Dental enamel defects in celiac patients

Dental and oral manifestations of celiac disease

Background

The objective of this study was to evaluate the dental and oral manifestations in patients with celiac disease.

Material and Methods

The sample consisted of 40 patients with the disease and 40 without the disease matched by age in southern Brazil. The CD group included patients previously diagnosed by positive anti-endomysial (IgA) examination and confirmed by small intestine biopsy. The presence of dental enamel defects and dental caries was evaluated by a calibrated researcher according to AINE’s and WHO’s criteria, respectively. The history of recurrent aphthous ulcers and dry mouth was obtained through reporting. For the evaluation of the salivary flow, the saliva samples were obtained through the non-stimulated and stimulated saliva collection method.

Results

There was a significant association between CD and dental enamel defects (OR=2.38, P=0.045) and dry mouth (OR=9.15, P=0.002). No difference was found for the report of recurrent aphthous ulcers and caries experience between the two groups. Patients with CD had normal pattern of unstimulated and stimulated saliva flow rates (0.67 ± 0.38 ml / min and 1.14 ± 0.47 ml / min, respectively). A higher occurrence of dental enamel defects was observed in patients with classic CD (P=0.054). Of the 1,962 permanent teeth, 59 presented dental enamel defects, 71.8% of which were in patients with CD (P=0.001), predominantly in molars (P=0.009).

Conclusions

CD increased the likelihood of dental enamel defects and dry mouth sensation. The oral examination can be an important auxiliary tool for the identification of cases of the disease.

Key words:Celiac disease, oral manifestations, dental enamel hypoplasia.

Clinical evaluation of dental enamel defects and oral findings in coeliac children

Purpose

To examine dental hard and soft tissue changes of coeliac children in order to increase the awareness of the pediatric dentists in prediagnosis of especially undiagnosed coeliac disease.

Materials and methods

Sixty children, 28 (46.7%) boys and 32 (53.3%) girls whose ages were between 6 to 16 years were included in the present study. Thirty children who had undergone endoscopy and diagnosed with the coeliac disease in the Şişli Hamidiye Etfal Hospital, İstanbul, Turkey, formed the study group. Also, thirty children clinically suspected of having the coeliac disease with the same gastrointestinal complaints had undergone endoscopy and proven not coeliac were chosen as the control group. Oral examination involved assessment of dentition and specific and unspecific dental enamel defects. Also, soft tissue lesions, clinical delay of the dental eruption, salivary flow rate, pH, and buffering capacity were examined.

Results

Twenty coeliac patients had enamel defects, however none in the control subjects. In the coeliac group, all enamel defects were diagnosed in permanent teeth and as specific in all children. Grade I dental enamel defects found mainly in the incisors. The clinical delayed eruption was observed in 10 (33.3%) of 30 coeliac children and none of the children in the control group. While the level of DMFT/S numbers and stimulated salivary flow rate were found significantly lower in the coeliac group, pH was found significantly higher.

Conclusion

Oral cavity may be involved in coeliac disease and pediatric dentists can play an important role in the early diagnosis of the coeliac disease.

Interrelationships Between Morphometric, Densitometric, and Mechanical Properties of Teeth in 5-Month-Old Polish Merino Sheep

Interrelationships between morphological, densitometric, and mechanical properties of deciduous mandibular teeth (incisors, canine, second premolar) were investigated. To perform morphometric, densitometric, and mechanical analyses, teeth were obtained from 5-month-old sheep. Measurements of mean volumetric tooth mineral density and total tooth volume were performed using quantitative computed tomography. Microcomputed tomography was used to measure total enamel volume, volumetric enamel mineral density, total dentin volume, and volumetric dentin mineral density. Maximum elastic strength and ultimate force of teeth were determined using 3-point bending and compression tests. Pearson correlation coefficients were determined between all investigated variables. Mutual dependence was observed between morphological and mechanical properties of the investigated teeth. The highest number of positive correlations of the investigated parameters was stated in first incisor indicating its superior predictive value of tooth quality and masticatory organ function in sheep. Positive correlations of the volumetric dentin mineral density in second premolar with final body weight may indicate predictive value of this parameter in relation with growth rate in sheep. Evaluation of deciduous tooth properties may prove helpful for breeding selection and further reproduction of sheep possessing favorable traits of teeth and better masticatory organ function, leading to improved performance and economic efficiency of the flock.

