Oral Findings and Salivary Parameters in Children with Celiac Disease: A Preliminary Study

Abstract

Objective: The aim of this study was to investigate the prevalence of dental enamel defects, recurrent aphthous stomatitis (RAS) and caries experience and to measure salivary flow rate, buffer capacity, saliva and plaque pH and salivary cariogenic microflora in patients with celiac disease (CD) compared to healthy subjects. Subjects and Methods: Thirty-five patients, aged 6-19 years, with a diagnosis of CD and 35 healthy children of the same age participated in the study. Enamel defects were diagnosed and classified using Aine's classification. The patients with RAS and dental caries were recorded using WHO criteria. The parents were interviewed about various oral health-related factors. Saliva samples were collected to measure the stimulated salivary flow rate, buffer capacity and pH values of saliva and plaque. Salivary mutans streptococci and lactobacilli were counted. Results: The enamel defects and RAS prevalence were statistically higher (40 and 37.1%, respectively) in the CD group, and the prevalence of salivary mutans streptococci (48 and 14%) and lactobacilli (51 and 34%) colonization was statistically lower (p = 0.012, p = 0.010) in the CD group; the DMFS and dfs values were similar in both groups. Conclusion: CD appeared to be associated with a significantly higher prevalence of developing enamel defects and RAS, but a lower prevalence of salivary mutans streptococci and lactobacilli colonization, and the diagnosis of these oral manifestations might be helpful for an early diagnosis of CD.

Celiac Disease and Its Impact on the Oral Health Status – Review of the Literature

“…Developmental defects of the dental enamel are especially frequently observed [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Impairment of dental crowns mineralization may occur in numerous systemic diseases.…”

“…Other complications observed in the oral cavity in patients with celiac disease are disturbances within mucosa. Aphthae are observed particularly often (RAS -recurrent aphtous stomatitis) ( Table 2) [7,9,11,12,16,18]. Cheng et al directed attention to frequent coexistence of aphthaes, and disturbances of dental enamel mineralization [9].…”

“…It may be the effect of better control over a diet, and a smaller number of snacks [36], as well as better oral cavity hygiene [13]. Some authors report on a smaller level of bacteria causing caries in the saliva of patients with celiac disease (Streptococcus mutans, Lactobacillus) [11]. However, other studies have not confirmed this fact [13].…”

The Effect of Celiac Disease on the Oral Cavity: A Review )

“…Some studies have evaluated the effects of celiac disease on the salivary parameters of affected patients. Acar et al [40] evaluated the salivary parameters of patient with celiac disease and compared the findings with those for healthy individuals; they found a lower prevalence of salivary mutans streptococci and lactobacilli colonization in celiac disease patients than in healthy individuals, with no significant differences in other parameters such as the salivary flow rate, pH, and buffering capacity [40]. In contrast, Tian et al [61] found a higher prevalence of lactobacilli with a higher glutenase activity in celiac disease patients, which may play a role in the pathogenicity of the disease [61].…”

“…The oral features of celiac disease are varied and atypical, and affected patients may exhibit enamel defects, delayed tooth eruption, and impaired mandibular jaw growth [27]. Among the oral manifestations of celiac disease, enamel defects and RAS are the most common and well documented in several studies (Table 1) [29,[31][32][33][34][35][36][37][38][39][40].…”