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Gruper Y, Wolff ASB, Glanz L, Spoutil F, Marthinussen MC, Osickova A, Herzig Y, Goldfarb Y, Aranaz-Novaliches G, Dobeš J, Kadouri N, Ben-Nun O, Binyamin A, Lavi B, Givony T, Khalaila R, Gome T, Wald T, Mrazkova B, Sochen C, Besnard M, Ben-Dor S, Feldmesser E, Orlova EM, Hegedűs C, Lampé I, Papp T, Felszeghy S, Sedlacek R, Davidovich E, Tal N, Shouval DS, Shamir R, Guillonneau C, Szondy Z, Lundin KEA, Osicka R, Prochazka J, Husebye ES, Abramson J. Autoimmune amelogenesis imperfecta in patients with APS-1 and coeliac disease. Nature 2023; 624:653-662. [PMID: 37993717 DOI: 10.1038/s41586-023-06776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/23/2023] [Indexed: 11/24/2023]
Abstract
Ameloblasts are specialized epithelial cells in the jaw that have an indispensable role in tooth enamel formation-amelogenesis1. Amelogenesis depends on multiple ameloblast-derived proteins that function as a scaffold for hydroxyapatite crystals. The loss of function of ameloblast-derived proteins results in a group of rare congenital disorders called amelogenesis imperfecta2. Defects in enamel formation are also found in patients with autoimmune polyglandular syndrome type-1 (APS-1), caused by AIRE deficiency3,4, and in patients diagnosed with coeliac disease5-7. However, the underlying mechanisms remain unclear. Here we show that the vast majority of patients with APS-1 and coeliac disease develop autoantibodies (mostly of the IgA isotype) against ameloblast-specific proteins, the expression of which is induced by AIRE in the thymus. This in turn results in a breakdown of central tolerance, and subsequent generation of corresponding autoantibodies that interfere with enamel formation. However, in coeliac disease, the generation of such autoantibodies seems to be driven by a breakdown of peripheral tolerance to intestinal antigens that are also expressed in enamel tissue. Both conditions are examples of a previously unidentified type of IgA-dependent autoimmune disorder that we collectively name autoimmune amelogenesis imperfecta.
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Affiliation(s)
- Yael Gruper
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Anette S B Wolff
- Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Liad Glanz
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Frantisek Spoutil
- Czech Centre for Phenogenomics & Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the Czech Academy of Sciences v.v.i 252 50, Vestec, Czech Republic
| | - Mihaela Cuida Marthinussen
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
- Oral Health Centre of Expertise in Western Norway/Vestland, Bergen, Norway
| | - Adriana Osickova
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Yonatan Herzig
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Yael Goldfarb
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Goretti Aranaz-Novaliches
- Czech Centre for Phenogenomics & Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the Czech Academy of Sciences v.v.i 252 50, Vestec, Czech Republic
| | - Jan Dobeš
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
- Department of Cell Biology, Faculty of Science, Charles University, Prague, Czech Republic
| | - Noam Kadouri
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Osher Ben-Nun
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Amit Binyamin
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Bar Lavi
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Tal Givony
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Razi Khalaila
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Tom Gome
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Tomáš Wald
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Blanka Mrazkova
- Czech Centre for Phenogenomics & Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the Czech Academy of Sciences v.v.i 252 50, Vestec, Czech Republic
| | - Carmel Sochen
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Marine Besnard
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Shifra Ben-Dor
- Bioinformatics Unit, Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Ester Feldmesser
- Bioinformatics Unit, Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Elisaveta M Orlova
- Endocrinological Research Center, Institute of Pediatric Endocrinology, Moscow, Russian Federation
| | - Csaba Hegedűs
- Department of Biomaterials and Prosthetic Dentistry, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - István Lampé
- Department of Biomaterials and Prosthetic Dentistry, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Tamás Papp
- Division of Dental Anatomy, Department of Basic Medical Sciences, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Szabolcs Felszeghy
- Division of Dental Anatomy, Department of Basic Medical Sciences, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Radislav Sedlacek
- Czech Centre for Phenogenomics & Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the Czech Academy of Sciences v.v.i 252 50, Vestec, Czech Republic
| | - Esti Davidovich
- Department of Pediatric Dentistry, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Noa Tal
- The Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror S Shouval
- The Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raanan Shamir
- The Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carole Guillonneau
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Zsuzsa Szondy
- Division of Dental Biochemistry, Department of Basic Medical Sciences, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Knut E A Lundin
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Radim Osicka
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jan Prochazka
- Czech Centre for Phenogenomics & Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the Czech Academy of Sciences v.v.i 252 50, Vestec, Czech Republic
| | - Eystein S Husebye
- Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jakub Abramson
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel.
