Clinical evaluation of dental enamel defects and oral findings in coeliac children

Coeliac disease and its implications on the oral health of children: A systematic review

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.

Extra-Intestinal Manifestations of Celiac Disease: What Should We Know in 2022?

Celiac disease (CD) is a chronic, small-intestinal, immune-mediated enteropathy due to gluten exposition in genetically predisposed individuals. It occurs in about 1% of the population and often remains an underdiagnosed condition. This could be due to the fact that the adult population often lacks the classical signs and symptoms of CD, manifesting only atypical symptoms. In this review we analyzed the main extra-intestinal manifestations of CD which include cutaneous and endocrinological disorders, abnormal liver function tests, and neuropsychiatric features. When CD is not diagnosed and therefore is not treated with a gluten-free diet (GFD), it can predispose to severe complications, not only gastrointestinal. Thus, it is important for clinicians to quickly recognize the atypical manifestations of CD, considering that an early diagnosis can significantly impact on a patient's prognosis.

Serological study of celiac disease in children with dental caries

BACKGROUND

Celiac disease is a common gastrointestinal autoimmune disorder. Studies have shown that the prevalence of tooth decay is high in patients with celiac disease. This study was performed to evaluate the serology of celiac disease in children with dental caries.

METHODS

Children aged 3 to 12 years who referred to the dental clinic with enamel caries were included in the study. Celiac disease was assessed by measuring serum IgA levels and anti-TTG (Anti TTG (IgA)) antibodies. Then, by analyzing the collected data, the prevalence of celiac disease in children with dental caries and its relationship with various variables were investigated.

RESULTS

120 children, 56 girls (46.7%) and 64 boys (53.3%) with dental caries were involved in this study. The positive celiac serology rate of studied population was 14 (11.6%). Based on the results of this study, a significant relationship was obtained between maternal education, sex and place of residence and celiac disease (p< 0.05). There were no significant relationships between celiac positive serology in children with dental caries, the number of decayed teeth, and breastfeeding (p> 0.05).

CONCLUSION

The present study showed that dental caries, might be a red flag indicating possible celiac disease and prevent its complications. On the other hand, pediatricians and dentists should be aware of the oral symptoms of celiac disease. Further studies are needed to plan screening for children with celiac disease.

Oral manifestations of celiac disease in French children

Celiac disease (CD) is an immune-mediated systemic disorder caused by ingestion of the gluten found in wheat, rye, and barley. The currently estimated prevalence in children is about 1%. CD is a chronic enteropathy with gastrointestinal manifestations including diarrhea, abdominal distension and weight loss, but extra-intestinal features are increasingly being reported. Dental and oral manifestations such as dental enamel defects (ED), delay in dental eruption, and recurrent aphthous stomatitis (RAS) are well-recognized manifestations of CD. The aim of this study was to compare the frequency of oral manifestations (ED, RAS and delay in dental eruption) on deciduous and permanent teeth between children with CD and a control population. An oral examination was performed on 28 CD children and 59 control children. All children were younger than 12 years old and had deciduous or mixed dentition. CD children had significantly more ED and RAS than the control group (67.9% vs. 33.9% P=0.004 and 50.0% vs. 21.8% P=0.011, respectively). No delay in dental eruption was observed in CD children. ED were mainly grade I and II of Aine's classification (color defects and slight structural defects). ED were more often seen on CD children's deciduous teeth than on permanent teeth (57.1% and 13.6%, respectively; P<0.001). The main teeth affected by ED are the second molar and canines of the deciduous teeth, and the first molar, central incisor, and lateral incisors of the permanent teeth. RAS and ED that were symmetrical in all quadrants and occurred firstly in teeth that mineralize during the first year of life both seem to be signs of CD. Thus, more information for dentists and pediatricians on these oral manifestations should help improve detection of CD.

MOLAR INCISOR HYPOMINERALIZATION AND CELIAC DISEASE

BACKGROUND

Molar incisor hypomineralization (MIH) is a developmental enamel defect with multifactorial etiology. Although the relationship between celiac disease (CD) and developmental enamel defect was demonstrated, the association between CD and MIH is uncertain.

OBJECTIVE

The objective of this study was to analyze the occurrence of MIH in CD patients.

METHODS

Forty CD patients and a control group with 40 healthy individuals were selected. A calibrated examiner (k≥0.889) according to the European Academy of Pediatric Dentistry criteria performed the diagnosis of MIH. Data were analyzed by descriptive statistics and Fischer's exact test (α=0.05).

RESULTS

Of the 80 participants, ten presented MIH with eight individuals with CD. Celiac patients presented 4.75 times the chance of occurrence of MIH than the control group (95% CI: 2.22-10.18; P=0.044). In all the evaluated teeth (n=978), 22 had MIH: 20 teeth in individuals with CD and two in those without the disease. All CD participants with MIH presented the classic form of the disease. CD participants showed 17 teeth (85.0%) with demarcated opacities, two (10.0%) post-eruptive collapses and one (5.0%) atypical restoration. The control group presented only demarcated opacities.

CONCLUSION

CD increased the chance of MIH and associated with its clinical manifestations can assist in the diagnosis of CD.

Celiac disease and hematological abnormalities in children with recurrent aphthous stomatitis

BACKGROUND

Recurrent aphthous stomatitis (RAS) is one of the most common diseases of the oral mucosa and may be related to vitamin deficiencies or systemic diseases such as celiac disease (CD). The aim of this study was to investigate the frequency of hematinic deficiency and CD in children with RAS.

METHODS

The medical records of patients diagnosed with RAS were reviewed for the presence of hematinic deficiencies (hemoglobin, mean corpuscular volume, ferritin, vitamin B₁₂ , folic acid), and CD. The study group included 108 children with RAS and 57 healthy children who were evaluated for hematological abnormalities in routine evaluation.

RESULTS

The frequency of a family history of RAS was significantly higher in the RAS group compared to the control group (34.2% vs 7%, respectively; P < 0.001). A hematological abnormality was detected in 32.4% of the RAS group and 10.5% of the control group (P = 0.02). The prevalence of iron deficiency anemia was significantly higher in the RAS group (P = 0.037). Three (2.7%) patients with RAS were diagnosed with CD, which is a significantly higher frequency than that observed in healthy children in Turkey (P < 0.01; OR 6.03, 95% CI [2.37, 4.56]). These children had mild malnutrition, iron deficiency, and iron deficiency anemia.

CONCLUSIONS

Children with RAS should be evaluated for nutritional status and hematological indices, and in the case of hematological abnormalities and malnutrition screening for CD should be considered.