Tooth Stain

Effects of Celiac Disease on Tooth Development

Tooth Stain

Do you think the problems I experienced may have been due to undiagnosed CD? My baby and permanent teeth were terrible. They were very soft. I had 4 rotted molars removed when I was in kindergarten, and my permanent teeth would break easily. Like every time I ate popcorn, chewed on a pencil eraser (teenager), and either my fillings would fall out or the teeth around the filing would break off. I had all of them out when I was 24… Does CD cause only pitted, discolored and jagged teeth, or is the tooth enamel STRENGTH also affected?

(Actual question asked by person with possible CD)

Celiac disease can definitely affect tooth enamel. This is well established, but not necessarily known by all dentists. Just as doctors are learning that celiac disease is not as rare as once believed, so are dentists. The enamel defects can look like other problems that have been recognized for longer periods of time.

The enamel defects in celiac disease almost always occur only in the permanent teeth. They are symmetrical and range from slight to severe defects. They are mainly cosmetic in nature. They occur more often in people who have symptoms of celiac disease in childhood as the permanent teeth are developing.

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Baby teeth develop when a baby is still in the womb. That is the explanation for why they are very rarely affected by celiac disease. Infants do not develop CD until exposed to gluten. The fact that there have been children with CD whose baby teeth do have enamel defects shows that this problem may be due to the underlying genetic disorder and not actual celiac disease. Relatives of people with CD can have enamel defects, which again means that there may be inherited factors at work.

Children with celiac disease may have their permanent teeth come in later than other children.

There have been studies about the rate of dental caries (cavities) in people with enamel defects that have had differing results. At least one showed an increased rate, and another showed no increase. There are researchers looking into this.

The enamel defects include discoloration, which can be brown, white, or yellow spots that are visible on the teeth, causing what would be called a mottled appearance. There can be enamel pitting or banding visible across the teeth. The teeth can look like they are partially transparent.

These defects occur on both sides symmetrically and usually on the incisors and molars.

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Dentists using a grading system for the enamel defects, with Class 1 referring to changes in color only. Grade 2 includes structural defects, and the grading goes up to Grade 4, in which the defects are severe and can change the shape of the teeth.

The tooth defects in CD are usually considered cosmetic and the appearance of the teeth can be improved by things like bonding or veneers.

Treatment with a gluten-free diet does not change the appearance of the teeth.

People with CD frequently also have mouth sores, called apthous ulcers, as well as other problems with the lining of the mouth and tongue.

Dentists need to be aware of these problems, since they may be the first clue that a person has CD.

To answer the question above, it is very unlikely that celiac disease caused the severe problems with both baby and adult teeth that were described. Something else was probably at work. Since the teeth have been removed there is no way for a dentist to determine the cause now. While the enamel in the teeth of people with CD can be abnormal, it is not considered primarily weak, but more of a cosmetic problem.


Dental Enamel Defects and Celiac Disease. Celiac Disease Awareness Campaign. April 2011.
Rashid M., Zardakas M., Anca A., Limeback H. Oral Manifestations of Celiac Disease: A Clinical Guide for Dentists. Journal of the Canadian Dental Association. 2011; 77:b39.

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