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2
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Turska-Szybka A, Dąbrowska E, Głogowska K, Janczewska A, Olczak-Kowalczyk D, Piekoszewska-Ziętek P. Coeliac disease and its implications on the oral health of children: A systematic review. J Paediatr Child Health 2023; 59:1105-1111. [PMID: 37712495 DOI: 10.1111/jpc.16494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/15/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
AIM Apart from various typical gastrointestinal symptoms, coeliac disease may have its clinical manifestations in the oral cavity which is the entrance of the gastrointestinal tract. METHODS A systematic review of literature was performed using the following databases: Medline, Scopus, EBSCOhost and Cochrane Library for Systematic Review. INCLUSION CRITERIA observational or experimental original studies published in English with full text available between January 2000 and December 2022, regarding children and adolescents under the age of 20. Risk of bias was determined with the use of Risk Of Bias In Non-randomised Studies of Exposure. RESULTS Thirty-four studies were included in the review. The analysis confirmed a higher prevalence of numerous oral manifestations in coeliac disease concerning both hard and soft tissues. Our study found the prevalence of dental enamel defects to be at the level of 17.9%-83.5% (P value <0.047) and recurrent aphthous stomatitis of 8.3%-69% (P value <0.039). CONCLUSION Oral manifestations may precede gastrointestinal symptoms. Patients presenting such manifestations should be screened for coeliac disease. The cooperation of gastroenterologists and dentists could lead to an increased detectability of coeliac disease.
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Affiliation(s)
- Anna Turska-Szybka
- Department of Paediatric Dentistry, Faculty of Dental Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ewelina Dąbrowska
- Students' Scientific Group by Department of Paediatric Dentistry, Faculty of Dental Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Karen Głogowska
- Students' Scientific Group by Department of Paediatric Dentistry, Faculty of Dental Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Anna Janczewska
- Students' Scientific Group by Department of Paediatric Dentistry, Faculty of Dental Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Olczak-Kowalczyk
- Department of Paediatric Dentistry, Faculty of Dental Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Paula Piekoszewska-Ziętek
- Department of Paediatric Dentistry, Faculty of Dental Medicine, Medical University of Warsaw, Warsaw, Poland
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Bulut M, Tokuc M, Aydin MN, Ayyildiz Civan H, Polat E, Dogan G, Altuntas C, Bayrak NA, Beser OF. Nutrition and oral health in children with recently and previously diagnosed celiac disease. Clin Oral Investig 2023:10.1007/s00784-023-04971-x. [PMID: 36961593 DOI: 10.1007/s00784-023-04971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/19/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVES To evaluate the nutritional and oral health status of children with previously diagnosed celiac disease (CD) who follow a gluten-free diet and recently diagnosed CD patients. MATERIALS AND METHODS Previously and recently diagnosed groups were formed from children with CD, aged 4 to 15 years. A questionnaire was completed about the children's dental history and nutritional and oral hygiene habits. All the children underwent an oral examination, and dmft-DMFT indices were determined. Dental plaque status, periodontal health, and dental enamel defects were recorded. Oral soft tissues were examined for the presence of lesions. Unstimulated salivary flow rate and pH value were evaluated. RESULTS A statistically significant difference was determined between the previously and recently diagnosed patients in terms of toothpaste preference (p=0.003), frequency of going to the dentist (p=0.039), and the types of dental treatment they had received (p=0.001). A statistically significant difference was determined between the previously and recently diagnosed patient groups in terms of dmft values (p=0.005). CONCLUSIONS Children with CD should be directed to a pediatric dentist to improve oral and dental health, relieve the symptoms of oral mucosal lesions, be informed about enamel defects, and be encouraged to use gluten-free oral care products. CLINICAL RELEVANCE The collaboration of pediatric gastroenterologists and pediatric dentists can prevent the progression of oral symptoms in children with CD and eliminate long-term complications in terms of both oral health and multisystemic problems.
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Affiliation(s)
- M Bulut
- Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul Okan University, Istanbul, Türkiye.
| | - M Tokuc
- Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul Okan University, Istanbul, Türkiye
| | - M N Aydin
- Department of Pediatric Dentistry, Faculty of Dentistry, Istanbul Okan University, Istanbul, Türkiye
| | - H Ayyildiz Civan
- Pediatric Gastroenterology, Hepatology and Nutrition, I.A.U. VM Medical Park Hospital Florya, Istanbul, Türkiye
| | - E Polat
- Pediatric Gastroenterology, Hepatology and Nutrition, Sancaktepe Sehit Prof Dr Ilhan Varank Training & Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - G Dogan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bezmialem Vakif University Faculty of Medicine, Istanbul, Türkiye
| | - C Altuntas
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istinye University Faculty of Medicine, Istanbul, Türkiye
| | - N A Bayrak
- Pediatric Gastroenterology, Hepatology and Nutrition, Zeynep Kamil Women & Children's Training & Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - O F Beser
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Türkiye
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4
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Petronijevic S, Stig S, Halstensen TS. Epitope mapping of anti-amelogenin IgG in untreated celiac children. Eur J Oral Sci 2021; 129:e12770. [PMID: 33656197 DOI: 10.1111/eos.12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/04/2021] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
Children with untreated celiac disease (CeD) may develop enamel defects, and children with severe CeD have significantly increased levels of IgG to amelogenin, which may interfere with normal amelogenesis depending on which epitope(s) they bind. Children with untreated CeD (n = 42), for whom CeD had been confirmed either by biopsy (n = 17, cohort 1) or by the presence of particularly high serum levels of anti-transglutaminase 2 (TG2) IgA (n = 25, cohort 2), were selected from 146 children with CeD, and 10 controls were selected from 34 children who did not have CeD. Samples from these 52 children were used for detailed IgG anti-amelogenin, X isoform (AMELX) epitope mapping using 31 overlapping, 10-22mer peptides in ELISA. Although sera from both groups showed reactivity to peptides containing sequences from the N and C terminus of AMELX, sera from children with CeD reacted more strongly to peptides from the central region (amino acids 75-150) containing both a binding site for transforming growth factor-β (TGF-β), as well as the enzymatic cleavage sites for matrix metalloproteinase-20 and for kallikrein-4. Antigen-specific extraction revealed that only IgG to the central region cross-reacted to gliadin. Thus, cross-reactive anti-gliadin/amelogenin IgG may affect normal amelogenesis by interfering with enzymatic degradation, proper folding, and/or TGF-β signaling in children with untreated CeD.
