Dental and Oral Manifestations of Celiac Disease: A Cross-Sectional Study

Celiac disease is an immune-mediated chronic enteropathy of the small intestine that occurs due to gluten sensitivity in genetically predisposed people. Due to the relatively high incidence of celiac disease in Iran and limited studies on oral manifestations in the Iranian population, the aim of this study was to examine hard and soft tissue manifestations of the oral cavity.

 53 patients with celiac disease and 53 healthy individuals who matched the case group in terms of age and sex were evaluated. The case group included patients whose disease had been previously confirmed by serological testing and small intestine biopsy. Enamel defects and caries were evaluated according to Aine and WHO criteria, respectively. Other soft tissue manifestations, such as aphthous stomatitis, were either confirmed based on the presence of the lesion at the time of clinical examination or reported by the patient. Xerostomia was assessed based on the answers to Dyasanoor’s questionnaire, and Community Periodontal Index for Treatment Needs was used to assess periodontal status. Data were analyzed using SPSS software version 16. The Chi-square and, if required, Fisher’s exact test was used.

 There was a significant difference between the two groups in the frequency of enamel defects (OR=8.4, P<0.001) and xerostomia (OR=3.3, P=0.025). In addition, there was no significant difference between subjects with classical and non-classical celiac disease in frequency (P=0.337) and pattern (P=0.466) of hypoplasia and xerostomia (P=0.415). The subjects did not differ significantly in mean Decayed, Missing, Filled Teeth index . Although patients with celiac disease brushed less frequently and their xerostomia was significantly higher compared to controls, caries indices were not significantly different (P=0.85) even when the effect of brushing frequency was adjusted. Multivariate linear regression showed that after adjusting for brushing frequency, the mean periodontal index of the celiac disease group was higher than that of controls (P=0.03). Although soft tissue manifestations such as aphthous stomatitis (P=0.231), atrophic glossitis, geographic tongue, and angular cheilitis were more frequent in the patients, no statistically significant difference was observed.

 Celiac disease increases the risk of enamel defects and xerostomia. Therefore, dentists can play a key role in the early detection of celiac disease using oral findings. However, the presence of soft tissue manifestations, especially in adults, could not be proven as a meaningful criterion for the early detection of celiac disease