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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    DENTAL ENAMEL DEFECTS IN CHILDREN STRONG INDICATORS OF CELIAC DISEASE


    Jefferson Adams

    Celiac.com 10/12/2007 - A team of Dutch dentists recently conducted a study to determine if Dutch children with proven celiac disease exhibit corresponding defects in dental enamel and to gauge whether children without proven celiac disease, but showing celiac-associated gastro-intestinal complaints lack any such defects in their dental enamel.


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    The research team included CLAAR D. WIERINK, General dentist, DENISE E. VAN DIERMEN, Department of Oral and Maxillofacial Surgery, Academic Centre for Dentistry, Amsterdam, The Netherlands, IRENE H. A. AARTMAN, Department of Social Dentistry and Behavioral Sciences, Academic Centre for Dentistry, Amsterdam, The Netherlands, HUGO S. A. HEYMANS Emma Children’s Hospital, Academic Medical Centre, Amsterdam, The Netherlands

    The team was led by Claar D. Wierink, and looked at a group of 81 children, 53 who were known to have celiac disease, and 28 of whom served as a control group.

    The children underwent examinations from 2003-2004 and the Oral Surgery Outpatient Clinic of the Academic Medical Center in Amsterdam. 29 (55%) of the 53 children with celiac disease showed enamel defects, compared with 5 (18%) of the 28 non-celiac control subjects.

    Enamel defects were diagnosed as being specific in 20 of the 53 children with celiac disease, compared with only 1 (4%) of the 28 control subjects. Overall, children with celiac disease showed more specific enamel defects than did the control subjects.

    From these results, the researchers concluded that dentists might have a significant role to play in the early screening of patients who have undiagnosed celiac disease.

    International Journal of Paediatric Dentistry 2007


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    I find this information ABSOLUTELY AMAZING!!! Just think how many children this could help...

    Thank you for sharing!!

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    It would be nice to know the age of the children and whether primary or permanent teeth were affected and were those teeth affected similarly or were there specific differences. teeth develop in a finite sequence at specific ages.

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    Anything that could help detect celiac disease as early as possible is fantastic. I agree with Eric (comment #2), it would have been nice to have a little more info on the teeth

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    Interesting article but I have yet to find pictures as examples of the kind of dental deformities that are discussed so I can asses whether my son is affected. Dentists seem to know little or nothing about this in relation to Celiac Disease.

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    Guest Denise RDH

    Posted

    Nice article but please provide clinical references of specific enamel defects. As a dental professional with celiac disease I have never in 30 years seen a picture or heard of an enamel defect that was suggested it was related to celiac disease. This is new news. High fevers, medications, injury during tooth development have always been suggested of poor enamel. And when all else fails you blame it on genetics.

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    Guest Hannah

    Posted

    I wish my dentist knew about this - I can't tell you how many times I was accused of not brushing my teeth as a kid, and I couldn't figure out why I was getting so many cavities!

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    My daughter is 21 month old and I have celiacs. I know that she has it but she is still in the process of seeing doctors. Her front 4 teeth are missing enamel and they are very discolored (poor thing). I did not know that this also was associated with Celiacs. Would of been nice to know when I first noticed her teeth months ago, would of saved her from being so sick, underweight and under height.

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    My daughter does not eat wheat. Her brother has celiac disease and 3 of my other children also do not eat wheat. My daughter was loosing the enamel on her teeth and the dentist could not explain why, this went on from childhood to early adulthood. She also has a diagnosis of juvenile rheumatoid, the main reason she quit eating wheat. Enamel issues and joint deformities are all resolved.

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    Guest VIJAYKUMAR SONAR

    Posted

    My daughter suffering from celiac problem, & her dental strength is comparatively less than her sister. This article is simply good.

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    Guest Sunny

    Posted

    Hannah, I know just how you feel!! Let us not forget the possibility of a true lack of fluoride. I grew up on well water in Louisiana, & I, too, was accused of not brushing, BY MY DENTIST! I wish the idiot had realized that due to the lack of naturally occurring fluoride, my teeth were doomed from the start. My younger brothers & my husband were blessed to grow up with water that was fluoridated or had it naturally occurring. I had more cavities by he 1st grade than the 3 of them combined to the present! At the same time, this is yet one more symptom to tally on my checklist. I'm considering getting tested in the near future.

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    Many states and counties in the U.S. are wising up to the dangers of fluoride to your teeth and health, and are actually making it ILLEGAL to fluoridate the drinking water supply. Fluoride causes defects in enamel, too--sometimes quite severely--and taking it internally does even worse things to your teeth. To properly study the link to Celiac Disease, they would need to eliminate fluoride as a possible factor. Google 'dental fluorosis.' There is plenty of information on this subject.

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    Guest Author

    Posted

    Nice article but please provide clinical references of specific enamel defects. As a dental professional with celiac disease I have never in 30 years seen a picture or heard of an enamel defect that was suggested it was related to celiac disease. This is new news. High fevers, medications, injury during tooth development have always been suggested of poor enamel. And when all else fails you blame it on genetics.

    Just FYI:

     

    1)

    Eur J Paediatr Dent. 2007 Mar;8(1):31-7.

