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Enamel Defects May Uncover Unknown Celiac Disease

Celiac disease has been a much-discussed topic in recent years, despite its relatively low occurrence in the general population.  Though only about one percent of Americans suffer from this serious, genetic autoimmune disorder, the name celiac disease has become synonymous with the “gluten-free,” diet movement, which has spurned an entire market of gluten-free products. But while many people who choose a gluten-free lifestyle claim to be ‘gluten-sensitive’ or even believe they have celiac disease, many more who have the disorder may not even realize they have it – until now. Researchers have recently found a link between certain tooth enamel defects and celiac disease- and it may make diagnosing celiac disease a lot easier. We asked Dr. Stephen Hill of Allen, Texas for some insight.

Unlike the gluten-free movement, celiac disease is not simply an elective diet choice, but a genuine autoimmune illness. It manifests itself in the form of an immune response, which occurs when the celiac patient ingests foods with gluten. Exposure to gluten in a celiac patient will cause the body to attack the small intestine as it might a virus or other illness. This can cause severe abdominal discomfort that can last for several days, but worse- it can cause permanent damage to the villi of the small intestine. Villi are small, ‘finger-like’ tissue structures that line the small intestine and aid in nutrient absorption. Without villi, the body cannot absorb the nutrients we get from food.  Complicating matters for many celiac sufferers is the fact that though many patients with celiac disease do experience serious pain when exposed to gluten, many more do not- making it nearly impossible to diagnose them with the illness. This means the food these patients eat can be both damaging their small intestine and robbing them of vital nutrients for years- without the patient ever realizing there’s a problem.  However, there could be promising news on the horizon for celiac patients- and it comes in the form of another, seemingly unrelated medical issue.

According to a study published in the European Journal of Internal Medicine, researchers at the University of Pavia, Italy recently discovered that enamel defects were present in 85 percent of the celiac patients studied. Yet another study in Canada echoed the same results- estimating that anywhere between 70-80 percent of celiac patients have some kind of enamel defect present. These defects can appear as the roughness of the tooth, discoloration of the tooth, yellow or brown spots, deep grooves or pits on the surface of the tooth, or irregular or odd-shaped teeth. But though researchers do not know what causes this link between tooth enamel and celiac, Hill theorizes it could have a lot to do with those embattled villi. 

“Because the villi in a patient with celiac disease cannot absorb nutrients, the enamel defects present in that patient could be due to their body’s inability to absorb the proper amount of dietary calcium and vitamin D,” Hill said. “It could also simply be a result of the total-body autoimmune response, but there is simply not enough research on the link yet.


So, now that we know there’s a strong possibility of a link between enamel defects and celiac disease, what can we do with this information? According to Hill, the obvious answer is a diagnosis. 

“If a dentist sees a patient with these types of defects and there is no other red flag in their medical history, such as the use of tetracycline antibiotics or genetics, we may recommend the patient get tested for celiac disease,” he said.  

For those patients where no other symptoms are present, Hill says he may still recommend the patient speak with their doctor, just to be safe. 

“Another symptom that frequently goes hand-in-hand with enamel defects in celiac patients is frequent canker sores,” Hill said. “So, if the patient is experiencing a lot of canker sores in addition to having enamel issues, that’s a big red flag to me.” 

According to Hill, early diagnosis is especially important in children, because though enamel defects may be too late to correct in adults, they usually aren’t in children. 

“If we can see these types of defects appearing early on in children, we can not only save their teeth but prevent the child from a lifetime of damage to their intestines and overall health, as well,” he said. 

Celiac is a disease that can come on suddenly at any age- but it is especially dangerous for children, who require more nutrients than adults as they grow.

Ultimately, a celiac diagnosis isn’t the end of the world. Thanks to that gluten-free diet craze, dietary options for celiac patients are better than ever these days. In fact, some stores have entire aisles dedicated solely to gluten-free products, and many products that are ‘naturally gluten-free’ are proudly touting that fact on their packaging.

“That first step- diagnosis- is often the hardest one,” Hill said. “Don’t be afraid to bring up dental abnormalities with both your dentist and doctor. If you think there may be a connection- or if you have any of these symptoms, or know of a genetic link to celiac, it’s definitely worth getting checked out sooner than later.” 

While your dentist cannot diagnose celiac disease, he can provide information to your doctor if there are concerns that you may be affected.

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