In cases of silent celiac disease, sometimes your dentist may be the one to discover and diagnose your long-suffering condition. Two common celiac symptoms, or conditions closely associated with celiac disease, include defects with your dental enamel and chronic, recurring canker sores.
Both non-celiac gluten sensitivity and celiac disease can manifest symptoms and ailments well beyond the most well-known symptoms associated with gluten intolerance. In fact, over time these conditions can affect every part of your body, from every internal organ to your entire nervous system. This extends to your mouth. This is why an attentive, celiac-savvy dentist, rather than a gastroenterologist, can sometimes be the one to put the patient on the path to recovery.
Canker Sores and Dental Defects Common In Celiac Disease
Dental enamel defects and canker sores have a wide range of causes, so don’t assume celiac disease is always the origin. However, these problems are significantly more common among celiac disease patients than they are among the general population.
In 2009, The Journal of Clinical Gastroenterology published findings where 87 percent of children with celiac disease had dental enamel defects, compared to only 33 percent of children without celiac disease. They also found that 42 percent of adults and children with celiac disease experienced frequent canker sores (or “apthous stomatitis”), compared to only 22 percent of the general population.
As this research highlighted, dental enamel defects are particularly common among children with celiac disease. In fact, according to Dr. Alessio Fasano, Chief of Pediatric Gastroenterology and Nutrition at Massachusetts General Hospital for Children, dental defects are often the only early symptom of celiac disease in children.
In 2011, the Journal of the Canadian Dental Association published clinical guidelines to help dentists understand the relationship between celiac disease and dental defects.
Identifying Dental Enamel Defects
The tell-tale sign of dental problems resulting from celiac disease involves symmetrical imperfections on the incisors and molars. They may appear as brown, white or yellow spots, or they may appear as banding and pitting. Sometimes the patients of celiac disease may have translucent-looking teeth.
Some of these tooth defects may resemble defects occurring as a result of excess fluoride in the diet or maternal illnesses. Unfortunately, many dentists may blame these problems, particularly translucent-looking teeth, on fluoride or early childhood illness without considering celiac disease. This is why it is important for greater celiac awareness to extend to dental practices. Dentists need to know they should at least take steps to exclude celiac disease when these dental defects present themselves, especially in children.
Please note identifying these defects is only the first step towards diagnosis. After the dentist identifies a possible celiac situation, he or she will refer you to a gastroenterologist for a proper gluten intolerance test and evaluation.
Unfortunately, the dental enamel defects caused by celiac disease are permanent. However, a strict gluten-free diet will prevent further defects from developing. On older children and adults, dentists use a wide variety of effective cosmetic techniques to disguise these defects.
How Celiac Disease Causes Dental Defects
While the exact mechanism for how celiac disease causes defects in the enamel of your teeth remains a little bit of a mystery, we do have a couple of strong theories. First, specific antibodies triggered by celiac disease, tTG antibodies, appear to somehow suppress or contort proper development of enamel. Second, nutritional deficiencies resulting from the damage done to the small intestine probably contribute to poorly developed teeth, just as it can contribute to osteoporosis.
In particular, calcium and vitamin D are best absorbed in the part of the small intestine where celiac disease tends to do its earliest and most severe damage. Calcium and vitamin D are two of the most common nutrient deficiencies in celiac patients, which is why both dental problems and osteoporosis are common problems for people with untreated celiac disease.
How Celiac Disease Causes Canker Sores
How celiac disease causes canker sores is an even bigger mystery, though we suspect it more closely relates to nutritional deficiencies. Specifically, deficiencies in folate, vitamin B6, vitamin B12 or zinc will increase your risk for canker sores. Vitamin B12 deficiencies are strongly correlated with canker sores. For more detail on canker sores, read my recent post canker sores and gluten intolerance.
I would also like to add my own conjecture: I believe both the antibodies triggered by celiac disease (and NCGS), and the pro-inflammatory cytokines triggered by gluten intolerance may contribute to increased risk for canker sores.
Take Action to Improve Your Oral Health
While dental enamel defects aren’t reversible, you can prevent them from getting worse by adhering to a strict gluten-free diet and making sure your gluten-free diet contains plenty of calcium and vitamin D. In the early days of recovery, I recommend taking a supplement with these nutrients, but discuss extended supplementation with your doctor or a dietitian.
A strict gluten-free diet that includes plenty of vitamin B12 should help you minimize or eliminate your canker sores.
Please note that some evidence suggests that both dental defects and canker sores can can continue or reappear if you cheat on your gluten-free diet. Remember, the GFD is not a fad diet for people with celiac disease: it is a necessary life-long prescription.
But now more than ever before, you should view your new gluten-free lifestyle as an opportunity for healing, improved energy and renewed optimism.