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Dental Enamel Defects in Children Strong Indicators of Celiac Disease 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.

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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 welcomes your comments below (registration is NOT required).

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13 Responses:

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said this on
24 Oct 2007 12:11:15 AM PDT
I find this information ABSOLUTELY AMAZING!!! Just think how many children this could help...
Thank you for sharing!!

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said this on
04 Nov 2007 7:46:13 AM PDT
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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said this on
07 Nov 2007 6:58:19 AM PDT
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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said this on
12 Dec 2007 5:18:11 AM PDT
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.

Denise RDH
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said this on
01 Jan 2008 9:53:56 AM PDT
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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said this on
11 Apr 2010 12:30:26 PM PDT
Just FYI:

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.

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

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 CD, 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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said this on
01 Jan 2008 2:54:54 PM PDT
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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said this on
24 Jan 2008 1:12:19 PM PDT
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.

an unknown user
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said this on
03 Feb 2008 9:30:35 AM PDT
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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said this on
20 Feb 2008 7:01:10 AM PDT
My daughter suffering from celiac problem, & her dental strength is comparatively less than her sister. This article is simply good.

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said this on
03 Apr 2008 10:27:11 PM PDT
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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said this on
15 Nov 2008 5:17:57 PM PDT
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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said this on
04 Jan 2009 10:41:13 AM PDT
Fluoride also interferes with thyroid regualtion.

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All Activity Celiac Disease & Gluten-Free Diet Forum - All Activity

Hi wondering if someone could help. my daughter has mildly raised TTG levels and the gliadine levels, she has one Coeliacs gene, but her biopsy came back negative. We have kept her off gluten (and low dairy) for nearly a year to see if her symptoms improved. They haven't. But I don't know if they are related to gluten specifically. Just wondering if anyone has other suggestions that may be going on with her. Her symptoms are: - Short stature, she's nearly 9 and my 6 year old boy is nearly bigger than her - bumps on back of her arms - urine leaking and occasional soiled pants, which could be from constipation she has at time's - sticking out stomach - dry patchy rashes on her face - joint pain sporadically - vomits every 6 weeks, but hasn't had gluten and seems to be no food connection - reoccurring thrush She had gluten last night at a party and was fine today. I'm a bit lost and not sure where else to turn. Thanks for any help.

We have gone gluten free, our whole house, as of a month ago. It was pretty seamless since I had been gluten-free for 5 months last year. I have found many good recipes, and my picky husband and one of my boys who is also a picky eater, even prefer many gluten-free recipes to the regular ones. My husband did see my point about the size of the gluten protein means nothing. Its a gluten protein period, that's what you are avoiding. It doesn't matter if its hiding in the scratch of your baking sheet and you can't see it. You can't see the wind, but it's still there. I hear you on the anemia. I've been anemic for several years, I just thought it as because I was getting a little older. Has your anemia gone away or do you still have problems with it?

Ennis, it is made out of metal, coated with plastic I think. You have such a hard time, my heart really hurts for you. But you are such a support to those on this board, and a great teacher for those of us who are new.

Thanks everyone! I think its hard for people to fully accept because they cant see the damage it does every time you get glutened. It's invisible. Im glad to know I wasnt being paranoid. I sure was when I was first diagnosed. I laugh at myself now, but its a pretty steep learning curve.

FYI......anxiety is a common symptom with celiac disease and NCGI. It seems to resolve on a gluten-free diet. ?