The Tooth Health Connection
Tooth damage may signal celiac disease; here’s why early detection is the key to keeping your teeth looking good.
By Lio Perron
WHILE ALL CHILDREN SHOULD HAVE regular dental visits for good oral health, parents should take special care if they notice unusual tooth damage or have a family history of celiac disease.
Celiac disease is a hereditary autoimmune disorder of the small intestine that is caused by exposure to gluten. Not all cases of celiac disease are triggered by a genetic history; just because there isn’t a history of celiac disease in your family doesn’t mean your child is immune.
“You can have autoimmune damage to other organs and one of them is teeth. Nobody is exactly sure how that happens,” said Dr. Mohsin Rashid, a gastroenterologist at the IWK Health Centre in Halifax. Researchers have presented two possible explanations. One is that autoimmune responses triggered by celiac disease may affect tooth development. Another theory is that malabsorption of nutrients such as calcium and vitamin D may prevent patients from building healthy tooth enamel.
Although celiac disease can strike at any age, dental-enamel defects “can only occur when teeth are forming,” said Anthony Iacopino, a spokesman for the Canadian Dental Association and dean of dentistry at the University of Manitoba. “Children diagnosed with celiac disease before their adult teeth are fully formed, at about age seven, have a good chance of developing healthy tooth enamel if the disease is treated with a gluten-free diet,” he added.
Tooth defects resulting from celiac disease are permanent and don’t improve after adopting a gluten-free diet. In patients with the disease, dental enamel may be rough and discoloured, with spots of yellow or brown. There may be structural defects, including deep horizontal grooves and large pits, or the entire tooth may be irregular in shape.
Could you have celiac disease?
In adults, symptoms of celiac disease may include pain and discomfort in the digestive tract, chronic diarrhea or constipation. In children, the disease usually manifests itself by insufficient weight gain or inappropriate weight loss. Paediatricians refer to this phenomenon as “failure to thrive.”
In patients with no other symptoms, dentists and dental hygienists can play an important role in recommending screening for celiac disease.
Left untreated, celiac disease can lead to osteoporosis, serious vitamin and mineral deficiencies and an increased risk for lymphoma and other cancers. “Awareness of the link between tooth damage and celiac disease is crucial. If you talk to most dentists, they would not know anything about this connection,” said Rashid. A gastroenterologist can detect the disease by administering a biopsy. However, when dentists are knowledgeable about the manifestations of celiac disease they can easily spot it.
The Canadian Celiac Association has been trying to educate dentists on how to spot celiac disease when they see a patient with dental enamel defects. “In some patients, abnormalities in tooth enamel and recurrent canker sores are the only manifestations of celiac disease,” Rashid said. “This is a relatively easy way to identify this condition.”
Iacopino notes that patients may have dental enamel defects for other reasons, including a genetic predisposition or exposure to tetracycline antibiotics. “Just because you see enamel defects doesn’t mean it’s automatically celiac disease,” he says. But if the patient has tooth abnormalities, as well as frequent canker sores, celiac disease is a likely culprit.
Although celiac disease affects the small intestine, more than half of all celiac patients have no gastrointestinal symptoms, Rashid said. Dental enamel defects, however, are found in the majority of celiac patients. “Anywhere between 70 and 80 percent of celiac patients have some type of tooth abnormality.”
Finding celiac disease as early as possible is critical because a diagnosis in adulthood is too late to reverse the damage to a patient’s teeth. Treatment options for dental enamel defects include sanding the teeth into more regular shapes and other cosmetic procedures. When it comes to your teeth, the earlier you find out you have celiac disease and make changes to you diet, the better. VM
