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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
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]
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
Acta Paediatr Suppl 1996 May;412:47-48 Martelossi S, Zanatta E, Del Santo E, Clarich P, Radovich P, Ventura A 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). The known incidence of celiac disease in the study area was 1:1,000 before the study program and 1:670 (an increase of 44%) after it. Dental enamel inspection may be utilized for detecting undiagnosed coeliac disease in symptom-free schoolchildren. This clinical test is probably less sensitive than serum AGA screening test, but deserves some consideration because it is cheap, easy to perform and well accepted by the population. PMID: 8783757, UI: 96377982