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Affiliation(s)
- Sanja Petronijevic
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Solveig Stig
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Trond S Halstensen
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Medical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
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5
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Petronijevic S, Stig S, Halstensen TS. Epitope mapping of anti‐amelogenin IgA in coeliac disease. Eur J Oral Sci 2020; 128:27-36. [DOI: 10.1111/eos.12672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Sanja Petronijevic
- Institute of Oral Biology Faculty of Dentistry University of Oslo Oslo Norway
| | - Solveig Stig
- Institute of Oral Biology Faculty of Dentistry University of Oslo Oslo Norway
| | - Trond S. Halstensen
- Institute of Oral Biology Faculty of Dentistry University of Oslo Oslo Norway
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6
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Nardecchia S, Auricchio R, Discepolo V, Troncone R. Extra-Intestinal Manifestations of Coeliac Disease in Children: Clinical Features and Mechanisms. Front Pediatr 2019; 7:56. [PMID: 30891436 PMCID: PMC6413622 DOI: 10.3389/fped.2019.00056] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/13/2019] [Indexed: 12/11/2022] Open
Abstract
Celiac disease (CD) is a systemic autoimmune disease due to a dysregulated mucosal immune response to gluten and related prolamines in genetically predisposed individuals. It is a common disorder affecting ~1% of the general population, its incidence is steadily increasing. Changes in the clinical presentation have become evident since the 80s with the recognition of extra-intestinal symptoms like short stature, iron deficiency anemia, altered bone metabolism, elevation of liver enzymes, neurological problems. Recent studies have shown that the overall prevalence of extra-intestinal manifestations is similar between pediatric and adult population; however, the prevalence of specific manifestations and rate of improvement differ in the two age groups. For instance, clinical response in children occurs much faster than in adults. Moreover, an early diagnosis is decisive for a better prognosis. The pathogenesis of extra-intestinal manifestations has not been fully elucidated yet. Two main mechanisms have been advanced: the first related to the malabsorption consequent to mucosal damage, the latter associated with a sustained autoimmune response. Importantly, since extra-intestinal manifestations dominate the clinical presentation of over half of patients, a careful case-finding strategy, together with a more liberal use of serological tools, is crucial to improve the detection rate of CD.
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Affiliation(s)
- Silvia Nardecchia
- Department of Medical Translational Sciences and European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
| | - Renata Auricchio
- Department of Medical Translational Sciences and European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
| | | | - Riccardo Troncone
- Department of Medical Translational Sciences and European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
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Bıçak DA, Urgancı N, Akyüz S, Usta M, Kızılkan NU, Alev B, Yarat A. Clinical evaluation of dental enamel defects and oral findings in coeliac children. Eur Oral Res 2018; 52:150-156. [PMID: 30775719 DOI: 10.26650/eor.2018.525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/22/2017] [Accepted: 01/11/2018] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Damla Akşit Bıçak
- Department of Pediatric Dentistry, Near East University, Faculty of Dentistry, KKTC
| | - Nafiye Urgancı
- Clinic of Pediatric Gastroenterology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Serap Akyüz
- Department of Pediatric Dentistry, Marmara University, Faculty of Dentistry, İstanbul, Turkey
| | - Merve Usta
- Clinic of Pediatric Gastroenterology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Nuray Uslu Kızılkan
- Clinic of Pediatric Gastroenterology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.,Clinic of Pediatric Gastroenterology, Koç University Hospital, İstanbul, Turkey
| | - Burçin Alev
- Department of Basic Medical Sciences, Division of Biochemistry, Marmara University, Faculty of Dentistry, İstanbul, Turkey
| | - Ayşen Yarat
- Department of Basic Medical Sciences, Division of Biochemistry, Marmara University, Faculty of Dentistry, İstanbul, Turkey
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8
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Souto-Souza D, da Consolação Soares ME, Rezende VS, de Lacerda Dantas PC, Galvão EL, Falci SGM. Association between developmental defects of enamel and celiac disease: A meta-analysis. Arch Oral Biol 2017; 87:180-190. [PMID: 29306074 DOI: 10.1016/j.archoralbio.2017.12.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 12/19/2017] [Accepted: 12/23/2017] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Débora Souto-Souza
- Department of Pediatric Dentistry, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
| | | | - Vanessa Silva Rezende
- Department of Pediatric Dentistry, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
| | - Paulo César de Lacerda Dantas
- Department of Oral and Maxillofacial Surgery, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil
| | - Endi Lanza Galvão
- Clinical Research and Public Policy in Infectious and Parasitic Diseases, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Saulo Gabriel Moreira Falci
- Department of Oral and Maxillofacial Surgery, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil.