Association between developmental defects of enamel and celiac disease: A meta-analysis

OBJECTIVES

Studies have observed the presence of extra-intestinal manifestations of celiac disease (CD), including involvement of the oral cavity, such that developmental defects of enamel (DDE) occur. Thus, the aim of this review was to access the polled prevalence of DDE in individuals with CD, and to establish the strength of the association between these two variables.

METHODS

To carry out the systematic review, four electronic databases and the Grey Literature were searched, complemented by a manual search of reference lists within the selected articles. Two pairs of independent reviewers selected the articles, and perform the data extractions and bias risk assessment Studies evaluating the presence of DDE in individuals with CD as well as in healthy individuals and which performed the DDE diagnosis by direct visualization of tooth enamel changes and the CD diagnosis were included. Meta-analyses were performed using the software R.

RESULTS

Of 557 studies, 45 were selected for review, encompassing 2840 patients. The prevalence of DDE in people with CD was 50% (95% CI 0.44-0.57, I² = 88%). In a general analysis, it was observed that patients with CD had a significantly higher prevalence of enamel defects compared to healthy people (RR: 2.31, 95% CI: 1.71-3.12, I² = 98%). Only developmental defects of enamel diagnosed using Aine's method were associated with the disease (RR: 3.30, 95% CI 2.39-4.56, I² = 75%). In a sensitivity analysis involving the deciduous, mixed and permanent dentitions, only individuals with deciduous dentition were observed to have association with the disease (RR: 2.34, 95% CI 1.25-4.39, I² = 39%).

CONCLUSIONS

Patients with enamel developmental defects should be screened for the possibility of their having celiac disease.

Tooth Wear Is Frequent in Adult Patients with Celiac Disease

(1) Background: Celiac disease (CD) patients can be affected by mouth and tooth disorders, which are influenced by their gluten-free diet. The aim of our research was to evaluate the pathological conditions of the stomatognathic system observed in celiac patients on a gluten-free diet. (2) Methods: we consecutively recruited celiac patients on a gluten-free diet at our celiac center, as well as healthy volunteers. Two dentists examined all patients/controls and checked them for any mouth disorder. (3) Results: Forty-nine patients affected by celiac disease (age at test 31.8 ± 11.58, time on GFD 8.73 ± 7.7) and 51 healthy volunteers (age at test 30.5 ± 8.7) were included. Recurrent aphthous stomatitis was reported in 26 patients (53.0%) and in 13 (25.5%) controls (p = 0.005). Dental enamel disorders were reported in 7 patients (14.3%) and in 0 controls (p = 0.002), with none having geographic tongue. We 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 (p = 0.05). (4) Conclusion: Recurrent aphthous stomatitis and enamel hypoplasia are "risk indicators" that may suggest that an individual has CD. We detected a high prevalence of non-specific tooth wear that can be caused by several factors such as malocclusion, sleep bruxism, parafunctional activity, and age.

Dental enamel defects in adult coeliac disease: prevalence and correlation with symptoms and age at diagnosis

BACKGROUND

Coeliac disease is a condition characterized by a wide spectrum of clinical manifestations. Any organ can be affected and, among others, dental enamel defects have been described. Our aims were to study the prevalence of dental enamel defects in adults with coeliac disease and to investigate a correlation between the grade of teeth lesion and clinical parameters present at the time of diagnosis of coeliac disease.

METHODS

A dental examination was performed in 54 coeliac disease patients (41 F, mean age 37 ± 13 years, mean age at diagnosis 31 ± 14 years). Symptoms leading to diagnosis were diarrhoea/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, they were all on a gluten-free diet. Enamel defects were classified from grade 0 to 4 according to its severity.

RESULTS

Enamel defects were observed in 46/54 patients (85.2%): grade 1 defects were seen in 18 patients (33.3%) grade 2 in 16 (29.6%), grade 3 in 8 (14.8%), and grade 4 in 4 (7.4%). We also observed that grades 3 and 4 were more frequent in patients diagnosed with classical rather than non-classical coeliac disease (10/32 vs. 2/20). However, this was not statistically significant.

CONCLUSION

This study confirms that enamel defects are common in adult coeliac disease. Observation of enamel defects is an opportunity to diagnose coeliac disease.

