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Celiac.com 11/11/2024 - Celiac disease is an autoimmune condition triggered by gluten, a protein found in wheat, barley, and rye. While gastrointestinal symptoms are common, many individuals, especially children, may present with non-specific or atypical signs, making diagnosis challenging. This study sought to explore whether certain oral manifestations, such as recurrent aphthous stomatitis (commonly known as canker sores) and molar incisor hypomineralization (MIH), could be early indicators of celiac disease in children. By identifying these signs in dental examinations, healthcare providers might have a better chance of diagnosing celiac disease in children who otherwise lack typical symptoms. Purpose of the Study The primary goal of the study was to investigate whether celiac disease could be diagnosed through certain oral manifestations in children, specifically focusing on recurrent aphthous stomatitis and MIH. The research aimed to highlight the role dentists could play in the early diagnosis of celiac disease by recognizing these signs during routine dental examinations. Study Design and Methods Participants Sixty children aged 7 to 13 participated in the study, all of whom initially presented with complaints of recurrent aphthous stomatitis. These children were divided into two groups: MIH group: 40 children who had been diagnosed with MIH, a condition that causes developmental defects in the enamel of molars and incisors. Control group: 20 children who did not show any signs of MIH lesions. Oral Examination Two pediatric dentists conducted detailed oral examinations, during which they noted signs of MIH and recorded data such as decayed, missed, or filled teeth (DMFT). MIH lesions were diagnosed based on guidelines from the European Academy of Paediatric Dentistry. To ensure consistency, the dentists re-examined the children one week later to confirm the presence of MIH lesions. Medical History and Testing Following the dental examination, the parents of the children were asked to complete a questionnaire regarding their child's medical history, specifically looking for any symptoms or conditions related to celiac disease, as defined by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Blood samples were then taken from all children to conduct serological and genetic tests, which included: Serological tests: Tissue transglutaminase IgA (tTG-IgA), endomysial antibody IgA (EMA), and total IgA. Genetic testing: Human leukocyte antigen (HLA) typing for HLA-DQ2 and HLA-DQ8, which are genetic markers associated with celiac disease. Results The study found no significant differences between the groups when comparing their medical history or serological and genetic test results. However, six children in the MIH group showed borderline or positive results for the celiac disease-specific antibody tTG-IgA. Of these, two children had both positive tTG-IgA and EMA results and were also positive for the HLA markers associated with celiac disease. After a biopsy, these two children were formally diagnosed with celiac disease. While only 5% of the children in the MIH group were diagnosed with celiac disease, the findings suggest that MIH lesions and recurrent aphthous stomatitis may serve as early oral indicators of the condition. Importance of Oral Manifestations in Celiac Disease Diagnosis Recurrent Aphthous Stomatitis (RAS) Recurrent aphthous stomatitis, or canker sores, are small, painful ulcers that commonly occur in the mouth. While these sores are typically benign, their presence in children, particularly when recurrent, may be linked to underlying systemic conditions like celiac disease. In this study, all participants initially presented with RAS, suggesting that it could serve as an early warning sign, particularly when combined with other dental or medical symptoms. Molar Incisor Hypomineralization (MIH) MIH is a developmental condition that affects the enamel of the first permanent molars and incisors. The study found that MIH lesions are similar in appearance to the enamel defects commonly seen in celiac disease patients. This resemblance, along with the high prevalence of enamel defects in individuals with celiac disease, points to a potential overlap between the two conditions. MIH could be an important clinical clue for dentists when assessing children who may have undiagnosed celiac disease. Limitations and Considerations Although the study provides valuable insights, it has several limitations. The sample size was relatively small, and the study was conducted over a short period. Larger, long-term studies are needed to validate these findings and determine the true prevalence of celiac disease in children with MIH and recurrent aphthous stomatitis. Additionally, the genetic tests for HLA-DQ2 and HLA-DQ8, while helpful, are not always necessary for diagnosing celiac disease. The presence of these genetic markers does not confirm celiac disease but indicates a predisposition to it. On the other hand, the absence of these markers makes celiac disease highly unlikely. In this study, the two children diagnosed with celiac disease both had positive results for HLA-DQ2 or HLA-DQ8, but the utility of genetic testing remains a subject of debate. The Role of Dentists in Celiac Disease Diagnosis The findings of this study highlight the important role dentists can play in diagnosing celiac disease. Since many children with celiac disease do not present with the typical gastrointestinal symptoms, dentists are often in a unique position to spot the first signs of the condition through oral manifestations like RAS and MIH. Early detection of celiac disease is crucial for preventing long-term complications such as malnutrition, growth delays, and increased risk of certain cancers. Dentists should consider referring children for further medical testing if they observe persistent oral issues like RAS or MIH, especially when accompanied by a family history of