    Enamel hypoplasia in coeliac children: a potential clinical marker of early diagnosis.

    Bossù M, Bartoli A, Orsini G, Luppino E, Polimeni A.

     

    Department of Pediatric Dentistry, University La Sapienza, Rome, Italy.

     

     

    2)

    International Journal of Paediatric Dentistry

    Volume 17 Issue 3, Pages 163 - 168

    Published Online: 7 Feb 2007

     

    Dental enamel defects in children with coeliac disease

     

    CLAAR D. WIERINK 1 , DENISE E. VAN DIERMEN 2 , IRENE H. A. AARTMAN 3 & HUGO S. A. HEYMANS 4

    ABSTRACT

    Objective. The aim of this study was to investigate whether Dutch children with proven coeliac disease show specific dental enamel defects, and to asses whether children with the same gastrointestinal complaints, but proved no-coeliac disease, lack these specific dental enamel defects.

     

    Materials and methods. Eighty-one children (53 coeliac patients and 28 control subjects) were examined during the period 2003–2004 in the Oral Surgery Outpatient Clinic of the Academic Medical Centre in Amsterdam.

     

    Result. Twenty-nine (55%) coeliac patients had enamel defects against 5 (18%) control subjects. In the coeliac disease group, the enamel defects were diagnosed as specific in 20 (38%) children, compared with 1 (4%) in the control group. Statistical analysis showed significantly more specific enamel defects in children with coeliac disease than in children in the control group (χ 2 = 12.62, d.f. = 2, P = 0.002).

    Conclusion. This study showed significantly more specific enamel defects in Dutch children with coeliac disease as compared with children in the control group. Dentists could play an important role in recognizing patients with coeliac disease.

     

     

     

    3) From the National Digestive Diseases Information Clearinghouse

    A service of the National Institute of Diabetes and Digestive and Kidney Diseases, NIH

     

    Dental Enamel Defects and Celiac Disease

     

    Celiac disease manifestations can extend beyond the classic gastrointestinal problems, affecting any organ or body system. One of these manifestations—dental enamel defects—can help dentists and other health care providers identify people who may have celiac disease and refer them to a gastroenterologist. Ironically, for some people with celiac disease, a dental visit, rather than a trip to the gastroenterologist, was the first step toward discovering their illness.

     

    Not all dental enamel defects are caused by celiac disease, although the problem is fairly common among people with the condition, particularly children, according to Alessio Fasano, M.D., medical director at the University of Maryland Center for Celiac Research. And dental enamel defects might be the only presenting manifestations of celiac disease, Fasano said.

     

    Dental enamel problems stemming from celiac disease involve permanent dentition and include tooth discoloration—white, yellow, or brown spots on the teeth—poor enamel formation, pitting or banding of teeth, and mottled or translucent-looking teeth. The imperfections are symmetrical and often appear on the incisors and molars.

     

    Tooth defects resulting from celiac disease are permanent and do not improve once a diagnosed patient adopts a gluten-free diet—the only treatment available for celiac disease. But dentists may use bonding, veneers, and other cosmetic solutions to cover enamel defects in older children and adults.

     

     

     

    4) More resources:

     

    The following studies discuss celiac disease and dental enamel defects:

     

    Aguirre JM, Rodriguez R, et al. Dental enamel defects in celiac patients. Oral Surgery Oral Medicine Oral Pathology. 1997;84:646–650.

     

    Bossu M, Bartoli A, et al. Enamel hypoplasia in celiac children: a potential clinical marker of early diagnosis. European Journal of Pediatric Dentistry. 2007;8:31–37.

     

    Procaccini M, Campisi G, et al. Lack of association between celiac disease and dental enamel hypoplasia in a case-control study from an Italian central region. Head and Face Medicine. 2007;3:25.

     

    Wierink celiac disease, Van Diermen DE, et al. Dental enamel defects in children with celiac disease. International Journal of Pediatric Dentistry. 2007;17:163–168.

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    admin
    Acta Paediatr Suppl 1996 May;412:47-48
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    Istituto di Clinica Pediatrica, Istituto per lInfanzia IRCCS Trieste, Italy.
    Celiac.com 12/18/2002 - Specific dental enamel defects (DEDs) in permanent teeth are frequently observed in celiac patients. We examined the permanent teeth in 6,949 secondary school children living in Trieste (78% of 8,724 children born between 1978 and 1982). Children with DEDs were tested for serum antigliadin antibodies (AGAs) and antiendomysium antibodies (AEAs), and those positive for serum AGAs and/or AEAs underwent intestinal biopsy. Specific DEDs were observed in 52 children (0.59% of the total population examined). Serum AGAs and/or AEAs were positive in 10 cases. Nine patients underwent intestinal biopsy (one refused) and in four cases a flat mucosa was documented (one with short stature, three completely asymptomatic).
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    PMID: 8783757, UI: 96377982

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    admin
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide.

    WHY A GLUTEN-FREE DIET?
    Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. 
    A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years.
    For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease.
    WHAT ABOUT ENZYMES, VACCINES, ETC.?
    There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease.
    There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes.

    Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. 

    For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement.

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center