Çölyak Hastalığı Olan Çocukların Ağız ve Diş Sağlığı Durumu

Öz

Çölyak hastalığı buğday, çavdar ve arpada bulunan glüten alımının neden olduğu otoimmün bir hastalıktır. Çocukların yaklaşık %1’ini etkiler, ancak vakaların %90’ının teşhis edilmediği kabul edilir. Klinik olarak diyare, şişkinlik, kilo kaybı ve karın ağrısı gibi gastrointestinal belirtileri bulunmaktadır. Aynı zamanda mine defektleri, dişlerde sürme gecikmeleri, tekrarlayan aftöz ülserler gibi ağız belirtileri bulunmaktadır. Diş hekimleri rutin muayene ve diş tedavisi sırasında özellikle klinik semptom göstermeyen sistemik hastalığı olan çocuklarda çölyak hastalığının erken tanısında yönlendirme yapabilir. Erken tanı ile hastalığın tedavisine yönelik glütensiz diyete başlanması semptomların giderilmesine, bağırsak mukozasının iyileşmesine ve uzun dönemde gelişebilecek komplikasyonların önlenmesine yardımcı olur. Bu derleme çölyak hastalığının tanısı, klinik bulguları ve ağız bulguları konusunda literatürdeki bilgileri değerlendirmektedir. Diş hekimleri özellikle çocuk hastalarda çölyak hastalığının ağız bulgularını detaylı bir şekilde sorgulayıp hastayı uygun hekime yönlendirerek erken teşhis ve tedavinin başlatılmasında önemli rol oynamaktadır. Çölyak hastalığı olan çocuklarda çoklu organ bozukluğu gelişebileceği için pediatristler, gastroenterologlar ve diş hekimleri arasındaki iş birliğine dayalı çalışma önemlidir.

Anahtar Kelimeler

• çölyak hastalığı
• glüten
• ağız belirtileri

Oral and Dental Health Status of Children with Celiac Disease

Öz

Celiac disease is an autoimmune disease caused by the ingestion of gluten, which is found in wheat, rye, and barley. It affects about 1% of children, but 90% of cases are considered undiagnosed. Clinically, there are gastrointestinal symptoms such as diarrhea, bloating, weight loss and abdominal pain. Also, there are oral symptoms such as enamel defects, delayed eruption of teeth, recurrent aphthous ulcers. Dentists can guide in the early diagnosis of celiac disease, especially in children with systemic disease who do not show clinical symptoms during routine examination and dental treatment. Starting a gluten-free diet for the treatment of the disease with early diagnosis helps to relieve symptoms, heal the intestinal mucosa and prevent long-term complications. In this review, the literature on the diagnosis, clinical and oral findings of celiac disease is evaluated. Dentists play an important role in early diagnosis and initiation of treatment, especially in pediatric patients, by questioning the oral findings of celiac disease in detail and directing the patient to the appropriate physician. Collaboration between pediatricians, gastroenterologists, and dentists is important because children with celiac disease can develop multiple organ dysfunction.

Anahtar Kelimeler

• coeliac disease
• gluten
• oral manifestations

Kaynakça

1. Acar, S., Yetkıner, A. A., Ersın, N., Oncag, O., Aydogdu, S., & Arıkan, C. (2012). Oral findings and salivary parameters in children with celiac disease: a preliminary study. Medical Principles and Practice, 21(2), 129-133.
2. Aguirre, J. M., Rodriguez, R., Oribe, D., & Vitoria, J. C. (1997). Dental enamel defects in celiac patients. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 84(6), 646-650.
3. Alamoudi, N.M., Alsadat, F.A., El-Housseiny, A.A., Felemban, O.M., Al Tuwirqi, A.A., Mosli, R.H., Saadah, O.I. (2020). Dental maturity in children with celiac disease: A case-control study. BMC Oral Health. 201, 311.
4. Aydemir S, Solak Tekin N, Aktunç E, Numanoǧlu G, Üstündaǧ Y. Celiac disease in patients having recurrent aphthous stomatitis. Turkish J Gastroenterol. 2004;15(3):192-195.
5. Baccaglini, L., Lalla, R. V., Bruce, A. J., Sartori‐Valinotti, J. C., Latortue, M. C., Carrozzo, M., & Rogers III, R. S. (2011). Urban legends: recurrent aphthous stomatitis. Oral Diseases, 17(8), 755-770.
6. Barros IO, Mestrinho HD, Pratesi R, Gandolfi L, Medeiros OS, Acevedo AC. (2004). Dental alterations in celiac children: a review of literature and case report. Rev Reg Aracatuba Assoc Paul Cir Dent. 58, 140-143.
7. Barton, S. H., Kelly, D. G., & Murray, J. A. (2007). Nutritional deficiencies in celiac disease. Gastroenterology Clinics of North America, 36(1), 93-108.
8. Bascuñán, K.A., Vespa, M.C., Araya, M. (2017). Celiac disease: understanding the gluten-free diet. European Journal of Nutrition. 56(2), 449–459.

