It has been common practice to assume that the patient’s lack of proper dental hygiene is the cause of dental decay. But an examination of the medical history may reveal an underlying systemic disorder, such as coeliac disease, that may have caused these health problems.
Coeliac disease is generally associated with the digestive system and presents itself with common symptoms such as diarrhoea, vomiting, constipation, and failure to thrive in children, but also with other signs such as bone or joint pain, depression, anxiety, fatigue and migraines in adults. But there are also effects on the mouth and teeth which have tended to be overlooked - coeliac disease is now being recognised as a cause of dental enamel defects, delayed dental development and also an increased risk for cancers of the mouth, throat and oesophagus (particularly for those who are coeliacs but not on a gluten-free diet).
Dental enamel defects present in varying expressions such as pits, lines and grooves on the teeth and loss of enamel. Also, tooth discolouration - white, yellow, or brown spots on the teeth, poor enamel formation, pitting or banding of teeth, and mottled or translucent looking teeth. These are said to be more common in patients with coeliac disease compared to the general population and are more prevalent in children with coeliac disease than in adults. Research indicates that coeliac disease triggers this enamel damage due to an immune reaction that affects the cells that form enamel. Tooth defects resulting from coeliac disease are permanent and do not improve after adopting a gluten-free diet. People who develop Coeliac disease as adults may, however, avoid enamel defects as their adult tooth development will have been completed before the disease onset.
Children with undiagnosed coeliac disease generally lose their baby teeth more slowly than those without coeliac disease, and permanent teeth come later than usual. and for children under 7 years old with the coeliac condition. When a child’s permanent teeth are still developing, dental enamel defects are likely to occur. Coeliac disease prevents the gut from absorbing nutrients and compromises the chemical composition of primary teeth in young coeliac disease patients and making them vulnerable to cavities and dental caries (ie, tooth decay), and the teeth lose important minerals like calcium and phosphorus. It’s much easier for cavities to develop in teeth after minerals are leached away.
Coeliac disease patients who have adhered to a gluten-free diet for five or more years do not generally have an increased risk of developing cancers of the mouth, pharynx, oesophagus, and lymphoma when compared with the general population.
Dental enamel defects can sometimes be the only outward symptom of coeliac disease, and therefore, such defects can be a useful screening tool. The symptoms are certainly not adequate to diagnose coeliac disease, but dentists need to be aware of the possible coeliac connection and should refer patients - children or adults - with these signs for follow-up with a paediatrician or gastroenterologist. For some people with a coeliac condition, a dental visit, rather than a trip to the gastroenterologist, may be the first step toward discovering their condition.
Medical names for tooth conditions that have a close association with coeliac condition include:
One condition, dry mouth, can result in tooth decay because there is less saliva produced in the mouth to wash away bacteria and food debris.
Article provided by Coeliac New Zealand member Bill Darnell, following a major tooth reconstruction when his dentist advised that having coeliac disease might be part of the cause.
