBD currently active (flare) — needed for the decision
Crohn's disease and ulcerative colitis management depends on disease activity.
Emergency vs routine management
If EMERGENCY — what to do
- • Emergency care (pain, infection, swelling) is not delayed — use standard precautions.Ref: Moran GW et al. British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025. Gut 2025;74(Suppl 2):s1–s101
If ROUTINE — what to do
- • Answer the question above to see the routine-care plan.Ref: Moran GW et al. British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025. Gut 2025;74(Suppl 2):s1–s101
Clinical precautions
- • Avoid NSAIDs (risk of IBD flare) — paracetamol for pain
- • Antibiotics only when indicated; avoid clindamycin where possible (C. difficile risk) — prefer amoxicillin
- • Check for anaemia (FBC) before surgery if the patient is symptomatic or recently flared
- • Also add steroids, azathioprine/methotrexate or biologics (infliximab, adalimumab, vedolizumab, ustekinumab) to the evaluation
- • Oral signs (aphthous ulcers, cobblestoning, pyostomatitis vegetans) may reflect disease activity
Decision by clinical scenario
Is the IBD currently active (flare)?
Remission / controlled
IBD in remission — proceed with precautions
Controlled Crohn's disease or ulcerative colitis: routine dental care with drug-safety precautions.
- • Proceed with routine care once the listed precautions, labs or timing checks are satisfied.
- • Book at the most suitable time and keep appointments short where advised.
- • Avoid NSAIDs (risk of IBD flare) — paracetamol for pain
- • Antibiotics only when indicated; avoid clindamycin where possible (C. difficile risk) — prefer amoxicillin
Active flare — diarrhoea, pain, bleeding, recent steroid escalation
Active IBD flare — defer elective care
Active Crohn's/ulcerative colitis: systemic illness, possible anaemia and high-dose immunosuppression.
- • Defer elective / routine treatment until the condition is controlled, then re-assess.
- • Avoid NSAIDs (risk of IBD flare) — paracetamol for pain
- • Antibiotics only when indicated; avoid clindamycin where possible (C. difficile risk) — prefer amoxicillin
- • Check for anaemia (FBC) before surgery if the patient is symptomatic or recently flared
Information & tests to request
- • Is the IBD currently active (flare)? — During an active flare patients are often on high-dose steroids, anaemic and unwell — elective care is deferred.
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION Is the IBD currently active (flare) — needed for the decision |
| Supragingival scaling / polish | MODIFY / CAUTION Is the IBD currently active (flare) — needed for the decision |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Is the IBD currently active (flare) — needed for the decision |
| Root canal treatment | MODIFY / CAUTION Is the IBD currently active (flare) — needed for the decision |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Is the IBD currently active (flare) — needed for the decision |
| Surgical / bony extraction | MODIFY / CAUTION Is the IBD currently active (flare) — needed for the decision |
| Implant placement | MODIFY / CAUTION Is the IBD currently active (flare) — needed for the decision |
References
- Moran GW et al. British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025. Gut 2025;74(Suppl 2):s1–s101
- Gordon H et al. ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment. J Crohns Colitis 2024;18:1531–1555
- NSAIDs and IBD flare risk; clindamycin and C. difficile infection — CDC C. difficile guidance / BNF
Important — second opinion only. DentiCision provides an evidence-based second opinion to assist the dentist. It does not replace the treating dentist's professional clinical judgment or consultation with the patient's physician. The treating dentist retains full clinical, scientific and legal responsibility. Always verify drugs and doses against current guidelines.