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 About.com:(my 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

Dr. Bill Davis On Autoimmunity and Wheat! Evidence Wheat Affects All, Even Those Not Gluten Sensitive!

Here is a great article on autoimmunity disorders and wheat by Dr. Bill Davis!

First consumed in desperation 10,000 years ago, after not consuming grains for the preceding 2.5 million years, then altered by the efforts of geneticists and agribusiness, increased wheat consumption accounts for the increasing landscape of multiple autoimmune conditions, especially type 1 diabetes in children (and, now, adults), Hashimoto’s, and inflammatory bowel diseases.

So what is it about modern wheat that can cause such misguided immune responses? There are several reasons:

Increased intestinal permeability–Dr. Alessio Fasano and his team, working at the University of Maryland (now at Harvard) have worked out the complex path by which gliadin, when remaining intact, opens the “tight junction” barriers between intestinal cells, allowing foreign substances entry into the bloodstream and thereby organs. Among the substances that can enter: intact gliadin, gliadin-derived peptides, wheat germ agglutinin (a large and highly inflammatory protein), lipopolysaccharide from bacterial cell walls, and others.

Gliadin peptide toxicity–While some gliadin remains intact, some also gets degraded to peptides. Some of these peptides can enter the bloodstream to exert opiate effects on the brain, while other fractions are toxic to the intestinal lining.

Wheat germ agglutinin–Humans cannot digest the roots, stalk, leaves, or husk of wheat because it is a grass. For that reason, humans only consume the flour ground from the seed of wheat. We can only efficiently digest the amylopectin and amylose of the seed endosperm, the carbohydrates. Wheat germ agglutinin of the seed, a component of all wheat flour, is an example of another indigestible component of this grass. This large 4-part structure is highly toxic to the intestinal lining, causing complete denuding of the villi in experimental models. If it gains entry to the bloodstream, it is a potent activator of the immune system.

Molecular mimicry–As if this wasn't already strange enough, there are amino acid sequences in the gliadin protein of wheat (and thereby the secalin of rye, the hordein of barley, perhaps the zein of corn) that look just like sequences in some human proteins. To date, human proteins that resemble gliadin include transglutaminase (in muscle, liver, many other tissues), synapsin (in nervous tissue), and calreticulin (ubiquitous). The gliadin sequence activates an immune response, which can then launch an attack on the organs containing these cross-reacting proteins.

Dysbiosis–Wheat changes bowel flora, not uncommonly causing dysbiosis, or changes in bowel flora characterized by decreases in healthy species, such as Lactobacillus and Bifidobacteria, and increases in pathogenic bacteria, such as E. coli and Clostridium difficile. Dysbiosis increases intestinal permeability, especially to the lipopolysaccharide component of bacterial cell walls, a powerful activator of inflammation.

Note that NONE of these phenomena leading to autoimmunity require the presence of celiac disease or gluten sensitivity. The abnormal intestinal permeability induced by gliadin, for instance, develops in 80-90% of people; the toxic effects of wheat germ agglutinin affect everybody.

Read the whole article here.

To Your Health

Dr. Barbara