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    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]

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    Jefferson Adams
    Distinct Tooth Enamel Defects Can Help Reveal Celiac Disease
    Celiac.com 02/08/2017 - Celiac disease is a chronic autoimmune-mediated enteropathy, triggered by exposure to dietary gluten in genetically prone individuals. Celiac disease is also one of many gastrointestinal diseases that can have dental manifestations. In fact, distinct dental enamel defects are strong indicators of celiac disease, and may lead to a role for dentists in better celiac screening.
    While the disease often manifests in early childhood, a large number of patients are diagnosed over the age of 50. Despite increased awareness, the majority of patients still remain undiagnosed. Dentists should consider celiac disease when they observe certain symmetric enamel defects.
    Symptoms of celiac disease vary widely and are certainly not restricted to the intestine. They may include, among others, dental and oral manifestations.
    A team of researchers recently published an update in the British Dental Journal regarding the role of such defects in the timely diagnosis of celiac disease, which is requires a gluten-free diet to prevent complications.
    The research team included T. van Gils, H. S. Brand, N. K. H. de Boer, C. J. J. Mulder & G. Bouma. They are variously affiliated with the Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands, and the Departments of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA) in Amsterdam, The Netherlands.
    They note that most of the enamel defects are nonspecific, but symmetric in a way that is very specific to celiac disease. They also note the importance of recognizing this relationship, as it offers an easy way to help to identify unrecognized celiac sufferers, and to promote better screening and diagnosis. They encourage dental practitioners to take note.
    Source:
    British Dental Journal 222, 126 - 129 (2017). Published online: 27 January 2017 | doi:10.1038/sj.bdj.2017.80

    Jefferson Adams
    How Much Gluten Does an Average Celiac Patient Accidentally Consume?
    Celiac.com 04/02/2018 - Exactly how hard is it for people with celiac disease to faithfully follow a gluten-free diet? Anyone who’s ever tried to completely avoid gluten for any length of time likely has a story to tell about accidental gluten consumption, and the consequences that follow. It’s not at all uncommon for gluten-free celiacs to be exposed to low levels of gluten that can trigger symptoms and cause persistent intestinal histologic damage.
    To gain an understanding of gluten consumption across a wide population of celiac patients, a team of researchers recently set out to determine how much gluten people eat when they are trying to follow a gluten-free diet. 
    The team included Jack A Syage, Ciarán P Kelly, Matthew A Dickason, Angel Cebolla Ramirez, Francisco Leon, Remedios Dominguez, and Jennifer A Sealey-Voyksner. They are variously affiliated with ImmunogenX in Newport Beach, CA, the Beth Israel Deaconess Medical Center at Harvard Medical School in Boston MA, and with Biomedal in Seville, Spain.
    The team began by analyzing data from previous clinical studies. That meta-analysis focused on data from a clinical study of gluten in stool and urine in celiac patients, a second study on non-celiac populations; and an analysis of data from trials for the investigational therapeutic latiglutenase. 
    As part of the stool and urine studies the team included controlled gluten challenges. They then applied a calibration factor that allowed normal ingestion of gluten to be computed from the urine and stool measurements. They determined gluten consumption by estimating how much gluten was eliminated from patients’ diets due to a trial effect that resulted in improved histology, even in the placebo group.
    Using the stool test, the team estimated the average inadvertent exposure to gluten by celiac disease individuals on a GFD to be about 150–400 mg/d, while they estimated the median exposure to be about 100–150 mg/d. Using the urine test, those numbers showed an average exposure of about 300–400 mg/d, with a median of about 150 mg/d. 
    Meanwhile, data analyses showed that celiac patients with moderate to severe symptoms showed that patients ingested substantially more than 200 mg/d of gluten.
    The data indicate that many gluten-free celiacs regularly consume enough gluten to trigger symptoms and perpetuate gut damage.
    Source:
    The American Journal of Clinical Nutrition, Volume 107, Issue 2, 1 February 2018

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