Celiac disease can cause dental enamel defects, delayed dental development and more cavities in children. Patients of all ages have more frequent and severe outbreaks of canker sores. Those not on a gluten-free diet are at greater risk for cancers of the mouth, pharynx and esophagus.

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Celiac Disease Tooth Development and Soft Tissue Defects

Dental Enamel Defects

Patients who have celiac disease at an early age (seven years or younger) might have the enamel formation of their baby teeth and permanent teeth disrupted, resulting in dental enamel defects. Dental enamel defects appear as bilateral, symmetrical, and chronologic white or yellow opacities with or without rough horizontal lines or grooves; the enamel is without glaze and enamel structural defects could be present.
This is caused by an immune-mediated reaction affecting the cells, which form enamel and a nutritional disturbance. Early diagnosis of celiac disease while enamel is still forming may decrease the amount of future enamel defects. Adults who have dental enamel defects usually seek cosmetic dental options to improve the look of the affected teeth.

Delayed Dental Development

Children with undiagnosed celiac disease lose their baby teeth slower than those without celiac disease, and permanent teeth erupt later than usual. Celiac disease can cause delayed dental development, eruption of permanent teeth, and delay skeletal development.

Recurrent Aphthous Ulcers (Canker Sores)

Patients with celiac disease have frequent and severe outbreaks of aphthous ulcers, commonly called canker sores. Adherence to a gluten-free diet has been shown to decrease the frequency and severity of the outbreaks. Aphthous ulcers (canker sores) occur very frequently in celiac disease patients. A gluten-free diet has been shown to lessen the severity of these outbreaks.

Dental Caries

Recent studies have shown that children with celiac disease have dental caries, commonly known as dental cavities, more often than children without celiac disease. Electron microscopy of the primary teeth (baby teeth) of celiac disease patients shows a structural change as compared to patients without celiac disease. Additionally, chemical analysis of primary teeth of celiac disease patients shows a decrease in the calcium/phosphorous ratio, which could explain the incorporation of calcium in the tissue structure, making it more soluble.

Soft Tissue

Patients with celiac disease often experience a dry or burning sensation of the tongue due to the effect celiac disease has on the absorption of vitamin B-12, folate, and iron. Celiac disease patients who have adhered to the gluten-free diet for five or more years do not have an increased risk of developing cancers of the mouth, pharynx, esophagus, and lymphoma when compared with the general population. The risk is increased in those on a reduced gluten or normal diet. This population has an excess of cancers of the mouth, pharynx and esophagus.

Saliva

Celiac disease does not alter salivary flow rate. Studies show that the relative amount of secreted proteins (e.g. amylase IgG and IgM) tends to be significantly lower in celiac disease patients than in health controls. Completing the gluten challenge resulted in a decrease in myeloperoxidase activity IgA and IgM concentrations and the relative amounts of secreted IgA.