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9
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Amato M, Zingone F, Caggiano M, Iovino P, Bucci C, Ciacci C. Tooth Wear Is Frequent in Adult Patients with Celiac Disease. Nutrients 2017; 9:nu9121321. [PMID: 29207559 PMCID: PMC5748771 DOI: 10.3390/nu9121321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 02/07/2023] Open
Abstract
(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.
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Affiliation(s)
- Massimo Amato
- Department of Medicine, Surgery and Dentistry, Medical School of Salerno, 84131 Salerno, Italy.
| | - Fabiana Zingone
- Department of Medicine, Surgery and Dentistry, Medical School of Salerno, 84131 Salerno, Italy.
| | - Mario Caggiano
- Department of Medicine, Surgery and Dentistry, Medical School of Salerno, 84131 Salerno, Italy.
| | - Paola Iovino
- Department of Medicine, Surgery and Dentistry, Medical School of Salerno, 84131 Salerno, Italy.
| | - Cristina Bucci
- Department of Medicine, Surgery and Dentistry, Medical School of Salerno, 84131 Salerno, Italy.
| | - Carolina Ciacci
- Department of Medicine, Surgery and Dentistry, Medical School of Salerno, 84131 Salerno, Italy.
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10
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Beth SA, Jansen MAE, Elfrink MEC, Kiefte-de Jong JC, Wolvius EB, Jaddoe VWV, van Zelm MC, Moll HA. Generation R birth cohort study shows that specific enamel defects were not associated with elevated serum transglutaminase type 2 antibodies. Acta Paediatr 2016; 105:e485-91. [PMID: 27439586 DOI: 10.1111/apa.13533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 06/23/2016] [Accepted: 07/18/2016] [Indexed: 12/21/2022]
Abstract
AIM Coeliac disease can induce specific enamel defects (SED), but little is known about the consequences of antitissue transglutaminase (TG2A) autoimmunity. We investigated whether TG2A positivity in children and their mothers was associated with SED in the primary dentition. METHODS Maternal and child serum immunoglobulin A-TG2A levels were measured as part of the Generation R prospective cohort study. Clinical oral photographs of the primary dentition were taken, and SED and caries were recorded. We performed logistic regression analysis. RESULTS We analysed data on 4775 mothers and 4233 children (median age of 6.2 ± 0.5 years). SED and caries were not associated with maternal TG2A levels. The 59 TG2A-positive children tended to have more SED, particularly the 31 in the strongly positive subgroup, with odds ratio of 1.72 and 2.29, respectively. A positive linear trend was observed between higher TG2A levels and paediatric SED (p = 0.04), but this became nonsignificant after adjusting for ethnic and socio-economic background. No difference in caries was found between the groups. CONCLUSION TG2A did not play an independent role on SED in the primary dentition during pregnancy and childhood, and the relationship may be explained by ethnic and socio-economic background.
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Affiliation(s)
- Sytske A. Beth
- The Generation R Study Group; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Pediatrics; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Immunology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Michelle A. E. Jansen
- The Generation R Study Group; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Pediatrics; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Immunology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Maria E. C. Elfrink
- The Generation R Study Group; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Cariology, Endodontology and Pedodontology; Academic Center for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - Jessica C. Kiefte-de Jong
- Department of Epidemiology; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Global Public Health; Leiden University College; The Hague The Netherlands
| | - Eppo B. Wolvius
- The Dutch Cranofacial Centre; Department of Oral and Maxillofacial Surgery; Sophia's Children's Hospital; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study Group; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Pediatrics; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Menno C. van Zelm
- Department of Immunology and Pathology; Monash University; Melbourne Vic. Australia
| | - Henriëtte A. Moll
- Department of Pediatrics; Erasmus University Medical Center; Rotterdam The Netherlands
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Sóñora C, Arbildi P, Rodríguez-Camejo C, Beovide V, Marco A, Hernández A. Enamel organ proteins as targets for antibodies in celiac disease: implications for oral health. Eur J Oral Sci 2015; 124:11-6. [DOI: 10.1111/eos.12241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Cecilia Sóñora
- Cátedra de Inmunología; Instituto de Química Biológica; Facultad de Ciencias -Departamento de Biociencias; Facultad de Química; Universidad de la República; Montevideo Uruguay
- Escuela Universitaria de Tecnología Médica; Facultad de Medicina. Universidad de la República; Montevideo Uruguay
| | - Paula Arbildi
- Cátedra de Inmunología; Instituto de Química Biológica; Facultad de Ciencias -Departamento de Biociencias; Facultad de Química; Universidad de la República; Montevideo Uruguay
| | - Claudio Rodríguez-Camejo
- Cátedra de Inmunología; Instituto de Química Biológica; Facultad de Ciencias -Departamento de Biociencias; Facultad de Química; Universidad de la República; Montevideo Uruguay
| | - Verónica Beovide
- Servicio y Cátedra de Anatomía Patológica General y Bucomaxilofacial; Facultad de Odontología; Universidad de la República; Montevideo Uruguay
| | - Alicia Marco