Screening for celiac disease in children with dental enamel defects

Background. Dental enamel defects (DEDs) are seen in celiac disease (CD). Aim was to detect frequency of CD among such patients. Methods. This study included 140 children with DED. They were tested for CD. Gluten-free diet (GFD) was instituted for CD patients. A cohort of 720, age and sex-matched, normal children represented a control group. Both groups were evaluated clinically. Serum calcium, phosphorus, alkaline phosphatase, serum IgA, and tissue transglutaminase (tTG) IgG and IgA types were measured. Results. CD was more diagnosed in patients with DEDs (17.86%) compared to controls (0.97%) (P < 0.0001). Majority of nonceliac patients showed grade 1 DED compared to grades 1, 2, and 3 DED in CD. Five children had DED of deciduous teeth and remaining in permanent ones. After 1 year on GFD, DED improved better in CD compared to nonceliac patients. Gastrointestinal symptoms did not vary between celiac and nonceliac DED patients. Lower serum calcium significantly predicted CD in this cohort. Conclusion. CD is more prevalent among children with DED than in the general population. These DEDs might be the only manifestation of CD; therefore, screening for CD is highly recommended among those patients especially in presence of underweight and hypocalcemia.

Oral findings and salivary parameters in children with celiac disease: a preliminary study

OBJECTIVE

The aim of this study was to investigate the prevalence of dental enamel defects, recurrent aphthous stomatitis (RAS) and caries experience and to measure salivary flow rate, buffer capacity, saliva and plaque pH and salivary cariogenic microflora in patients with celiac disease (CD) compared to healthy subjects.

SUBJECTS AND METHODS

Thirty-five patients, aged 6-19 years, with a diagnosis of CD and 35 healthy children of the same age participated in the study. Enamel defects were diagnosed and classified using Aine's classification. The patients with RAS and dental caries were recorded using WHO criteria. The parents were interviewed about various oral health-related factors. Saliva samples were collected to measure the stimulated salivary flow rate, buffer capacity and pH values of saliva and plaque. Salivary mutans streptococci and lactobacilli were counted.

RESULTS

The enamel defects and RAS prevalence were statistically higher (40 and 37.1%, respectively) in the CD group, and the prevalence of salivary mutans streptococci (48 and 14%) and lactobacilli (51 and 34%) colonization was statistically lower (p = 0.012, p = 0.010) in the CD group; the DMFS and dfs values were similar in both groups.

CONCLUSION

CD appeared to be associated with a significantly higher prevalence of developing enamel defects and RAS, but a lower prevalence of salivary mutans streptococci and lactobacilli colonization, and the diagnosis of these oral manifestations might be helpful for an early diagnosis of CD.

The association between celiac disease, dental enamel defects, and aphthous ulcers in a United States cohort

GOALS AND BACKGROUND

European studies have demonstrated that dental enamel defects and oral aphthae are observed in celiac disease (CD). We investigated this association in a US population.

STUDY

Biopsy proven CD patients and controls were recruited from a private dental practice and from CD support meetings. History of aphthae was taken and dental examination was performed by a single dentist. Teeth were photographed and enamel defects graded according to the Aine classification. A second dentist reviewed all photographs.

RESULTS

Among patients (n=67, mean age 34.8+/-21.6 y) compared with controls (n=69, mean age 28.1+/-15.7 y), there were significantly more enamel defects [51% vs. 30%, P=0.016, odds ratio (OR) 2.4, 95% confidence interval (CI) 1.2-4.8]. This was confined to children (87% vs. 33%, P=0.003, OR 13.3, 95% CI 3.0-58.6), but not adults (32% vs. 29%, P=0.76, OR 1.2, 95% CI 0.5-2.8). This was reflected in defects being observed in those with mixed dentition compared with those with permanent dentition (68.4% vs. 29.6%, P<0.0001). The degree of agreement between the 2 dentists was good (kappa coefficient=0.53, P<0.0001), aphthous ulcers were more frequent in CD than controls (42.4% vs. 23.2%, P=0.02).

CONCLUSIONS

This study supports that CD is highly associated with dental enamel defects in childhood, most likely because of the onset of CD during enamel formation; no such association was found in adults. Our study also supports the association between CD and aphthous ulcer. All physicians should examine the mouth, including the teeth, which may provide an opportunity to diagnose CD. In addition, CD should be added to the differential diagnosis of dental enamel defects and aphthous ulcers.

Implications of gluten exposure period, CD clinical forms, and HLA typing in the association between celiac disease and dental enamel defects in children. A case-control study

BACKGROUND

The association between coeliac disease (CD) and dental enamel defects (DED) is well known.

AIM

The aim of this study was to investigate the prevalence of DED in children with CD and to specifically find the association of DED and gluten exposure period, CD clinical forms, HLA class II haplotype.

