Oral Manifestations in Pediatric Patients with Coeliac Disease – A Review Article
Individuals with coeliac disease (CD) may present with a variety of gastrointestinal or extraintestinal symptoms. The presence of oral lesions and dental defects have been observed amongst coeliac patients at higher frequency compared to the general population and may therefore be an additional tool to aid diagnosis, particularly amongst those patients who present with more atypical or silent forms of CD.
Current NICE guidelines for the diagnosis and management of CD state that patients presenting with severe or persistent mouth ulcers should be offered serological testing to exclude coeliac disease. Furthermore, NASPGHAN included the presence of specific enamel defects as a risk factor for CD.
A literature review was performed amongst related articles published between 2000 and April 2017. Following a full text analysis, 43 articles were selected for inclusion in this review, alongside the authors clinical experience of treating children with coeliac disease. A large prevalence of oral manifestations in patients with coeliac disease was described by numerous authors, these included:
Better knowledge of the oral manifestations of CD may facilitate diagnosis of patients affected by more atypical or silent forms of CD. Amongst children in whom CD is suspected, dietitians are well placed to ask additional questions when collating relevant medical history relating to mouth health and dental abnormalities. Dietitians may also wish to encourage patients to seek regular dental health checks in order to correct or prevent associated complications.
Link to full article: https://benthamopen.com/contents/pdf/TODENTJ/TODENTJ-11-539.pdf
A literature review was performed amongst related articles published between 2000 and April 2017. Following a full text analysis, 43 articles were selected for inclusion in this review, alongside the authors clinical experience of treating children with coeliac disease. A large prevalence of oral manifestations in patients with coeliac disease was described by numerous authors, these included:
- Dental enamel defects
- Recurrent aphthous stomatitis- RAS (recurrent mouth ulcers)
- Delayed tooth eruption
- Dental caries
- Geographic tongue (inflammation on top and sides of tongue)
- Angular cheilitis (inflammation, skin breakdown and crusting at sides of mouth)
- Atrophic glossitis (sore/ inflamed tongue)
- Burning tongue
- Dry mouth.
RAS (recurrent mouth ulcers)
RAS is one of the most prevalent oral pathological conditions, affecting 10-20% of the general population and is more prevalent in children with nutritional deficiencies, immunodeficiencies, malabsorption and coeliac disease. Articles included in this review found the prevalence of RAS to be between 23-33% amongst children with CD and an average of 3 times higher prevalence amongst children with CD compared to control groups. One study suggested that RAS was more frequent amongst coeliac patients who did not report gastro-related symptoms before diagnosis.Dental Enamel Defects
Dental enamel defects may occur in numerous systemic diseases and are mainly characterized by pitting, grooving and sometimes complete loss of enamel. The defects found amongst CD patients appear to be highly specific, occurring symmetrically and chronologically across each section of dentition. The etiology of dental enamel defects in CD is not precisely clarified but this condition is most commonly attributed to low serum levels of calcium and vitamin D (secondary to malabsorption). Other mechanisms may include an autoimmune response against ameloblasts (cells present during tooth development that deposit tooth enamel) and/or a particular genetic link that puts specific individuals with coeliac disease at greater risk of dental enamel defects. Articles reviewed here suggest that enamel defects could be a major sign of CD, being 3-5 times more prevalent amongst children with CD compared to controls. Some studies suggest that anterior teeth are more commonly affected and that the enamel of CD patients is generally more fragile compared to healthy individuals.Better knowledge of the oral manifestations of CD may facilitate diagnosis of patients affected by more atypical or silent forms of CD. Amongst children in whom CD is suspected, dietitians are well placed to ask additional questions when collating relevant medical history relating to mouth health and dental abnormalities. Dietitians may also wish to encourage patients to seek regular dental health checks in order to correct or prevent associated complications.
Link to full article: https://benthamopen.com/contents/pdf/TODENTJ/TODENTJ-11-539.pdf
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