Crohn’s disease has numerous oro-facial presentations. Intra-oral indications of Crohn’s disease are relatively common and well recognised, including oral ulceration and cobblestone mucosa. There are, however, many less well recognized expressions of the disease, which are rarer. We present the various oro-facial manifestations of Crohn’s disease as found in the literature. To illustrate our presentation, we present a case of Crohn’s disease whose initial manifestation was with a facial/buccal abscess, which later formed an oro-facial fistula. Although it had many features typical of a dental abscess we emphasise the need for a broad approach to facial swellings. We therefore, discuss the process that led to this diagnosis, following a history of bloody diarrhoea, which had defied investigation and explanation. The particular learning points surround the importance of obtaining a thorough history and undertaking a good general examination as the patient had other skin lesions typical of Crohn’s disease. This case was treated with steroids and newer immune-modifying agents and we also review these and the patient’s subsequent progress.