Coeliac disease in children – an update for general dental practitioners

Abstract

Coeliac disease (CD) is an immune-mediated systemic disorder caused by ingestion of gluten found in wheat, rye and barley. It affects around 1% of children but 90% of cases are considered to remain undiagnosed. CD classically presents with gastrointestinal manifestations including diarrhoea, bloating, weight loss and abdominal pain, but extra-intestinal features (including oral and dental manifestations) are increasingly being reported. Dental and oral manifestations such as dental enamel defects, delayed eruption of teeth, recurrent aphthous ulcers are well recognized manifestations of CD. In patients with yet undiagnosed CD, these can sometimes be the only presenting features. Dentists have regular contact with well children, and therefore the visit to the dentist is an opportunity to suspect CD. When CD is suspected, Dental practitioners can liaise with the General Medical Practitioner to organise screening for coeliac disease. Positive serology will prompt onward referral to a paediatric gastroenterologist to confirm the diagnosis. The recent European Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines have streamlined the diagnostic pathway for faster diagnosis of CD. Management involves strict adherence to a gluten free diet, which should lead to resolution of symptoms, recovery of intestinal mucosa and prevention of long-term complications associated with it. This article aims to describe CD, inform of recent changes to the diagnostic pathway and highlight the dental manifestations of the condition to equip Dental practitioners to aid early diagnosis and initiation of treatment for children with CD.

A Comparison of the Prevalence of Dental Enamel Defects and Other Oral Findings in Children with and Without Celiac Disease

“…Dental enamel defects have been reported in children with CD, although the prevalence varies between geographical regions (Table 4). In patients with undiagnosed CD, dental and oral manifestations such as enamel defects, delayed eruption of teeth, and recurrent aphthous ulcers can sometimes be the only initial presenting manifestations (9,10). In some European countries, dentists are known to refer children for testing for CD on the basis of finding dental enamel defects during routine dental visits.…”

Manifestações orais e qualidade de vida relacionada com a saúde oral em doentes celíacos

“…(43) O médico dentista para além de ter um papel importante no diagnóstico precoce da doença (3,17) , tem igualmente o dever de, no caso das manifestações orais persistirem, reforçar a importância da dieta sem glúten e alertar o médico gastroenterologista. (44) Neste estudo constatou-se que os doentes celíacos não só começaram em média a dieta 0,2 anos após o diagnóstico, como também na altura da investigação 6,2% faziam uma dieta com algumas transgressões.…”

“…Estes podem ser definidos como hipoplasias dentárias (defeitos quantitativos) ou hipomineralizações (defeitos qualitativos). (19,44) No presente estudo, as prevalências de hipoplasia e de opacidade dentária percecionadas pelos pais foi de 17,8% e 39,0%, respetivamente. Estes valores encontram-se dentro da prevalência global desta manifestação, que varia entre 10% e 96% nos doentes celíacos (8,17,19,20) , enquanto que na população em geral estes defeitos variam entre 2,4% e 40,2%.…”

Mulheres No Climatério E Sua Sexualidade: Uma Perspectiva Biopsicossocial

“…Sabe-se que quanto mais precoce for o diagnóstico e detecção da patologia melhor será o prognóstico, pois permitirá o portador a aderir a dieta, prevenindo futuras complicações malignas e não malignas, evidenciando que será necessário o acompanhamento médico e odontológico regularmente (WORLD GASTROENTEROLOGY ORGANISATION GLOBAL GUIDELINES, 2012;PAUL et al, 2016). Assim, pesquisadores descreveram como o único tratamento eficaz o método nutritivo onde há uma alimentação isenta de glúten, onde será capaz de reduzir ou até mesmo eliminar os sintomas, devendo restabelecer fisiologia intestinal adequada, parâmetros bioquímicos e qualidade de vida (WORLD GASTROENTEROLOGY ORGANISATION GLOBAL GUIDELINES, 2012;SHTEYER et al, 2013;ADORNETTO et al, 2015).…”