ORAL MANIFESTATIONS OF FAMILIAL MEDITERRANEAN FEVER: A NARRATIVE REVIEW

Background: Familial Mediterranean fever (FMF) is the most common inherited autoinflammatory disorder characterized by recurrent episodes of fever and systemic inflammation caused primarily by pathogenic variants in the MEFV gene encoding the pyrin protein. Although FMF predominantly affects serosal membranes, joints, and skin, increasing evidence suggests that chronic inflammatory activation may also influence oral tissues and contribute to a variety of oral manifestations. Recognition of these findings is clinically relevant because oral lesions may represent early or accompanying manifestations of systemic inflammatory activity and may overlap with other inflammatory and autoimmune disorders. Objective: This narrative review aimed to summarize the current evidence regarding oral manifestations associated with familial Mediterranean fever, including mucosal lesions, periodontal alterations, temporomandibular joint involvement, oral manifestations related to systemic complications, and treatment-associated oral findings. Methods: A narrative literature review was performed using available publications from major biomedical databases, including PubMed/MEDLINE, Scopus, and Web of Science. Relevant studies describing oral manifestations, inflammatory mechanisms, clinical characteristics, and dental considerations in patients with FMF were analyzed. Due to the limited and heterogeneous nature of available evidence, including case reports, observational studies, and clinical reviews, a narrative synthesis approach was applied. Results: The available literature indicates that recurrent oral ulcerations, particularly aphthous-like lesions, represent the most frequently reported oral finding in patients with FMF. These lesions may occur independently or during periods of increased inflammatory activity and may create diagnostic challenges due to clinical similarity with Behçet disease and other immune-mediated disorders. Additional reported findings include gingival inflammatory changes, altered periodontal responses, temporomandibular joint symptoms associated with inflammatory arthritis, and oral manifestations related to systemic complications such as AA amyloidosis. Longterm colchicine therapy may influence oral health indirectly through modulation of inflammatory activity; however, specific oral adverse effects in FMF patients remain insufficiently investigated. Conclusions: Although oral manifestations are not considered primary diagnostic criteria for familial Mediterranean fever, they represent clinically relevant findings that may reflect systemic inflammatory activity and influence patient quality of life. Dentists and oral healthcare professionals should be aware of the potential oral presentations of FMF to facilitate early recognition, appropriate differential diagnosis, and multidisciplinary patient management. Further prospective studies are required to better define the prevalence, clinical significance, and biological mechanisms underlying oral involvement in FMF.