- Cátedra de Inmunología; Instituto de Química Biológica; Facultad de Ciencias -Departamento de Biociencias; Facultad de Química; Universidad de la República; Montevideo Uruguay
| | - Ana Hernández
- Cátedra de Inmunología; Instituto de Química Biológica; Facultad de Ciencias -Departamento de Biociencias; Facultad de Química; Universidad de la República; Montevideo Uruguay
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12
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Bramanti E, Cicciù M, Matacena G, Costa S, Magazzù G. Clinical Evaluation of Specific Oral Manifestations in Pediatric Patients with Ascertained versus Potential Coeliac Disease: A Cross-Sectional Study. Gastroenterol Res Pract 2014; 2014:934159. [PMID: 25197270 PMCID: PMC4147289 DOI: 10.1155/2014/934159] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/25/2014] [Accepted: 07/25/2014] [Indexed: 12/30/2022] Open
Abstract
Patients involved on coeliac disease (CD) have atypical symptoms and often remain undiagnosed. Specific oral manifestations are effective risk indicators of CD and for this reason an early diagnosis with a consequent better prognosis can be performed by the dentist. There are not researches analysing the frequency of these oral manifestations in potential coeliac patients. The aim of this study is to investigate the oral hard and soft tissue lesions in potential and ascertained coeliac children in comparison with healthy controls. 50 ascertained children, 21 potential coeliac patients, and 54 controls were recruited and the oral examination was performed. The overall oral lesions were more frequently present in CD patients than in controls. The prevalence of oral soft tissue lesions was 62% in ascertained coeliac, 76.2% in potential coeliac patients, and 12.96% in controls (P < 0.05). Clinical dental delayed eruption was observed in 38% of the ascertained coeliac and 42.5% of the potential coeliac versus 11.11% of the controls (P < 0.05). The prevalence of specific enamel defects (SED) was 48% in ascertained coeliac and 19% in potential coeliac versus 0% in controls (P < 0.05; OR = 3.923). The SED seem to be genetically related to the histological damage and villous atrophy.
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Affiliation(s)
- Ennio Bramanti
- Resident Department of Clinical and Experimental Medicine and Stomatology, University of Messina, 98100 Messina, Italy
| | - Marco Cicciù
- Department of Human Pathology, School of Dentistry, University of Messina, Via Consolare Valeria, 98100 Messina, Italy
| | - Giada Matacena
- Resident Department of Clinical and Experimental Medicine and Stomatology, University of Messina, 98100 Messina, Italy
| | - Stefano Costa
- Department of Pediatric, Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, 98100 Messina, Italy
| | - Giuseppe Magazzù
- Department of Pediatric, Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, 98100 Messina, Italy
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Trotta L, Biagi F, Bianchi PI, Marchese A, Vattiato C, Balduzzi D, Collesano V, Corazza GR. Dental enamel defects in adult coeliac disease: prevalence and correlation with symptoms and age at diagnosis. Eur J Intern Med 2013; 24:832-4. [PMID: 23571066 DOI: 10.1016/j.ejim.2013.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/12/2013] [Accepted: 03/12/2013] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Lucia Trotta
- Coeliac Centre/First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
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14
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Muñoz F, Del Río N, Sóñora C, Tiscornia I, Marco A, Hernández A. Enamel defects associated with coeliac disease: putative role of antibodies against gliadin in pathogenesis. Eur J Oral Sci 2012; 120:104-12. [DOI: 10.1111/j.1600-0722.2012.00949.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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15
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Acar S, Yetkıner AA, Ersın N, Oncag O, Aydogdu S, Arıkan C. Oral findings and salivary parameters in children with celiac disease: a preliminary study. Med Princ Pract 2012; 21:129-33. [PMID: 22024774 DOI: 10.1159/000331794] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Accepted: 06/28/2011] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Sibel Acar
- Department of Pediatric Dentistry, Hepatology and Nutrition, Ege University, Izmir, Turkey.
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Orzechowska-Wylęgała B, Obuchowicz A, Malara P, Fischer A, Kalita B. Cadmium and lead accumulate in the deciduous teeth of children with celiac disease or food allergies. INTERNATIONAL JOURNAL OF STOMATOLOGY & OCCLUSION MEDICINE 2011; 4:28-31. [PMID: 22611455 PMCID: PMC3339619 DOI: 10.1007/s12548-011-0005-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/19/2011] [Indexed: 11/30/2022]
Affiliation(s)
| | - Anna Obuchowicz
- Department of Pediatrics and the Pediatric Ward of Gastroenterology, Medical University of Silesia, Bytom, Poland
| | - Piotr Malara
- Department of Cranio-Maxillo-Facial Surgery, Medical University of Silesia, Filarowa 5A, 40-565 Katowice, Poland
| | - Agnieszka Fischer
- Department of Toxicology, Medical University of Silesia, Sosnowiec, Poland
| | - Barbara Kalita
- Department of Pediatrics and the Pediatric Ward of Gastroenterology, Medical University of Silesia, Bytom, Poland
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17
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Cheng J, Malahias T, Brar P, Minaya MT, Green PHR. The association between celiac disease, dental enamel defects, and aphthous ulcers in a United States cohort. J Clin Gastroenterol 2010; 44:191-4. [PMID: 19687752 DOI: 10.1097/mcg.0b013e3181ac9942] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
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.
