Beyond the Gut: A Systematic Review of Oral Manifestations in Celiac Disease

Abstract

Background: Celiac disease (CD) is a chronic immune-mediated gluten-sensitive enteropathy, affecting about 1% of the population. The most common symptoms include diarrhea, abdominal pain, weight loss, and malabsorption. Extra-intestinal symptoms include oral manifestations. This systematic review aims to catalog and characterize oral manifestations in patients with CD. Methods: a systematic literature review among different search engines using PICOS criteria has been performed. The studies included used the following criteria: tissues and anatomical structures of the oral cavity in humans, published in English and available in full text. Review articles and papers published before 1990 were excluded. Results: 209 articles were identified in the initial search. In the end, 33 articles met the selection criteria. The information extracted from the articles was classified based on the type of oral manifestation. Recurrent aphthous stomatitis (34.6%), atrophic glossitis and geographic tongue (15.26%), enamel defects (42.47%), delayed dental eruption (47.34%), xerostomia (38.05%), glossodynia (14.38%), and other manifestations including cheilitis, fissured tongue, periodontal diseases, and oral lichen planus were found in the celiac subjects of the studies analyzed. The quality of articles on the topic should be improved; however, oral manifestations in CD patients are widely described in the literature and could help diagnose celiac disease.

Coeliac disease and its implications on the oral health of children: A systematic review

“…The literature reports that iron, folic acid and vitamin B12 deficiencies due to intestinal malabsorption in CD may be a possible cause of oral symptoms 14 . Lucchese et al 17 . reported that hematins deficiencies such as iron, folates or vitamin B12 appear to play a role in the pathogenesis of RAS while up to 25% of angular cheilitis is supposed to be caused by iron or vitamin B deficiency 18 .…”

“…In various studies, the supplementation of these deficient microelements only marginally influenced the disease progression. Conversely, positive outcomes were reported in response to oral vitamin B12 supplementation in RAS patients, independent of their initial serum levels of this microelement 17 . The exact mechanism connecting RAS to CD has not yet been completely clarified.…”

“…However, it is presumed to be related to the immune response induced by gluten. Studies have shown elevated levels of inflammatory markers and antibodies in people with CD and gluten‐sensitive enteropathy (GSE), which may lead to RAS 17 …”

The Contribution of the Intestinal Microbiota to the Celiac Disease Pathogenesis along with the Effectiveness of Probiotic Therapy

“…Taking into account the clinical picture and the results of laboratory studies, two forms of the disease are distinguished: symptomatic (manifest) and asymptomatic (latent) [27,35,36]. The main manifestations of celiac disease are characterized by the presence of gastrointestinal symptoms (persistent diarrhea, flatulence, abdominal pain, nausea and others) and/or extraintestinal manifestations (osteoporosis, anemia, infertility, neurological symptoms and others).…”

Otorhinolaryngological Manifestations and Esophageal Disorders in Celiac Disease: A Narrative Review

“…In some cases, extra-intestinal symptoms are the only clinical manifestations of CeD that frequently remain undiagnosed. The oral cavity is likewise one of the areas of extra-intestinal signs and symptoms [5][6][7]. For example, dental complaints, particularly dental enamel defects, are well-known manifestations of CeD [8].…”