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.
Ted Malahias, DDS, Celiac Disease Foundation Medical Advisory Board Member and affiliate of the Celiac Disease Center at Columbia University, discusses the oral presentation of celiac disease and its effects on dental health
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.
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.
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.
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.
Oral Care Products and Dental Materials
Celiac disease patients should be confident that the products a dentist and dental hygienist use are gluten-free. In the past few years, dental manufacturers have been more forthcoming in indicating which professional products are gluten-free.
The polishing paste that the hygienist uses to clean your teeth is available gluten-free. Some examples are:
- ACCLEAN PROPHY PASTE 23% APF. Henry Schein
- ACCLEAN ZERO PROPHY PASTE. Henry Schein
- UNI-PRO PROPHY PASTE. Henry Schein
- D-LISH PROPHY PASTE .Young Dental
- KOLORZ PROPHY PASTE. DMG America
- NUPRO Plus Prophy Paste. DENTSPLY Professional
- NUPRO Extra Care Prophy Paste DENTSPLY Professional
- Oral-B Prophy Paste. Young Dental
- Smart Select Selective Polishing Prophy Paste. Young Dental
- Sparkle Prophy Paste. Crosstex
- Zooby Prophy Paste Denticator
The fluoride that the hygienist applies after cleaning your teeth is available gluten-free. Some examples are:
- ACCLEAN 1.23% APF 60 second fluoride gel,
- NUPR fluoride gel DENTSPLY professional 1.23% Gel
- NUPRO Fluoride foam DENTSPLY Professional 1.23% Aerosol
- Enamel Pro non-Acidulated Fluoride Gel with ACP Premier Dental
- Kolorz Fluoride foam DMG America 1.23% APF Foam
- Kolorz Fluoride Gel DMG America 1.23% APF Gel
- Zap Fluoride Gel Crosstex 1.23% APF Gel
- Zooby Fluoride Foam Denticator 1.23% Foam
- D-LISH fluoride varnish. Young Dental
- Duraflor Halo Medicom
- ProFluorid Varnish. VOCO
- ProGuard 5% sodium fluoride Varnish. Crosstex
- Fluoride Varnish with Xylitol. Crosstex
- Zooby 5% Sodium Fluoride Varnish Denticator
- Biotene products for dry mouth are gluten-free
- Oraqix topical anesthetic is gluten-free
- Sensodyne pro enamel is gluten-free
- Tom’s of Maine toothpastes are gluten-free
- 3M Oral Care – 3M Oral care states that “Gluten is not an added component to any of 3M Oral care products. Only dental materials/products are manufactured in our plants.” Components of 3M products can be found at 3mespe.com. At the bottom of the page under “Regulatory” click “SDS Search.” Type the name of the product to which you are inquiring in the search bar. Click on Regulatory Data Sheet. Product components will be listed under the Regulatory Data sheet.
- Crest toothpastes, Crest white strips or Crest night effects and Glide dental floss are gluten-free.
According to Colgate, all Colgate, Ultrabrite and PreviDent toothpastes are gluten-free. In addition, all Colgate Mouthwashes are gluten-free. These include:
- Colgate Optic White Mouthwash
- Colgate Total Mouthwash
- Colgate Total Advanced ProShield Mouthwash
- Periogard Mouthwash
- Peroxyl Oral Cleanser (all varieties)
- PhosFlur (all flavors, including, Grape, Mint and Bubblegum)
The following Oral Care Device Delivery Systems are certified gluten-free:
- Colgate Optic White Toothbrush + Built In Whitening Pen
- Colgate Toothbrush + Sensitive Enamel Health Relief Pen
According to Colgate, “we do not intentionally add gluten to any of our other products. Although we obtain our ingredients from reliable and trusted suppliers who maintain our high standards for safety, quality, and efficacy, we cannot guarantee that the ingredients used have not come in contact with any gluten. Sorbitol is an ingredient which can be derived from grain and may be found in toothpastes. Our sorbitol is corn-derived.”
- Colgate Wisp
- Gel-Kam Home Care Gel
- Orabase Paste
- PreviDent Gel
- PreviDent Varnish
- PreviDent Rinse
- Colgate Total Floss
There are more than 200 symptoms associated with celiac disease, which makes diagnosis difficult. A significant percentage of people with celiac disease, both adults and children, have no or minimal symptoms.
CDF offers a Symptoms Checklist to help you and your physician determine if you should be tested for celiac disease.
Screening and Diagnosis
A simple blood test is available to screen for celiac disease. People with celiac disease who eat gluten have higher than normal levels of certain antibodies in their blood. These antibodies are produced by the immune system because it views gluten (the proteins found in wheat, rye and barley) as a threat. You must be on a gluten-containing diet for antibody (blood) testing to be accurate.
The only way to confirm a celiac disease diagnosis is by undergoing an endoscopic biopsy of the small intestine.
Finding the Right Doctor
Celiac Disease Foundation can help you find the right doctor to discuss symptoms, diagnose, and treat celiac disease. Our nationwide Healthcare Practitioner Directory lists primary care physicians and specialists,and dietitians and mental health professionals, experienced in celiac disease and non-celiac wheat sensitivity.