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  • Jefferson Adams
    Jefferson Adams

    Easy to Spot Tooth Wear and Enamel Defects Point to Celiac Disease

      A new study shows that non-specific tooth wear can be seen nearly 20% of celiac patients, while such wear is seen in just under 6% of non-celiac control subjects.

    Caption: Image: CC--Zdenko Zivkovic

    Celiac.com 07/05/2018 - We’ve known for a while that dental enamel defects can be an indicator of celiac disease. Now, a new study has evaluated the pathological conditions of the stomatognathic system observed in celiac patients on a gluten-free diet, and found that non-specific tooth wear can be seen nearly 20% of celiac patients, while such wear is seen in just under 6% of non-celiac control subjects. 

    The data come from a team of researchers that recently set out to evaluate the pathological conditions of the stomatognathic system observed in celiac patients on a gluten-free diet. The research team included Massimo Amato, Fabiana Zingone, Mario Caggiano Orcid, Paola Iovino, Cristina Bucci and Carolina Ciacci. They are variously affiliated with the Department of Medicine, Surgery and Dentistry, Medical School of Salerno in Salerno, Italy.

    For their study, the team consecutively recruited celiac patients on a gluten-free diet, along with healthy control volunteers, from the team’s celiac clinic. Two dentists examined all patients and controls and examined them for mouth disorders. 

    The study included forty-nine patients with celiac disease, and 51 healthy volunteer subjects. The team found recurrent aphthous stomatitis in 26 patients (53.0%) and in 13 (25.5%) controls. They found dental enamel disorders in 7 patients (14.3%) and in 0 controls (p = 0.002), with no cases of geographic tongue. 

    They found non-specific tooth wear, characterized by loss of the mineralized tissue of the teeth, in 9 patients (18.3%) and in 3 (5.9%) controls. From this data, the team notes that recurrent aphthous stomatitis and enamel hypoplasia are “risk indicators” that indicate the possible presence of celiac disease. 

    Among patients with celiac disease, the team found high rates of non-specific tooth wear that can be caused by several factors such as malocclusion, sleep bruxism, parafunctional activity, and age.

    This study, and previous studies on dental enamel defects, confirms that non-specific tooth wear and enamel defects can be strong indications of celiac disease, and may lead to a more active role for dentists in helping to spot and diagnose celiac disease.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    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.
    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

    Jefferson Adams
    Celiac.com 08/23/2013 - Previous studies have noted the presence of dental enamel defects in people with celiac disease.
    A team of researchers recently set out to study the prevalence of dental enamel defects in adults with celiac disease, and to determine if there is in fact a connection between the grade of teeth lesion and clinical parameters present at the time of diagnosis of celiac disease.
    The research team included L.Trotta, F. Biagi, P.I. Bianchi, A. Marchese, C. Vattiato, D. Balduzzi, V. Collesano, and G.R. Corazza.
    They are affiliated with the Coeliac Centre/First Department of Internal Medicine at the Fondazione IRCCS Policlinico San Matteo at the University of Pavia in Italy.
    The team looked at 54 celiac disease patients who had undergone dental examination. The patients included 41 females and 13 males, with an average age of 37±13 years, and with an average age of 31±14years at the time of diagnosis.
    Symptoms leading to diagnosis were diarrhea/weight loss (32 pts.), anaemia (19 pts.), familiarity (3 pts.). None of the patients was diagnosed because of enamel defects.
    At the time of evaluation, all of the patients were following a gluten-free diet.
    The team classified enamel defects from grade 0 to 4 according to severity. They found dental enamel defects in 46 of the 54 patients (85.2%). They found grade 1 defects in 18 patients (33.3%), grade 2 defects in 16 patients (29.6%), grade 3 defects in 8 patients (14.8%), and grade 4 defects in 4 patients (7.4%).
    They also observed that grades 3 and 4 were more common in patients diagnosed with classical rather than non-classical coeliac disease (10/32 vs. 2/20). However, this was not statistically significant.
    From this study, the team concludes that enamel defects are common in adult celiac disease, and that the observation of enamel defects offers a way to diagnose celiac disease.
    Source:
     Eur J Intern Med. 2013 Apr 6. pii: S0953-6205(13)00091-5. doi: 10.1016/j.ejim.2013.03.007. [Epub ahead of print]

