by John Libonati
Dentists can be the first identifiers of celiac disease. Up to 89% of people with celiac disease exhibit dental enamel defects. Dental enamel defects are characterized by alteration in the hard, white, dense, inorganic substance covering the crowns of the teeth. These defects may include demarcated opacities (white spots), undersized teeth, yellowing, grooves and/or pitting on one or more permanent teeth.(1)
A study of 128 patients on a gluten-free diet revealed that changes in the permanent teeth may be the only sign of an otherwise symptomless celiac disease.(1) It should also be noted that calcium and vitamin D deficiencies are common in celiac disease. Deficiencies of these nutrients lead to cavities.
“Dentists mostly say it’s from fluoride, that the mother took tetracycline, or that there was an illness early on,” said Peter H.R. Green, M.D., director of the Celiac Disease Center at Columbia University. “Celiac disease isn’t on the radar screen of dentists in this country. Dentists should be made aware of these manifestations to help them identify eople and get them to see their doctors so they can exclude celiac disease.”(2)
Green completed a U.S. study with his dental colleague, Ted Malahias, DDS, that demonstrates celiac disease is highly associated with dental enamel defects in childhood—most likely due to the onset of celiac disease during enamel formation. The U.S. study, which did not identify a similar association in adults, concluded that all physician education about celiac disease should include information about the significance of dental enamel defects.(2)
It is critical that children are identified early. Dental enamel defects will have occurred before the critical age of 7 years, when the crowns of permanent teeth have developed. Defects can also be used as a screening tool in the adult population. Those with defects should be checked for celiac disease to avoid other health complications, such as irritable bowel disease, weight gain, osteoporosis or cancer.
If you know someone who cannot determine the cause of their dental enamel defects, tell them to ask their physician to consider celiac disease.
Celiac disease is a multi-system, hereditary, chronic, auto-immune disease estimated to affect 1% of the human population (3 million in the US) that is caused by the ingestion of wheat, barley, rye and oats. It is treated by removing these items from the diet. Signs, symptoms, associated disorders and complications can affect any part of the body and removal of the offending foods can result in complete recovery. Check out Gluten Free Works, for more information.
1. Libonati, Cleo. Recognizing Celiac Disease, p. 126.
2. National Institutes of Health. http://celiac.nih.gov/DentalEnamel.aspx