DESIGN

This study was designed as a matched case-control study: 250 children were enrolled (125 coeliac children - 79 female and 46 male, 7.2 +/- 2.8 years and 125 healthy children). Data about age at CD diagnosis, CD clinical form, and HLA haplotype were recorded.

RESULTS

Dental enamel defects were detected in 58 coeliac subjects (46.4%) against seven (5.6%) controls (P < 0.005). We found an association between DED and gluten exposure period, as among CD subjects the mean age at CD diagnosis was significantly (P = 0.0004) higher in the group with DED (3.41 +/- 1.27) than without DED (1.26 +/- 0.7). DED resulted more frequent (100%) in atypical and silent CD forms than in the typical one (30.93%). The presence of HLA DR 52-53 and DQ7antigens significantly increased the risk of DED (P = 0.0017) in coeliac children.

CONCLUSIONS

Our results confirmed a possible correlation between HLA antigens and DED.

Aetiology of molar-incisor hypomineralization: a critical review

OBJECTIVE

The objective of this study was to assess the strength of evidence for the aetiology of molar-incisor hypomineralization (MIH), often as approximated by demarcated defects.

METHOD

A systematic search of online medical databases was conducted with assessment of titles, abstracts, and finally full articles for selection purposes. The level and quality of evidence were then assessed for each article according to Australian national guidelines.

RESULTS

Of 1123 articles identified by the database search, 53 were selected for review. These covered a variety of potential aetiological factors, some of which were grouped together for convenience. The level of evidence provided by the majority of papers was low and most did not specifically investigate MIH. There was moderate evidence that polychlorinated biphenyl/dioxin exposure is involved in the aetiology of MIH; weak evidence for the role of nutrition, birth and neonatal factors, and acute or chronic childhood illness/treatment; and very weak evidence to implicate fluoride or breastfeeding.

CONCLUSION

There is currently insufficient evidence in the literature to establish aetiological factor/s relevant for MIH. Improvements in study design, as well as standardization of diagnostic and examination protocols, would improve the level and strength of evidence.

Prevalence of dental enamel defects in celiac patients with deciduous dentition: a pilot study

OBJECTIVE

To describe the prevalence of unspecific and systematic enamel defects in children with deciduous dentition diagnosed with celiac disease compared with a control group.

STUDY DESIGN

Thirty children (mean age 3.6 yrs) diagnosed with celiac disease and a reference group (n = 30; mean age 3.8 yrs) were studied to determine the prevalence of enamel defects. Both groups had complete deciduous dentition. Unspecific and systematic enamel defects were evaluated according to Aine criteria.

RESULTS

Enamel defects were detected in 83.3% of the celiac children versus 53.3% of the control children (P = .025). The corresponding figures for symmetric defects were 73.3% and 23.3% (P < .001), respectively. The most frequent defect severity classification was Aine grade 1. Dental enamel defects were most frequently detected in deciduous molars (45.1%), followed by deciduous incisors.

CONCLUSIONS

This study showed significantly more systematic enamel defects in children with celiac disease and deciduous dentition compared with a control group in the same stage of dentition. Dental examination of these defects may be useful to alert for this disease.

Oral manifestations of celiac disease

INTRODUCTION

Contrary to early beliefs, celiac disease (CD) is relatively common; however, it still remains underdiagnosed since most cases are atypical, with few or no gastrointestinal symptoms and predominance of extraintestinal manifestations. As a consequence, the diagnosis of the disorder often requires a multidisciplinary approach. Also some oral ailments have been described in celiac patients. In this study, we review the papers that have reported oral manifestations in subjects with CD.

METHODS

A comprehensive literature search was conducted in Medline and Embase databases using appropriate key words. Additional papers were selected by cross-referencing from the retrieved articles.

RESULTS

Dental enamel defects are the oral lesions most closely related to CD. There are conflicting data on the association between CD and recurrent aphthous stomatitis. A correlation of CD with atrophic glossitis has been reported, although robust evidence in support of it is lacking. Patients with CD have caries indexes seemingly lower than healthy individuals, but they may experience delay in tooth eruption. Occurrence of other oral mucosal lesions in CD subjects is likely occasional.

CONCLUSIONS

Patients with systematic dental enamel defects should be screened for CD even in the absence of gastrointestinal symptoms. CD screening tests for patients with oral aphthae or idiopathic atrophic glossitis should be selectively considered during a medical evaluation that focuses on all aspects of the patient's status.