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Affiliation(s)
- Jianfeng Cheng
- Department of Medicine, New York Medical College (Sound Shore Medical Center), New Rochelle, New York, NY, USA
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18
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Majorana A, Bardellini E, Ravelli A, Plebani A, Polimeni A, Campus G. 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. Int J Paediatr Dent 2010; 20:119-24. [PMID: 20384826 DOI: 10.1111/j.1365-263x.2009.01028.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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Abstract
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.
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Affiliation(s)
- Felicity Crombie
- Melbourne Dental School, University of Melbourne, Parkville, Victoria, Australia
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Ortega Páez E, Junco Lafuente P, Baca García P, Maldonado Lozano J, Llodra Calvo JC. Prevalence of dental enamel defects in celiac patients with deciduous dentition: a pilot study. ACTA ACUST UNITED AC 2008; 106:74-8. [PMID: 18585624 DOI: 10.1016/j.tripleo.2008.01.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 01/18/2008] [Accepted: 01/18/2008] [Indexed: 01/01/2023]
Abstract
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.
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Affiliation(s)
- E Ortega Páez
- Department of Pediatrics, Virgen de las Nieves University Hospital, University of Granada, Granada, Spain
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21
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Abstract
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.
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Campisi G, Di Liberto C, Iacono G, Compilato D, Di Prima L, Calvino F, Di Marco V, Lo Muzio L, Sferrazza C, Scalici C, Craxì A, Carroccio A. Oral pathology in untreated coeliac [corrected] disease. Aliment Pharmacol Ther 2007; 26:1529-36. [PMID: 17919276 DOI: 10.1111/j.1365-2036.2007.03535.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- G Campisi
- Oral Sciences, University Hospital of Palermo, Palermo, Italy
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23
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Abstract
Celiac disease (CD) or gluten sensitive enteropathy is relatively common in western populations with prevalence around 1%. With the recent availability of sensitive and specific serological testing, many patients who are either asymptomatic or have subtle symptoms can be shown to have CD. Patients with CD have modest increases in risks of malignancy and mortality compared to controls. The mortality among CD patients who comply poorly with a gluten-free diet is greater than in compliant patients. The pattern of presentation of CD has altered over the past three decades. Many cases are now detected in adulthood during investigation of problems as diverse as anemia, osteoporosis, autoimmune disorders, unexplained neurological syndromes, infertility and chronic hypertransaminasemia of uncertain cause. Among autoimmune disorders, increased prevalence of CD has been found in patients with autoimmune thyroid disease, type 1 diabetes mellitus, autoimmune liver diseases and inflammatory bowel disease. Prevalence of CD was noted to be 1% to 19% in patients with type 1 diabetes mellitus, 2% to 5% in autoimmune thyroid disorders and 3% to 7% in primary biliary cirrhosis in prospective studies. Conversely, there is also an increased prevalence of immune based disorders among patients with CD. The pathogenesis of co-existent autoimmune thyroid disease and CD is not known, but these conditions share similar HLA haplotypes and are associated with the gene encoding cytotoxic T-lymphocyte-associated antigen-4. Screening high risk patients for CD, such as those with autoimmune diseases, is a reasonable strategy given the increased prevalence. Treatment of CD with a gluten-free diet should reduce the recognized complications of this disease and provide benefits in both general health and perhaps life expectancy. It also improves glycemic control in patients with type 1 diabetes mellitus and enhances the absorption of medications for associated hypothyroidism and osteoporosis. It probably does not change the natural history of associated autoimmune disorders.
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Affiliation(s)
- Chin Lye Ch'ng
- Department of Gastroenterology, Singleton Hospital, Swansea, United Kingdom
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Procaccini M, Campisi G, Bufo P, Compilato D, Massaccesi C, Catassi C, Muzio LL. Lack of association between celiac disease and dental enamel hypoplasia in a case-control study from an Italian central region. Head Face Med 2007; 3:25. [PMID: 17537244 PMCID: PMC1891285 DOI: 10.1186/1746-160x-3-25] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 05/30/2007] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Maurizio Procaccini
- Istituto di Scienze Odontostomatologiche, Università Politecnica delle Marche, Italy
| | | | - Pantaleo Bufo
- Dip. Scienze Chirurgiche, Università di Foggia, Italy
| | | | - Claudia Massaccesi
- Istituto di Scienze Odontostomatologiche, Università Politecnica delle Marche, Italy
| | - Carlo Catassi
- Istituto di Clinica Pediatrica, Università Politecnica delle Marche, Italy
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Abstract
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.
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Bucci P, Carile F, Sangianantoni A, Sangianantoni A, D'Angiò F, Santarelli A, Lo Muzio L. Oral aphthous ulcers and dental enamel defects in children with coeliac disease. Acta Paediatr 2006; 95:203-7. [PMID: 16449028 DOI: 10.1080/08035250500355022] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Paolo Bucci
- Dipartimento di Scienze Odontostomatologiche e Maxillo-facciali, Università degli Studi di Napoli Federico II, Napoli, Italy
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Abstract
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.