9. Bıçak, D.A., Urgancı, N., Akyüz, S., Usta, M., Uslu Kizilkan, N., Alev Tuzuner, B., Yarat, A. (2018) Clinical evaluation of dental enamel defects and oral findings in coeliac children. Eur. Oral Res.523,150–156.
10. Bingley, P. J., Norcross, A. J., Lock, R. J., Ness, A. R., & Jones, R. W. (2004). Undiagnosed coeliac disease at age seven: population based prospective birth cohort study. Br Med J., 328(7435), 322-323.
11. Bramanti, E., Cicciù, M., Matacena, G., Costa, S., Magazzù, G. (2014). Clinical evaluation of specific oral manifestations in pediatric patients with ascertained versus potential coeliac disease: a cross-sectional study. Gastroenterology research and practice.
12. Bucci, P., Carile, F., Sangianantoni, A., D’Angiò, F., Santarelli, A., & Lo Muzio, L. (2006). Oral aphthous ulcers and dental enamel defects in children with coeliac disease. Acta Paediatrica, 95(2), 203-207.
13. Campisi, G., Di Liberto, C., Carroccio, A., Compilato, D., Iacono, G., Procaccini, M., Scully, C. (2008). Coeliac disease: oral ulcer prevalence, assessment of risk and association with gluten-free diet in children. Digestive and Liver Disease, 40(2), 104-107.
14. Cantekin, K., Arslan, D., Delikan, E. (2015). Presence and distribution of dental enamel defects, recurrent aphthous lesions and dental caries in children with celiac disease. Pakistan journal of medical sciences, 31(3), 606-609.
15. Casellas, F., Rodrigo, L., Vivancos, J. L., Riestra, S., Pantiga, C., Baudet, J. S., Malagelada, J. R. (2008). Factors that impact health-related quality of life in adults with celiac disease: a multicenter study. World journal of gastroenterology: WJG, 14(1), 46-52.
16. Cigic, L., Galic, T., Kero, D., Simunic, M., Medvedec Mikic, I., Kalibovic Govorko, D., Biocina Lukenda, D. (2016). The prevalence of celiac disease in patients with geographic tongue. Journal of Oral Pathology & Medicine, 45(10), 791-796.
17. Condò, R., Costacurta, M., Maturo, P., & Docimo, R. (2011). The dental age in the child with coeliac disease. European Journal of Paediatric Dentistry, 12(3), 184-188.
18. Costacurta, M., Maturo, P., Bartolino, M., & Docimo, R. (2010). Oral manifestations of coeliac disease: a clinical-statistic study. Oral & implantology, 3(1), 12-19.
19. da Silva, P. C., de Almeida, P. D. V., Machado, M. Â. N., de Lima, A. A. S., Grégio, A. M. T., Trevilatto, P. C., & Azevedo-Alanis, L. R. (2008). Oral manifestations of celiac disease: A case report and review of the literature. Med Oral Patol Oral Cir Bucal. 13(9): E559-62.7
20. de Carvalho, F. K., de Queiroz, A. M., da Silva, R. A. B., Sawamura, R., Bachmann, L., da Silva, L. A. B., & Nelson-Filho, P. (2015). Oral aspects in celiac disease children: clinical and dental enamel chemical evaluation. Oral surgery, oral medicine, oral pathology and oral radiology, 119(6), 636-643.
21. Dewar, D., Pereira, S. P., Ciclitira, P. J. (2004). The pathogenesis of coeliac disease. The International Journal of Biochemistry & Cell Biology, 36(1), 17-24.
22. El-Hodhod, M. A. A., El-Agouza, I. A., Abdel-Al, H., Kabil, N. S., & Bayomi, K. A. E. M. (2012). Screening for celiac disease in children with dental enamel defects. International Scholarly Research Notices, 2012, 1-7.