Celiac disease: pathophysiology, clinical manifestations, and associated autoimmune conditions

The clinical spectrum of celiac disease continues to evolve. What was once thought to be a rare disorder affecting young children is now recognized to be very common with a range of symptoms from asymptomatic disease to severely affected persons. Screening for celiac disease has become relatively easily with reliable antibodies against self-antigens (TG) and modified environmental antigens (DGP). Diagnosis is confirmed by small intestinal biopsy with characteristic changes graded by the Marsh score. Elimination of gluten from the diet has been the standard of care for the last half century. Patients often have difficulty adhering to a gluten-free diet, and the failure of symptoms, antibody levels, or pathologic changes to improve after initiating the diet may be largely due to this difficulty. The genetic risk for celiac disease is largely related to HLA genotypes, with over 90% of subjects with celiac disease positive for DQ2 and the remainder positive for DQ8. The HLA association with celiac disease is largely accountable for its link to other autoimmune diseases, including type 1 diabetes and autoimmune thyroid disease, and the majority of risk for celiac disease in these populations is related to HLA genotype. Celiac disease also carries an increased risk for type 1 diabetes and autoimmune thyroid disease. Genetic syndromes such as Turner and Down syndromes are associated with an increased risk for celiac disease. Practitioners can identify groups of subjects at high risk for celiac disease and perform screening with celiac disease-related antibodies.

Oral pathology in untreated coeliac [corrected] disease

BACKGROUND

Many coeliac disease patients with atypical symptoms remain undiagnosed.

AIM

To examine the frequency of oral lesions in coeliac disease patients and to assess their usefulness in making coeliac disease diagnosis.

PATIENTS AND METHODS

One hundred and ninety-seven coeliac disease patients and 413 controls were recruited and the oral examination was performed.

RESULTS

Forty-six out of 197 coeliac disease patients (23%) were found to have enamel defects vs. 9% in controls (P < 0.0001). Clinical delayed eruption was observed in 26% of the pediatric coeliac disease patients vs. 7% of the controls (P < 0.0001). The prevalence of oral soft tissues lesions was 42% in the coeliac disease patients and 2% in controls (P < 0.0001). Recurrent aphthous stomatitis disappeared in 89% of the patients after 1 year of gluten-free diet. Multi-logistic analysis selected the following variables as the most meaningful in coeliac disease patients: dental enamel defects (OR = 2.652 CI = 1.427-4.926) and soft tissue lesions (OR = 41.667, CI = 18.868-90.909). Artificial Neural Networks methodology showed that oral soft tissue lesions have sensitivity = 42%, specificity = 98% and test accuracy = 83% in coeliac disease diagnosis.

CONCLUSIONS

The overall prevalence of oral soft tissue lesions was higher in coeliac disease patients (42%) than in controls. However, the positive-predictive value of these lesions for coeliac disease diagnosis was low.

Lack of association between celiac disease and dental enamel hypoplasia in a case-control study from an Italian central region

Background

A close correlation between celiac disease (CD) and oral lesions has been reported. The aim of this case-control study was to assess prevalence of enamel hypoplasia, recurrent aphthous stomatitis (RAS), dermatitis herpetiformis and atrophic glossitis in an Italian cohort of patients with CD.

Methods

Fifty patients with CD and fifty healthy subjects (age range: 3–25 years), matched for age, gender and geographical area, were evaluated by a single trained examiner. Diagnosis of oral diseases was based on typical medical history and clinical features. Histopathological analysis was performed when needed. Adequate univariate statistical analysis was performed.

Results

Enamel hypoplasia was observed in 26% cases vs 16% in controls (p > 0.2; OR = 1.8446; 95% CI = 0.6886: 4.9414). Frequency of RAS in the CD group was significantly higher (36% vs 12%; p = 0.0091; OR = 4.125; 95% CI = 1.4725: 11.552) in CD group than that in controls (36% vs 12%). Four cases of atrophic glossitis and 1 of dermatitis herpetiformis were found in CD patients vs 1 and none, respectively, among controls.

Conclusion

The prevalence of enamel hypoplasia was not higher in the study population than in the control group. RAS was significantly more frequent in patients with CD.

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 (chi(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.

Oral aphthous ulcers and dental enamel defects in children with coeliac disease

AIM

Coeliac disease is characterized by oral manifestations, such as dental enamel defects and recurrent oral aphthae. In this study we compared the prevalence of enamel defects and recurrent aphthous stomatitis (RAS) between patients diagnosed with coeliac disease and healthy controls.