autoimmune diseases or other risk factors for celiac disease. A multidisciplinary approach, involving both dental and medical professionals, can lead to earlier diagnosis and treatment, improving outcomes for children with celiac disease. Conclusion This study underscores the potential link between certain oral manifestations, such as recurrent aphthous stomatitis and molar incisor hypomineralization, and celiac disease in children. While the sample size was small, the results suggest that dentists could play a pivotal role in diagnosing celiac disease, especially in children who do not exhibit typical symptoms. Early detection through dental examinations can lead to timely interventions, helping to prevent the serious complications associated with undiagnosed celiac disease. The study's findings emphasize the need for further research and greater awareness among dental professionals regarding the systemic implications of oral health conditions. Read more at: bmcgastroenterol.biomedcentral.com

Celiac.com 07/04/2024 - Celiac disease is an autoimmune condition where the ingestion of gluten causes an immune reaction that damages the small intestine in genetically predisposed individuals. This disease can lead to various systemic and localized health issues, including those affecting the oral cavity. One significant oral manifestation linked to celiac disease is dental enamel defects. A new study explores the connection between celiac disease and dental enamel defects, the potential mechanisms behind these defects, and the role of dentists in early diagnosis and management. The Relationship Between Celiac Disease and Dental Enamel Defects Dental enamel defects are abnormalities in the structure of the tooth enamel, often presenting as discoloration, pitting, or grooving of the teeth. These defects can occur due to several reasons, including genetic factors, nutritional deficiencies, and systemic diseases like celiac disease. Research has shown a high prevalence of dental enamel defects among individuals with celiac disease, ranging from 50% to 94.1%. These defects are often symmetrical and occur in a chronological pattern, which can be categorized using Aine’s classification system. Pathophysiological Mechanisms The development of dental enamel defects in individuals with celiac disease is thought to be due to multiple factors. One primary factor is the malabsorption of essential nutrients caused by the damage to the intestinal villi in the small intestine. This damage impairs the body's ability to absorb nutrients critical for proper enamel formation, such as calcium and vitamin D. Additionally, the autoimmune response triggered by gluten ingestion may directly affect the cells responsible for enamel formation. Clinical Implications for Oral Health The presence of dental enamel defects can significantly impact oral health. These defects can increase the susceptibility to dental caries, lead to aesthetic concerns, and cause sensitivity. Research indicates that individuals with celiac disease often have higher decayed, missing, and filled teeth (DMFT) scores, indicating more severe dental decay. They are also more likely to experience recurrent aphthous stomatitis and symptoms of dry mouth, which can further exacerbate oral health issues. The Role of Dentists in Early Diagnosis Dentists play a crucial role in the early diagnosis of celiac disease. Since dental enamel defects can be an early indicator of celiac disease, dentists can identify potential cases through routine dental examinations. By recognizing the patterns of enamel defects and considering patient history, dentists can refer patients for further investigation, including serological testing and intestinal biopsy. Aine’s classification of enamel defects provides a structured approach for dentists to categorize and suspect celiac disease. Interdisciplinary Collaboration Effective management of celiac disease and its oral manifestations requires a collaborative approach between dentists and gastroenterologists. This interdisciplinary collaboration ensures comprehensive care, addressing both the systemic and oral health aspects of the disease. Regular dental check-ups are essential for monitoring and managing dental enamel defects in celiac patients, helping to prevent further complications and improve overall health outcomes. Conclusion This study underscores the significant association between celiac disease and dental enamel defects. Early recognition of these oral manifestations by dentists can lead to timely diagnosis and management of celiac disease, even in the absence of gastrointestinal symptoms. Understanding this relationship emphasizes the importance of integrated care involving both dental and medical professionals. This holistic approach can enhance the quality of life for individuals with celiac disease, ensuring better health outcomes and effective management of both their oral and systemic health. Implications for Celiac Disease Patients For individuals with celiac disease, this study highlights the importance of regular dental visits and the need for heightened awareness of potential oral health issues. Early detection of dental enamel defects can prompt further investigation into underlying celiac disease, facilitating timely intervention and adherence to a gluten-free diet. This proactive approach can help prevent further health complications and improve overall well-being for those with celiac disease. By recognizing the critical role of dentists in the early diagnosis and management of celiac disease-related oral manifestations, this research paves the way for improved interdisciplinary collaboration and comprehensive patient care. Further large-scale studies are recommended to deepen our understanding of the link between celiac disease and dental enamel defects, ultimately contributing to better health outcomes for affected individuals. Read more at: mdpi.com

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. Source: mdpi.com