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Bonamico M, Tiberti C, Picarelli A, Mariani P, Rossi D, Cipolletta E, Greco M, Tola MD, Sabbatella L, Carabba B, Magliocca FM, Strisciuglio P, Di Mario U. Radioimmunoassay to detect antitransglutaminase autoantibodies is the most sensitive and specific screening method for celiac disease. Am J Gastroenterol 2001; 96:1536-40. [PMID: 11374695 DOI: 10.1111/j.1572-0241.2001.03754.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to establish the most sensitive and specific screening method for celiac disease. We tested three methods based on different principles, which all detect autoantibodies against the same antigen (tissue transglutaminase). METHODS Sixty-two celiac children at the first biopsy (group 1), 78 celiac children on a gluten-free diet (group 2), 14 celiac children on a gluten-challenge (group 3), and 56 controls with a normal duodenal mucosa (group 4) were studied. The methods used were: 1) radioimmunoprecipitation assay using recombinant tissue transglutaminase (RIA); 2) commercial enzyme immunoassay using guinea pig tissue transglutaminase (ELISA); and 3) indirect immunofluorescence method for detection of antiendomysium antibodies (IF-EMA). RESULTS RIA antitransglutaminase autoantibodies were detected in 100% of group 1, 43.6% of group 2, 100% of group 3, and none of the control subjects. ELISA antitransglutaminase autoantibodies were detected in 90.3% of group 1, 9% of group 2, 78.6% of group 3, and in none of the control subjects. IF-EMA were detected in 95.2% of group 1, 11.5% of group 2, 92.3% of group 3, and 1.8% of the controls. CONCLUSIONS Our results demonstrate a very high sensitivity and specificity of the RIA method to detect antitransglutaminase autoantibodies in comparison to ELISA and IF-EMA assays. We can explain this finding with the use of human recombinant antigen and the increased capacity of the RIA method to detect low titers of autoantibodies. If our data are confirmed by studies on larger series, tissue transglutaminase RIA could be proposed as the best screening method for celiac patients.
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Affiliation(s)
- M Bonamico
- Istituto di Clinica Pediatrica, Dipartimento di Scienze Cliniche, Medicina Sperimentale e Patologia, Università La Sapienza, Rome, Italy
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Toscano V, Conti FG, Anastasi E, Mariani P, Tiberti C, Poggi M, Montuori M, Monti S, Laureti S, Cipolletta E, Gemme G, Caiola S, Di Mario U, Bonamico M. Importance of gluten in the induction of endocrine autoantibodies and organ dysfunction in adolescent celiac patients. Am J Gastroenterol 2000; 95:1742-8. [PMID: 10925978 DOI: 10.1111/j.1572-0241.2000.02187.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE It is well known that a high number of celiac patients may develop autoantibodies against endocrine glands, but it has not yet been clarified if this increased autoimmune response and the impaired organ function that can develop may be related to the presence or absence of gluten in the diet. The aim of the present study was to evaluate the effect of gluten on the autoimmunity and function of the endocrine glands in adolescent celiac patients. METHODS To clarify this aspect we investigated 44 patients (28 females), aged 11-20 yr (15.21+/-2.7 yr): 25 (mean age, 15.1+/-2.2 yr) on a gluten-free diet (treated patients) and 19 (mean age 15.4+/-2.9 yr) with a diet containing gluten (untreated patients). Forty adolescent subjects, aged 14-19 yr (mean age, 14.9+/-2.7 yr), of whom 20 were females, were studied as controls. Antibodies against the thyroid, adrenal, and pancreas were evaluated. Thyroid-stimulating hormone FT3, FT4, T3, T4, dehydroepiandrosterone sulphate, 17-OH progesterone, and cortisol, analyzed basally and 60 min after intravenous ACTH stimulation, were assayed to evaluate thyroid and adrenal function. The fasting glycemia level was used to evaluate the endocrine pancreas function. An ultrasonogram of the thyroid gland was performed on all patients. HLA class II typing for DR3 and DQB1 was performed in 32 of 44 patients. RESULTS Seven of 44 (15.9%) patients were positive for antibodies against peroxidase. Six of 44 (13.6%) were positive for antibodies against thyreoglobulin and four of them also showed positive antibodies against peroxidase. Therefore, in nine of 44 at least one antibody directed against thyroid tissue was positive. Seven of 44 (15.9%) were positive for antibodies against islet cell, one of 44 (2.3%) positive for antibodies against glutamic acid decarboxilase, one of 44 (2.3%) positive for antibodies against insulin, and none for antibodies against islet cell- 512bdc. In 15 of 44 (34%) at least one antibody against an endocrine tissue was positive. The genotype DR3 was found in 21 of 32 (65.6%) celiac patients (10 in the untreated and 11 in the treated group, respectively) and the genotype DQB1*02 (DQ2) was found in 30 of 32 (93.8%) patients (16 in the treated and 14 in the untreated group, respectively). DHA-S values were significantly lower in the untreated (30.5+/-28.5 microg/dl) than in the treated group (61.3+/-59.4 microg/dl, p < 0.05), and both showing significantly (p < 0.01) lower levels with respect to the controls (161+/-52 microg/dl). One patient showed diabetes, another one clinical hypothyroidism (thyroid-stimulating hormone > 6), and two patients showed preclinical hypothyroidism. Interestingly, at least one antibody was positive in 10 of 19 untreated patients (52.6%) but only in five of 25 treated patients (20%), with a significantly different distribution (p < 0.001) between the two groups and without differences in the HLA genotype. The ultrasonographic evaluation of the thyroid resulted in a pathological score in six patients of the 44 examined (13.6%), suggesting the presence of thyropathy. CONCLUSIONS The main results of this study are the high incidence of thyroid and pancreatic antibodies, and the possible role of gluten in the induction of the antibodies as well as, in few cases, the consequent organ dysfunction.