METHODS

A total of 72 patients with coeliac disease were studied together with 162 normal healthy subjects as controls to individualize the prevalence of enamel defects and recurrent aphthous stomatitis (RAS) in this disease.

RESULTS

Dental enamel defects were found in 14/70 (20%) coeliac patients and in 9/159 (5.6%) controls. In particular, 13/53 (24.5%) coeliac patients with mixed or permanent dentition and 1/17 (5.8%) coeliac children with deciduous dentition had enamel defects. Altogether, 9/145 (6.2%) control subjects with mixed or permanent dentition had dental enamel defects. None of the controls with deciduous dentition had enamel defects. Thus, the enamel defects occurred more frequently in coeliac patients (p < 0.001). Regarding RAS, 24/72 (33.3%) coeliac patients and 38/162 (23.4%) control subjects had aphthous ulcers. Statistically significant differences were not observed between the two groups (p > 0.05). One in three coeliac subjects suffering from RAS received benefit from a gluten-free diet.

CONCLUSION

In the present study, the prevalence of enamel defects was found to be greater in coeliac patients than healthy controls. Even though the prevalence of RAS in coeliac subjects varied from healthy controls, the difference was not statistically significant. However, more than 1/3 coeliac subjects suffering from RAS benefited from a gluten-free diet.

Doença celíaca: sua relação com a saúde bucal

Doença Celíaca é uma intolerância permanente às proteínas contidas no glúten de alguns cereais, como o trigo, o centeio, a cevada e a aveia. A doença manifesta-se principalmente nos primeiros dois anos de vida, sendo o intestino delgado o principal órgão afetado, com manifestações clínicas de diarréia, vômitos e emagrecimento; porém, o diagnóstico, muitas vezes, é difícil, devido ao grande número de casos atípicos da doença. Nestes casos, os sintomas podem ser numerosos e diversificados, tais como baixa estatura, anemia, osteoporose, hipoplasia do esmalte dentário, além de sintomas próprios do quadro clínico de outras doenças imunológicas que podem associar-se à doença celíaca, tais como diabetes mellitus, dermatite herpertiforme, doenças da tireóide, alergia, estomatite aftosa recorrente, entre outras. Devido a essa associação, os profissionais da saúde procurados pelos pacientes podem não relacionar os sintomas à enteropatia; entretanto, esta, se não tratada, pode trazer várias outras complicações à saúde. O objetivo desta comunicação é demonstrar a importância das manifestações bucais, as quais, quando devidamente observadas, contribuem ao diagnóstico da doença celíaca.

Oral findings in coeliac disease and Sjögren's syndrome

OBJECTIVE

Both coeliac disease (CD) and Sjogren's syndrome (SS) have an autoimmune background and increased risk of oral mucosal and dental abnormalities. Individuals suffering concomitantly from CD and SS could even be at a higher risk.

STUDY DESIGN

Oral mucosal and dental abnormalities were examined in 20 patients with CD + SS (mean age 61 years) and compared with age- and sex-matched controls with either CD or SS.

RESULTS

Oral mucosal changes were most common in SS (80%), followed by CD + SS (65%) and CD (40%). Coeliac-type dental enamel defects were found in 89% in CD + SS and in 88% in CD compared with only 25% in SS (P < 0.001). The median number of teeth was six in the CD + SS, 24 in the CD and 22 in the SS group. The DMF index was higher (P < 0.005) in the CD + SS than in the CD group. CD + SS was characterized by higher salivary flow rate (P < 0.001) and lower inflammatory focus score in the salivary glands (P < 0.01) than SS.

CONCLUSIONS

The co-occurrence of CD and SS should be recognized because of its effects on dental and oral mucosal health. A lower salivary gland inflammatory focus score and higher salivary flow rate in CD + SS than in SS suggests that a gluten-free diet treatment may alleviate autoimmune inflammation.

Clinical features of coeliac disease today

Coeliac disease is an inflammatory disorder of the small intestine induced by dietary gluten. This frequently results in malabsorption of a range of important nutrients including iron, folic acid, calcium and fat-soluble vitamins. Coeliac disease in now considered to be a common disorder, possibly affecting 1:300 of the general population. Many patients present in adulthood, have minimal symptoms, and gastrointestinal manifestations are frequently absent. The diagnosis and screening for coeliac disease has been dramatically facilitated by testing for endomysial autoantibodies, although biopsy and demonstration of a characteristic histological lesion remains the definitive diagnostic investigation. Treatment with a gluten-free diet is effective but requires good patient compliance and monitoring to succeed.