Few Dentists Know - Celiac Disease Can Cause Dental Complications

By Jonathan Richter, DDS, FAGD

      Celiac disease is a hereditary autoimmune disorder and is one of the most common gastrointestinal disorders in the world. When gluten is consumed it triggers the body's immune response, which attacks the small intestine and damages the villa. Villa are small fingerlike projections that line the small intestine and promote nutrient absorption. When the villa are damaged, nutrients cannot be absorbed by the body properly resulting in vitamin and mineral deficiencies and the onset of health conditions if left undiagnosed.

     Gluten is a protein found in wheat, rye and barley and, believe it or not, pops up in skin care products, shampoos and even your dental wellness products like toothpaste, mouthwash, dental floss, fluoride and even in gloves!

     Diagnosis of celiac disease can be difficult since there are many symptoms associated with the condition, including but not limited to bloating, chronic diarrhea, constipation, gas, nausea, stomach pain and vomiting. Even asthma and skin conditions like rosacea, eczema and psoriasis have been linked to celiac disease or gluten sensitivity. Additionally, there are a multitude of dental complications that a patient with celiac might experience, but these symptoms are much less well known - even to dentists!

     One of the biggest complications related to celiac disease are dental enamel defects - children being especially vulnerable because enamel defects can lead to life-long oral health issues. If a child has celiac and he or she consumes gluten in any substantial quantity as the teeth are developing, they can end up with a defect in the enamel leading into post-teeth formation.

     Most enamel defects resulting from celiac disease place patients at very high risk for decay or other issues. Discoloration typically occurs with patients noticing white, yellow, or brown spots on the teeth. The enamel itself can be mottled and weak, sometimes exhibiting pitting, grooving or lines across the teeth.

     Other common dental symptoms include delayed eruption of teeth, cheilosis (fissuring and dry scaling of the lips and angles of the mouth) and atrophic glossitis (also known as bald tongue). Many people also experience issues with frequent aphthous ulcers, otherwise known as cold sores. These sores can be especially painful, and sometimes require prescribed medication to relieve them. In addition, a common problem is dry mouth syndrome, which, when coupled with dental enamel defects, puts patients at greater risk for tooth decay and cavity formation.

     If you suspect that you are suffering from celiac disease you can request a simple blood test that is available to screen for celiac disease. People with celiac 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. Keep in mind that when you do test, you must eat gluten for the blood test to pick up on those antibodies. If your blood test is positive, then your doctor may want to confirm your celiac disease diagnosis by undergoing an endoscopic biopsy of the small intestine.

     If you have celiac disease or a gluten sensitivity, tell your dentist because several products such as the prophy paste used in annual and bi-annual cleanings, some gloves, topical fluoride, polishing pastes, and even topical anesthetics might have gluten as an ingredient. In addition, dental products that are a color typically have gluten in them and if these products are used on a patient with celiac disease, it will cause a very unpleasant response. 

     It's important to remember that not all dental complications result from celiac disease or gluten exposure. Problems like dental enamel defects are fairly common in celiac patients and can help dentists identify patients who might be suffering from the disease, but they can result from other conditions. However, regarding celiac disease and its effect on oral health, it's not completely known in the dental community, so if you're dealing with celiac disease, it is up to you to advise your dentist so that they take the necessary steps to ensure your well-being.

     Jonathan Richter DDS, FAGD is a skilled dual trained holistic Periodontist (gum disease specialist), Prosthodontist (an expert in restoring teeth) and an expert in Implant Dentistry. He is one of only a few in the tri-state area. As both an integrative Periodontist and Prosthodontist, Dr. Richter believes in a total preventative wellness approach to a healthy mouth and body that includes prevention, integrative dental wellness and maintenance. Unlike most practitioners, Dr. Richter believes that all measures should be taken to save the natural tooth and has the ability to save most teeth that others would extract. As an integrative practitioner, he uses a holistic "natural" approach to Periodontics, General, Cosmetic, Restorative and Implant Dentistry. His knowledge of the systemic medical and dental inter-relationships allows him to devise treatment plans for each individual patient that improve overall well being.

     Jonathan Richter DDS, FAGD is located at: Cardiodontal 310 East Shore Rd. Great Neck, NY 11023 Visit: Cardiodontal.com, Call: 516-282-0310

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