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Affiliation(s)
- V Toscano
- II Endocrinologia, Dipartimento di Fisiopatologia Medica, and Istituto di Clinica Pediatrica, Università La Sapienza, Roma, Italy
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Bottaro G, Cataldo F, Rotolo N, Spina M, Corazza GR. The clinical pattern of subclinical/silent celiac disease: an analysis on 1026 consecutive cases. Am J Gastroenterol 1999; 94:691-6. [PMID: 10086653 DOI: 10.1111/j.1572-0241.1999.00938.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The demographic, clinical, and epidemiological features of subclinical/silent celiac disease in Italy were analyzed in a multicenter study carried out with the participation of 42 centers, in the years between 1990 and 1994. METHODS One thousand twenty-six subclinical/silent patients (644 children and 382 adults, 702 women and 324 men) were considered eligible for the study. RESULTS The prevalence of the subclinical/silent form increased significantly during the study both in adults (p < 0.001) and in children (p < 0.005), but its prevalence was always lower (p < 0.001) in children than in adults. This increase appears more likely due to a greater diagnostic awareness and to a better use of screening than to a higher number of subclinical/silent cases. Whereas in 1990 a significantly higher proportion (p < 0.001) of subclinical/silent celiac patients was diagnosed in Northern Italy rather than in Southern-Insular Italy, both in adults (46.7% vs 17.2%) and in children (22.0% vs 9.0%), in 1994 such a difference was no longer conspicuous. Both in children and in adults, iron-deficiency anemia appeared to be the most frequent extraintestinal symptom, followed by short stature in children and cutaneous lesions of dermatitis herpetiformis in adults. In 25.9% of the cases another disease was present, with a significantly higher frequency (p < 0.05) in adults (30.1%) than in children (20.7%). Diabetes and atopy appeared to be the most frequently associated conditions both in children and in adults. CONCLUSIONS This study has provided an analysis of the largest series of subclinical/silent celiac disease reported to date. In Italy, this form is most frequently recognized in adults, and prospective studies will clarify whether the lower frequency observed in children is a real or apparent phenomenon.
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Affiliation(s)
- G Bottaro
- I Pediatric Clinic, Catania University, Italy
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Abstract
Eighty-two consecutive patients with oral mucosal disorders were screened for celiac sprue with serum immunoglobulin A (IgA)-class endomysial and gliadin antibodies. In positive cases the diagnosis of celiac sprue was established by duodenal biopsy. Four patients were positive for endomysial antibodies and 22 for gliadin antibodies. Four (4.9%) patients were found to have celiac sprue: three of them by screening and one was previously diagnosed. Endomysial antibodies were present in all three newly diagnosed patients with celiac sprue, and gliadin antibodies were present in one. Sixteen of 22 patients positive for gliadin antibodies underwent small bowel biopsy, and 15 had normal mucosa. Patients with chronic oral mucosal disorders and a positive endomysial antibody test may suffer from celiac sprue. By contrast, gliadin antibodies were very prevalent even in the absence of celiac sprue.
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Affiliation(s)
- J Jokinen
- Tampere University Hospital, Finland
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Aguirre JM, Rodríguez R, Oribe D, Vitoria JC. Dental enamel defects in celiac patients. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 84:646-50. [PMID: 9431534 DOI: 10.1016/s1079-2104(97)90367-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The incidence and distribution of enamel defects among patients with celiac disease were examined. STUDY DESIGN The oral cavity was explored in 137 patients with celiac disease (mean age 16.2 years; age range 5 to 68 years) and in 52 control patients (mean age 19.8 years; age range 5 to 64 years). Permanent dentition enamel defects were recorded, along with their number and locations. The decayed, missing, and filled teeth index rates were also established, and an investigation was made of the human leukocyte antigens among the patients with celiac disease. The results obtained were analyzed with the chi-squared test, statistical significance being regarded for p < or = 0.05. RESULTS Enamel defects were observed in 72 (52.5%) of the patients with celiac disease (52 patients had systematic defects) and in 22 (42.3%) of the control patients (9 patients had systematic defects). Systematic defects were significantly more common in the celiac disease group. In the patients with celiac disease, 72.2% were symmetrical, compared with 40.9% of the defects in the control patients. The incisors were the most frequently affected teeth, the extent of involvement being significantly greater in the celiac disease group. In patients with celiac disease, DR7, DR3, and DQ2 were the most commonly observed human leukocyte antigens. The mean decayed, missing, and filled teeth index rates were 4.8 and 6.2 in the celiac disease group and the control group, respectively. CONCLUSIONS Enamel defects are common among patients with celiac disease. They tend to be bilateral and symmetrical, and they are chronologically distributed. The lesions affect mainly the incisors and the molars. Patients with such characteristics should be evaluated for possible celiac disease.
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Affiliation(s)
- J M Aguirre
- Departamento de Estomatología, Universidad del País Vasco/E.H.U., Bilbao, Vizcaya, Spain
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