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How Celiac Disease Affects Your Teeth

Dentist Tools

Does your dentist know that you have celiac disease? Even if you don’t tell your dentist, he or she might be able to tell because of certain tooth problems that occur more often in people with celiac disease. It is even possible that a very observant dentist might suggest the diagnosis of celiac disease to someone because of what he or she sees in their mouth.

The most commonly seen problem in people with celiac disease is abnormal tooth enamel. The enamel is the outside part of the tooth. It can become discolored, ridged, dull, grooved, and pitted, and the edges can become uneven and rough. Color can change from the white color of a normal tooth to cream, yellow or even brown. The color changes are usually seen as marks on the teeth.

Your permanent teeth develop inside your mouth by the time you are seven years old. Illnesses and some medications can cause damage to the teeth as they are developing. Most people and most dentists do not think of celiac disease as a cause of enamel defects in the permanent teeth. Enamel problems are more commonly seen if a child takes tetracycline or gets much too much fluoride.

Children with celiac disease can have teeth that look like they have taken tetracycline. No one is sure why. It may have something to do with the poor nutrition common in children with CD, not enough calories or not enough specific vitamins. Or the reason might be some aspect of the immune system problem that causes celiac disease. Defects in the enamel are more common when celiac disease has started in children younger than 7 years old.

In one study, around two thirds of children (less than or equal to 18 years old) with known celiac disease had enamel defects, compared slightly less than a quarter of children the same age without CD. Also, when the teeth are partly permanent and partly baby teeth (in children less than or equal to 13 years old), almost all of the children with CD and mixed teeth had enamel defects, as opposed to less than half of  the children without CD.

In this study, the people with celiac disease were already diagnosed and on a gluten-free diet. There was no significant difference in enamel defects seen in adults with celiac disease. There have been studies in Europe showing that adults may also have abnormal tooth enamel. There may be different effects on the teeth depending on when celiac disease becomes active in the body.

It may be difficult to tell if adults have had this problem, because people may have already had cosmetic work done to the teeth. They may have been capped, extracted, or otherwise altered, so that the worst problems are not visible.

Any doctor or dentist seeing a patient with tooth enamel defects should be aware of this association with celiac disease, and should consider suggesting that they be checked for celiac disease.

References:
Malahias T, Cheng J, Brar P, et al. The Association Between Celiac Disease, Dental Enamel Defects, and Aphthous Ulcers in a United States Cohort.  J Clin Gastroenterol 2009;00:000–000.
Rashid M, Zarkadas M, Anca A, Limeback H. Oral Manifestations of Celiac Disease: A Clinical Guide for Dentists.. J Can Dent Assoc 2011;77:b39

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