Wednesday, May 14, 2014

55% of Kids with Celiac Disease have Dental Enamel Defects- Dentists Play an Important Role-Part 1

Grade 1 enamel defects in celiac disease
As it turns out, it is depressingly common for adults and children with celiac disease to have problematic teeth. And expensive. And these may lead to long-term health problems.Previous studies have shown that celiacs tend to have more dental problems than average, and new research backs that up.

As reported in bold), the study, published in the European Journal of Internal Medicine, looks at dental enamel defects in adult celiac disease. Defects in your teeth's enamel, or coating, can appear as discoloration or as pitted, rough surfaces.

grade 2 enamel defects, notice the scalloped edges

The researchers performed a dental exam in 54 adults with celiac disease to look for enamel defects, and found them in a whopping 85% of those they examined. One-third had minor defects (also called "grade 1" defects), another 30% had grade 2 defects, 15% had grade 3 defects and 7% had grade 4.                                                                    

The researchers, who are based at the University of Pavia in Italy, noted that "dentists have a chance to refer people for celiac disease testing if they find enamel defects".

And according to researchers out of Halifax, Nova Scotia, Canada, 55% of children with the diagnosis of celiac disease have dental enamel defects. These may be the only manifestation of this disorder. They say "Dentists can play an important role in identifying people who may have unrecognized celiac disease". J Can Dent Assoc 2011;77:b39.

Other oral and dental manifestations of celiac disease, besides enamel defects include delayed eruption, recurrent aphthous ulcers (RAS), Cheilosis, oral lichen planus, atrophic glossitis, dens invaginatus, squamous cell carcinoma of the pharynx and mouth, red smooth shiny tongue, and dry mouth. According to this paper sometimes aphthous ulcers are the only sign of celiac disease.

A clinical guide for dentists is here. Dr. Rashid and his colleagues recommend the following clinical tips for dentists:

-Consider celiac disease as a possible diagnosis in any patient with dental enamel defects, recurrent oral      aphthous ulcers or both.
-Question about other clinical symptoms of celiac disease, including abdominal pain, diarrhea, weight loss,  poor growth, anemia and extreme fatigue. Remember that absence of these symptoms does not rule out  celiac disease.
-Inquire about the presence of other autoimmune diseases, especially type 1 diabetes and thyroiditis. The  presence of these will further increase the probability of celiac disease.
-Consider adding celiac disease to the list of disorders that you inquire about during family history screening.  Having a first- or second-degree relative with celiac disease increases the likelihood of a positive diagnosis.
-If celiac disease is suspected, the dentist or dental hygienist may wish to coordinate laboratory testing with  the patient’s primary care physician or specialist. The currently recommended screening test for celiac  disease is serum IgA-TTG antibody test, which is readily available. The TTG is an IgA-based test and IgA  deficiency is common in celiac disease. Therefore, total IgA level should also be measured.

An information sheet is available at Canadian Celiac Association , which would be helpful if you suspect or you know you or your child has celiac disease, and you want to open a discussion with your dentist.

Celiac Disease is an autoimmune disease, not a food allergy, which affects infants, children and adults and results in a permanent intolerance to gluten, a protein found in wheat, rye and barley. And other grain proteins found in oats, hemp and coffee.

Dentists play an important role in diagnosing celiac. More studies on the incidence of gluten sensitivity and dental disorders need to be done.

See Dr. Onusic's excellent article on the relationship of this abnormal autoimmune disorder, not a food allergy to our health in general and to our teeth, in "Part 2".

To Your Health

Dr. Barbara