Clinical evaluation of dental enamel defects and oral findings in coeliac children

Year 2018, Volume: 52 Issue: 3, 150 - 156, 01.09.2018

Damla Akşit Bıçak , Nafiye Urgancı Seap Akyüz Merve Usta Nuray Uslu Kızılkan Burçin Alev Ayşen Yarat

Abstract

DOI: 10.26650/eor.2018.525

Purpose

To examine dental hard and soft tissue
changes of coeliac children in order to increase the awareness of the pediatric
dentists in prediagnosis of especially undiagnosed coeliac disease.

Materials and methods

Sixty children, 28 (46.7%) boys and 32
(53.3%) girls whose ages were between 6 to 16 years were included in the
present study. Thirty children who had undergone endoscopy and diagnosed with
the coeliac disease in the Şişli Hamidiye Etfal Hospital, İstanbul, Turkey,
formed the study group. Also, thirty children clinically suspected of having
the coeliac disease with the same gastrointestinal complaints had undergone
endoscopy and proven not coeliac were chosen as the control group. Oral examination
involved assessment of dentition and specific and unspecific dental enamel
defects. Also, soft tissue lesions, clinical delay of the dental eruption,
salivary flow rate, pH, and buffering capacity were examined.

Results

Twenty coeliac patients had enamel defects,
however none in the control subjects. In the coeliac group, all enamel defects
were diagnosed in permanent teeth and as specific in all children. Grade I
dental enamel defects found mainly in the incisors. The clinical delayed
eruption was observed in 10 (33.3%) of 30 coeliac children and none of the
children in the control group. While the level of DMFT/S numbers and stimulated
salivary flow rate were found significantly lower in the coeliac group, pH was
found significantly higher.

Conclusion

Oral cavity may be involved in coeliac
disease and pediatric dentists can play an important role in the early
diagnosis of the coeliac disease.

Keywords

Caries; coeliac disease; dental enamel defects; dental eruption; recurrent aphthous stomatitis

