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Celiac disease has made a major impact on family physicians and internists, but thus far it hasn't changed the way most dentists treat patients. One dentist says it should.
According to the
, as many as one in 141 Americans currently lives with celiac disease.
is an autoimmune disorder wherein the small intestine is damaged by the consumption of gluten. When gluten, a protein found in wheat, rye, and barley, is eaten, it triggers the body’s immune response, which attacks the small intestine and damages the villi that help it absorb nutrients properly.
Celiac disease is one of the most common gastrointestinal disorders in the world. Diagnosis can be difficult since there are many symptoms attributed to the condition, including but not limited to bloating, chronic diarrhea, constipation, gas, nausea, stomach pain, and vomiting. Additionally, there are a multitude of dental complications that patients with celiac might experience, but these symptoms are much less well known, even to dentists.
Dental Complications of Celiac Disease
The exact cause of dental complications in celiac patients is unknown, but it’s thought that damage is caused by the heightened immune response in these patients. One of the biggest complications from celiac disease is dental enamel defects. Children as especially vulnerable to enamel defects, which could cause life-long oral health issues. Nicholas Calcaterra, DDS, explained that “if a child has celiac, and he or she consumes gluten in any substantial quantity as the teeth are developing, they can end up with a defect in the enamel as a result of gluten consumption. Post teeth formation, as with teenagers and adults, there can be other types of complications as well, although typically not as severe as the enamel defects that can occur.”
Most enamel defects resulting from celiac disease place patients at very high risk for decay or other issues. Discoloration typically occurs, with patients noticing white, yellow, or brown spots on the teeth. The enamel itself can be mottled and weak, sometimes exhibiting pitting, grooving, or lines across the teeth.
include delayed eruption of teeth, cheilosis, and atrophic glossitis. Many people also experience issues with frequent aphthous ulcers, otherwise known as cold sores. These sores can be especially painful, and sometimes require prescribed medication to relieve them. Another common problem is dry mouth syndrome, which, when coupled with dental enamel defects, puts patients at greater risk for tooth decay and cavity formation.
How Can Dentists Help Celiac Patients Limit Their Exposure to Gluten?
Many patients are able to avoid gluten entirely at home through a special diet.
naturally include fruits, vegetables, meat and poultry, fish and seafood, dairy, and beans, legumes, and nuts. Unfortunately, strict adherence to a gluten-free lifestyle might not limit all exposure — in fact, many celiac patients are routinely exposed to gluten at their dentist’s office.
Some dental practices have begun to go gluten-free, as is the case with
in Connecticut. When researching celiac disease and oral health in peer-reviewed journals, Calcaterra found gluten-containing dental products can cause “quite an unpleasant response” in patients with gluten-sensitivity. For instance, if a celiac patient has a biannual dental cleaning and a hygienist uses prophy paste that contains gluten, the patient might have a negative reaction to the product. “The type of response and severity of it depends on the patient, and further research is needed. It all depends on how thorough the dental cleaning was, and the concentration of gluten in the prophy paste that as used” he said.
Calcaterra also found that colored dental products generally tend to have gluten in them. Based on his research and conversations with product vendors, Calcaterra said that “where we see gluten in dental products is primarily in the preventative products. That’s what people are exposed to the most.” Patients can be exposed to gluten in a variety of preventative products - toothpaste, prophy paste, polishing pastes, topical fluoride, and even topical anesthetics might contain gluten.
“If you’re getting a cleaning every six months, you’re going to be exposed to gluten every six months” notes Calcaterra. Since many patients with gluten sensitivity do see dentists every six months for preventative care, “that’s where dentists and patients really have to do their homework.”
What Can Dentists Do If They Suspect a Patient Has Celiac Disease?
Since dentists are uniquely trained to recognize dental abnormalities, they can be instrumental in identifying patients that should be screened further for celiac disease. If you suspect a patient might have celiac disease,
• Ask the patient about other symptoms of celiac disease they might be experiencing, like abdominal pain, diarrhea, and chronic fatigue. But remember, celiac disease cannot be ruled out in the absence of further symptoms.
• Ask about other immune system disorders, especially thyroiditis and type 1 diabetes. The presence of other immune system diseases can increase the likelihood of developing celiac disease.
• Ask about other family members that might have celiac disease. It is a hereditary disorder.
• To confirm a diagnosis of celiac disease, refer the patient to their primary medical care provider. A simple blood test is used to diagnose the condition.
It’s important to remember that not all dental complications result from celiac disease or gluten exposure. Problems like dental enamel defects are fairly common in celiac patients and can help dentists identify patients who might be suffering from the disease, but they can result from other conditions. However, regarding celiac disease and its effect on oral health, Calcaterra notes, “It’s not like this is well known within the dental community. I would estimate that most dentists don’t know much about this at all. I’d wager 95% of dentists, if you asked them are there oral manifestations of celiac disease, they’d say I don’t know.”
“I don’t know if it’s included in dental school curriculum today,” he said. “There’s no sort of standard protocol that I’m aware of. Hopefully there will be.”