Oral Health Status and Salivary Properties in Relation to Gluten‐free Diet in Children With Celiac Disease

Shteyer, Eyal; Berson, Tamar; Lachmanovitz, Odelia; Hidas, Ariela; Wilschanski, Michael; Menachem, Moti; Shachar, Edna; Shapira, Joseph; Steinberg, Doron; Moskovitz, Moti

doi:10.1097/mpg.0b013e31828b3705

Cited by 36 publications

(45 citation statements)

References 11 publications

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“…Lactobacilli are natural colonizers of the oral cavity, with Lactobacillus rhamnosus being the most prevalent (26). While several studies have shown that the levels of Lactobacillus were lower in the duodenal and fecal samples in CD patients compared to healthy controls (31-33), reports on Lactobacillus levels in the oral cavity are inconsistent (34)(35)(36). Regardless of the microbial source, the modest increase in salivary enzyme activity is likely to be derived from bacteria given that dental plaque is a rich source of glutendegrading activity (21).…”

Section: Discussionmentioning

confidence: 96%

Salivary Gluten Degradation and Oral Microbial Profiles in Healthy Individuals and Celiac Disease Patients

Tian

Faller²,

Leffler

et al. 2017

Appl Environ Microbiol

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Celiac disease (CD) is a chronic immune-mediated enteropathy induced by dietary gluten in genetically predisposed individuals. Saliva harbors the second highest bacterial load of the gastrointestinal (GI) tract after the colon. We hypothesized that enzymes produced by oral bacteria may be involved in gluten processing in the intestine and susceptibility to celiac disease. The aim of this study was to investigate salivary enzymatic activities and oral microbial profiles in healthy subjects versus patients with classical and refractory CD. Stimulated whole saliva was collected from patients with CD in remission (n ϭ 21) and refractory CD (RCD; n ϭ 8) and was compared to healthy controls (HC; n ϭ 20) and subjects with functional GI complaints (n ϭ 12). Salivary gluten-degrading activities were monitored with the tripeptide substrate Z-Tyr-Pro-Gln-pNA and the ␣-gliadin-derived immunogenic 33-mer peptide. The oral microbiome was profiled by 16S rRNA-based MiSeq analysis. Salivary glutenase activities were higher in CD patients compared to controls, both before and after normalization for protein concentration or bacterial load. The oral microbiomes of CD and RCD patients showed significant differences from that of healthy subjects, e.g., higher salivary levels of lactobacilli (P Ͻ 0.05), which may partly explain the observed higher gluten-degrading activities. While the pathophysiological link between the oral and gut microbiomes in CD needs further exploration, the presented data suggest that oral microbe-derived enzyme activities are elevated in subjects with CD, which may impact gluten processing and the presentation of immunogenic gluten epitopes to the immune system in the small intestine.IMPORTANCE Ingested gluten proteins are the triggers of intestinal inflammation in celiac disease (CD). Certain immunogenic gluten domains are resistant to intestinal proteases but can be hydrolyzed by oral microbial enzymes. Very little is known about the endogenous proteolytic processing of gluten proteins in the oral cavity. Given that this occurs prior to gluten reaching the small intestine, such enzymes are likely to contribute to the composition of the gluten digest that ultimately reaches the small intestine and causes CD. We demonstrated that endogenous salivary protease activities are incomplete, likely liberating peptides from larger gluten proteins. The potentially responsible microbes were identified. The study included refractory CD patients, who have been studied less with regard to CD pathogenesis.

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Section: Discussionmentioning

confidence: 96%

Salivary Gluten Degradation and Oral Microbial Profiles in Healthy Individuals and Celiac Disease Patients

Tian

Faller²,

Leffler

et al. 2017

Appl Environ Microbiol

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“…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]. In some studies, no significant correlation between celiac disease and caries and the difference in oral hygiene levels has been observed [11,24].…”

mentioning

confidence: 94%

“…Nevertheless, in the literature an opposite view is more frequent [8,14,17,35,36]. 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].…”

mentioning

confidence: 99%

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

B¹,

Herman²,

Kowalczyk−Zając³

et al. 2014

Adv Clin Exp Med

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The paper presents the most recent reports on celiac disease, especially its manifestations within the oral cavity. Particular attention should be paid to typical dental enamel defects with a various degree of advancement: discolorations, horizontal groves and pits, and even significant structural destruction causing the change of the dental crown. Symmetric location of defects within all dentition sections, and within the same anatomic groups of teeth (the most frequently: incisors and first permanent molars), is specific for celiac disease. The changes described above may be the only manifestation of celiac disease; therefore, in the case of their occurrence further studies towards gluten intolerance are recommended even when other symptoms are not present. In celiac patients, recurrent aphthae and other disorders of the oral mucosa such as ulceration, erythema, atrophic glossitis, as well as dryness and a burning sensation (particularly of the tongue) may be present, which may be caused by malnutrition. Delayed tooth eruption may also be a consequence of alimentary deficiency in celiac disease (Adv Clin Exp Med 2014, 23, 5, 675-681).

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“…Oral and dental manifestations of CD Specific dental and oral manifestations of CD are now increasingly being recognised and are highlighted below 12,13 : (Fig 2) are one of the most common dental manifestations seen in children 14 . The likely mechanism of development of DED is a combination of immune-mediated enamel damage and nutritional disturbance (e.g.…”

Section: Clinical Presentationmentioning

confidence: 99%

Coeliac disease in children – an update for general dental practitioners

et al. 2016

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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.

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Oral Health Status and Salivary Properties in Relation to Gluten‐free Diet in Children With Celiac Disease

Cited by 36 publications

References 11 publications

Salivary Gluten Degradation and Oral Microbial Profiles in Healthy Individuals and Celiac Disease Patients

Salivary Gluten Degradation and Oral Microbial Profiles in Healthy Individuals and Celiac Disease Patients

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

Coeliac disease in children – an update for general dental practitioners

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