References

• 1. Küçükazman M, Ata N, Dal K, Nazlıgül Y. Çölyak hastalığı. Dirim Tıp Derg 2008; 83: 55-92. 2. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Mäki M, Ribes-Koninckx C, Ventura A, Zimmer KP; ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012; 54: 136-60. 3. Cataldo F, Montalto G. Celiac disease in the developing countries. A new and challenging public health problem. World J Gastroenterol 2007; 13: 2153-9. 4. Pastore L, Carroccio A, Compilato D, Panzarella V, Serpico R, Lo Muzio L. Oral manifestations of coeliac disease. J Clin Gastroenterol 2008; 42: 224-32. 5. Campisi G, Di Liberto C, Iacono G, Compilato D, Di Prima L, Calvino F, Di Marco V, Lo Muzio L, Sferrazza C, Scalici C, Craxì A, Carroccio A. Oral pathology in untreated coeliac disease. Aliment Pharmacol Ther 2007; 26: 1529-36. 6. Procaccini M, Campisi G, Bufo P, Compilato D, Massaccesi C, Catassi C, Lo Muzio L. Lack of association between celiac disease and dental enamel hypoplasia in a case-control study from İtalian central region. Head Face Med 2007; 3: 25. 7. Aine L, Maki M, Keyriläinen O, and Collin P. Dental enamel defects in Celiac disease. J Oral Path Med 1990; 19: 241-5. 8. Maki M, Aine L, Lipsanen V, Koskimies S. Dental enamel defects in first-degree relatives of coeliac disease patients. Lancet 199; 337: 763-4. 9. Maki M, Sulkanen S, Collin P. Antibodies in relation to gluten intake. Digest Dis 1998; 16: 330-2. 10. Seow W.K. Enamel hypoplasia in the primary dentition: a review. ASDC J Dent Child 1991; 58: 441-52. 11. Abenavoli L, Proietti I, Leggio L, Ferrulli A, Vonghia L, Capizzi R, Rotoli M, Amerio PL, Gasbarrini G, Addolorato G. Cutaneous manifestations in Celiac disease. World J Gastroenterol 2006; 12: 843-52. 12. Wierink CD, Van Dierman DE, Aartman IH, Heymans HS. Dental enamel defects in children with coeliac disease. Int J Paediatr Dent 2007; 17: 163-8. 13. Lähteenoja H, Toivanen A, Viander M, Mäki M, Irjala K, Räihä I, Syrjänen S. Oral mucosal changes in coeliac patients on a gluten-free diet. Eur J Oral Sci 1998; 106: 899-906. 14. Bramanti E, Cicciu M, Matacena G, Costa S, Magazzu G. Clinical Evaluation of specific oral manifestations in pediatric patients with ascertained versus potential coeliac disease: A cross-sectional study. Gastroenterol Res Pract 2014; 2014: doi: 10.1155/2014/934159. 15. Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Child 1990; 65: 909-11. 16. Costacurta M, Maturo P, Bartolino M, Docimo R. Oral manifestations of coeliac disease. A clinical-statistic srudy. Oral Implantol (Rome) 2010; 1: 12-9. 17. Avşar A, Kalaycı AG. The presence and distribution of dental enamel defects and caries in children with celiac disease. Turk J Pediatr 2008; 50: 45-50. 18. Rashid M, Zarkadas M, Anca A, Limeback H. Oral manifestations of celiac disease: A clinical guide for dentists. J Can Assoc 2011; 77: 39-44. 19. Ortega Páez E, Junco Lafuente P, Baca García P, Maldonado Lozano J, Llodra Calvo JC. Prevalence of dental enamel defects in celiac patients with deciduous dentition: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: 74-8. 20. Aine L. Dental enamel defects and dental maturity in children and adolescents with coeliac disease. Proc Finn Dent Soc 1986; 82: 1-7. 21. World Health Organization. Oral health surveys: basic methods 4th edn. Geneva: WHO; 1997. 22. Erriu M, Canargiu F, Orru G, Garau V, Montaldo C. Idiopathic atrophic glossitis as the only clinical sign for celiac disease diagnosis: a case report. J Med Case Rep 2012; 6: 185. 23. Cigic L, Galic T, Kero D, Simunic M, Mikic IM, Govorko DK, Lukenda DB. The prevalence of celiac disease in patients with geographic tongue. J Oral Pathol Med 2016; 45: 791-6. 24. Ertekin V, Sümbüllü MA, Tosun MS, Selimoğlu MA, Kara M, Kılıç N. Oral findings in children with celiac disease. Turk J Med Sci 2012; 42: 613-7. 25. Mina S, Azcurra AI, Riga C, Cornejo LS, Brunotto M. Evaluation of clinical dental variables to build classifiers to predict celiac disease. Med Oral Patol Oral Cir Bucal 2008; 13: 398-402. 26. Campisi G, Di Liberto C, Carroccio A, Compilato D, Iacono G, Procaccini M, Di Fede G, Lo Muzio L, Craxi A, Catassi C, Scully C. Coeliac disease: Oral ulcer prevalence, assessment of risk and association with gluten-free diet in children. Dig Liver Dis 2008; 40: 104-7. 27. Koç Öztürk L, A Yarat, Akyuz S, Furuncuoglu H, Ulucan K. Investigation of the N-terminal coding region of MUC7 alterations in dentistry students with and without caries. Balkan J Med Genet 2016; 19: 71-6. 28. Da Silva PC, de Almeida P del V, Machado MA, de Lima AA, Grégio AM, Trevilatto PC, Azevedo-Alanis LR. Oral manifestations of celiac disease. A case report and review of the literature. Med Oral Patol Oral Cir Bucal 2008; 13: 559-62. 29. Holmes GKT, Prior P, Lane MR, Pope D, Allan RN. Malignancy in coeliac disease: effect of a gluten free diet. Gut 1989; 30: 333-8. 30. Aquirre JM, Rotriguez R, Oribe D, Vitoria JC. Dental enamel defects in celiac patients. Oral Surg Oral Med Oral Path Oral Radiol Endod 1997; 84: 646-50. 31. Acar S, Aykut Yetkiner A, Ersin N, Oncag O, Aydogdu S, Arıkan C. Oral findings and salivary parameters in children with celiac disease: A preliminary study. Med Princ Pract 2012; 21: 129-33. 32. Farmakis E, Puntis JW, Toumba KJ. Enamel defects in children with coeliac disease. Eur J Paediatr Dent 2005; 6: 129-32. 33. Priovolou CH, Vanderas AP, Papagiannoulis L. A comperative study on the prevalence of enamel defects and dental caries in children and adolescents with and without coeliac disease. Eur J Paediatr Dent 2004; 5: 102-6. 34. Cantekin K, Arslan D, Delikan E. Presence and distribution of dental enamel defects, recurrent aphtous lesions and dental caries in children with celiac disease. Pak J Med Sci 2015; 31: 606-9. 35. Ouda S, Saadah O, El Meligy O, Alaki S. Genetic and dental study of patients with celiac disease. J Clin Pediatric Dent 2010; 35: 217-24. 36. Shteyer E, Berson T, Lachmanovitz O, Hidas A, Wilschanski M, Menachem M, Shachar E, Shapira J, Steinberg D, Moskovitz M. Oral health status and salivary properties in relation to gluten-free diet in children with celiac disease. J Pediatr Gastroenterol Nutr 2013; 57: 49-52. 37. Rasmusson CG, Eriksson MA. Celiac diasese and mineralisation disturbances of permanent teeth. Int J Paediatr Dent 2001; 11: 179-83. 38. Cheng J, Malahias T, Brar P, Minaya MT, Green PH. The association between celiac disease, dental enamel defects, and aphthous ulcers in a United States Cohort. J Clin Gastroenterol 2010; 44: 191-4. 39. Aine L. Coeliac-type permanent-tooth enamel defects. Ann Med 1996; 28: 9-12. 40. Sedghizadeh P, Schuler CF, Allen CM, Beck FM, Kalmar JR. Celiac disease and recurrent aphtous stomatitis: A report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 474-8. 41. Yaşar Ş, Yaşar B, Abut E, Aşıran Serdar Z. Clinical importance of celiac disease in patients with recurrent aphthous stomatitis. Turk J Gastroenterol 2012; 23: 14-8. 42. Collin P, Reunala T, Pukkala E, Laippala P, Keyriläinen O, Pasternack A. Coeliac disease--associated disorders and survival. Gut 1994; 35: 1215-8. 43. Lenander-Lumikari, Ihalin R, Lähteenoja H. Changes in whole saliva in patients with coeliac disease. Arch Oral Biol 2000; 45: 347-54. 44. Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology 2001; 120: 636-51. 45. Mariani P, Mazzilli MC, Margutti G, Lionetti P, Triglione P, Petronzelli F, Ferrante E, Bonamico M. Coeliac disease, enamel defects and HLA typing. Acta Paediatr 1994; 83: 1272-5.