    Jefferson Adams
    Ten Things to Try if You Accidentally Eat Gluten
    Celiac.com 07/03/2015 - For people with celiac disease or gluten intolerance, accidentally eating gluten can have numerous undesirable consequences.
    Symptoms of gluten-exposure among people with celiac disease can vary, but main problems and complaints include: upset stomach, stomach pain, inflammation, diarrhea, gas, bloating, indigestion, heart burn, skin rash or breakouts, and nerve and arthritis pain, among others.
    If you're one of these people, then you likely work pretty hard to make sure everything you eat is gluten-free. But what can you do if you accidentally eat gluten?
    Officially, beyond simply waiting it out, there is no clinically accepted treatment for people with celiac disease or gluten sensitivity who accidentally eat gluten. However, there are things that many people claim will reduce the suffering and promote healing when this happens. Here are the best home remedies for accidental gluten ingestion, as submitted by readers to our gluten-free forum.
    The main goal is to reduce or eliminate the worst immediate symptoms, including pain, inflammation, diarrhea, gas and or bloating, etc. The secondary goal is to rebuild gut health.
    So what works? Or, what do people say works for them? The remedies listed below are not ranked in any particular order of importance or efficacy.
    Fasting—Recent studies indicate that fasting for a couple of days can help to reset the immune system, which might be beneficial for those suffering from an adverse gluten reaction. Be sure to check with a doctor before fasting, just to be safe. Digestive Enzymes-- For many people, digestive enzymes seem to help the bloating. Many people claim that such enzymes help provide relief, especially against small amounts of gluten. Two such products are Eater's Digest by Traditional Medicinals, and Gluten Defense digestive enzymes. Green tea or peppermint tea. Many people have reported that green tea is also helpful. Peppermint tea is said to promote muscle relaxation, and can help for gassy stomach issues. Strong gluten-free peppermints will work in a pinch. Imodium seems to help some people control associated diarrhea. If you have diarrhea, be sure to drink water with electrolytes to help replace lost fluids. Pepto-Bismol—Some people take Pepto-Bismol to help relieve stomach upset. Marshmallow root can help to sooth stomach and gas pain. Antihistamines—Some people claim to find relief with antihistamines, such as Benedryl, Clatratin, or Zyrtec. Often these are used in combination with other remedies Probiotics—Many people find probiotics to be helpful, especially as part of a general gut maintenance program. Probiotics are generally more helpful in advance of accidental gluten exposure, but many people take them after exposure. Either way, it certainly can't hurt. Broth—Many people with celiac disease, gut and/or nutritional issues turn to broth for help in building gut health and proper nutrition. Good old fashioned beef, chicken or fish broth can be a beneficial part of a healthy gut regimen. Broth also has many health properties beyond gut healing. Tummy Rescue Smoothie: This recipe was developed by a celiac.com reader in response to his own "gluten emergency.” The healing properties of each ingredient are also listed. Puree in blender until smooth, and slightly thickened. It is most soothing when consumed while still warm from the hot tea. Tummy Rescue Smoothie:
    1 cup hot freshly brewed nettle leaf tea (anti-histamine, anti-spasmodic) ¼ cup Santa-Cruz pear juice (flavoring/sweetener - pears are the least allergenic of fruits) ¼-½ teaspoon whole fennel seed (reduces gas & bloating) 2 Tablespoons slippery elm powder (healing & soothing to mucous membranes and the gut) 1 Tablespoon flax seed oil (soothing, anti-inflammatory) ¼ - ½ cup rice milk (hypoallergenic, use to thin to desired consistency) This smoothie is best consumed in small sips over an hour or so. Magnesium also helps with pain and relaxes muscle spasms, so taking a little extra magnesium may be of benefit. For severe symptoms, drink the smoothie while reclining in bed, with a warm castor oil pack over the abdomen, covered by a heating pad set on low. Do not leave the pack in place for more than an hour.
    Longer-term strategies include rebuilding intestinal health with an anti-inflammatory diet, taking supplements like L-Glutamine, coconut oil, fat-soluble vitamins A, E, D, and K, Calcium, Magnesium, B-Vitamins, Essential Fatty Acids (EFA's), and probiotics, including acidophilus for about a week to get intestinal flora back in order.
    This list is not intended to be authoritative or comprehensive. Nor is it intended as medical advice, or as a substitute for medical advice. As with any health remedy, do your research and make the choices that are right for you.
    If you have any thoughts or insights on how best to treat accidental gluten ingestion for people with celiac disease or gluten intolerance, please share them in our comments section below.

    Jefferson Adams
    Does Timing of Gluten-Free Diet Influence Dental Enamel Defects in Celiac Disease?
    Celiac.com 08/09/2017 - There have been a number of studies showing a strong connection between celiac disease and dental enamel defects (DEDs), however, the exact relationship is still unclear.
    To get a better understanding, a team of researchers recently set out to evaluate DEDs in people with celiac disease by looking at how long it took them to begin a gluten-free diet (GFD).
    The research team included AM de Queiroz, J Arid, FK de Carvalho, RAB da Silva, EC Küchler, R Sawamura, LAB da Silva, and P Nelson-Filho.
    They are variously affiliated with the Department of Pediatric Dentistry, University of São Paulo - School of Dentistry of Ribeirão Preto, Ribeirão Preto, SP, Brazil, and the Department of Childcare and Pediatrics, University of São Paulo School of Medicine of Ribeirão Preto, Ribeirão Preto, SP, Brazil.
    For their study, the team had a pediatric dentist examine forty-five children with celiac disease. The dentist then classified DEDs by the type of teeth affected. The study team divided celiac disease patients into two groups, those with and those without DEDs. They then tested the differences between these groups using chi-square or Fisher´s exact tests and t-test to compare differences between means.
    They used the Pearson coefficient test to determine the correlation between the age at gluten-free diet introduction and number of teeth with defects. They found that patients with Molar Incisor Hypomineralisation (MIH), a condition affecting the enamel of permanent teeth, were more often introduced earlier to the GFD (p = 0.038). They also saw a connection with molar DED (p = 0.013).
    Their study suggests that enamel defects in the molar are connected with the time that celiac disease patients were introduced to a gluten-free diet. What this means for patients with celiac disease remains to be seen.
    Source:
    Spec Care Dentist. 2017 Jul;37(4):194-198. doi: 10.1111/sceliac disease.12227.

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