23. Erriu, M., Canargiu, F., Orrù, G., Garau, V., & Montaldo, C. (2012). Idiopathic atrophic glossitis as the only clinical sign for celiac disease diagnosis: a case report. Journal of medical case reports. 6(1), 1-3.
24. Fraiha, P. M., Bittencourt, P. G., & Celestino, L. R. (2002). Recorrent aphthous stomatitis: bibliografic review. Rev Bras Otorrinolaringol, 68, 571-578.
25. Francavilla, R., Cristofori, F., Stella, M., Borrelli, G., Naspi, G., Castellaneta, S. (2014). Treatment of celiac disease: from gluten-free diet to novel therapies. Minerva Pediatrica, 66(5), 501–516.
26. Freeman, H. J. (2008). Refractory celiac disease and sprue-like intestinal disease. World Journal of Gastroenterology: WJG, 14(6), 828-830.
27. Gobbi, G. (2005). Coeliac disease, epilepsy and cerebral calcifications. Brain and Development, 27(3), 189-200.
28. Husby S, Koletzko S, Korponay-Szabó I R et al. (2012). European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 54,136–160.
29. Kalvandi, G., Shahramian, I., Farmany, A., Yadegari, S., Parooie, F. (2021). Serological study of celiac disease in children with dental caries. Hum. Antibodies. 294, 237–241.
30. Krisdapong, S., Sheiham, A., & Tsakos, G. (2012). Impacts of recurrent aphthous stomatitis on quality of life of 12-and 15-year-old Thai children. Quality of Life Research, 21(1), 71-76.
31. Kuklik, HH., Cruz, ITSA., Celli, A., Fraiz, FC., da Silva Assunção, LR. (2020) Hipomineralização de molares e incisivos e doença celíaca. Arq. Gastroenterol. 572, 167–171.
32. Lähteenoja, H., Toivanen, A., Viander, M., Mäki, M., Irjala, K., Räihä, I., & Syrjänen, S. (1998). Oral mucosal changes in coeliac patients on a gluten-free diet. European journal of oral sciences, 106(5), 899-906.
33. Lenander-Lumikari, M., Ihalin, R., & Lähteenoja, H. (2000). Changes in whole saliva in patients with coeliac disease. Archives of Oral Biology, 45(5), 347-354.
34. Lopes NR, Barbieri D, Ando T. (2001). Prevalence of enamel defects in patients with celiac disease. Rev Odontol UNICID. 13,37-47.
35. Mearin, M. L. (2007). Celiac disease among children and adolescents. Current problems in pediatric and adolescent health care, 37(3), 86-105.
36. Mina, S., Riga, C., Azcurra, A.I., Brunotto, M. (2012). Oral ecosystem alterations in celiac children: a follow-up study. Archives of Oral Biology. 57(2), 154–160.
37. Muggiano, F., Quaranta, A., & Giannantoni, I. (2013). Major dental clinical pathological manifestation of celiac disease. WebmedCentral ORAL MEDICINE. 4, WMC004448.
38. Muñoz, F., Del Río, N., Sóñora, C., Tiscornia I., Marco, A., Hernández, A. (2012). Enamel defects associated with coeliac disease: putative role of antibodies against gliadin in pathogenesis. European Journal of Oral Sciences. 120(2),104–112.
39. Murch, S., Jenkins, H., Auth, M., Bremner, R., Butt, A., France, S., Thorpe, M. (2013). Joint BSPGHAN and Coeliac UK guidelines for the diagnosis and management of coeliac disease in children. Archives of disease in childhood, 98(10), 806-811.
40. NICE Guidelines [NG20]. Coeliac disease: recognition, assessment and management National Institute of Health and Care Excellence. 2015. Available online at https://www.nice.org.uk/guid_ance/ng20 (accessed October 2015).
41. Nieri, M.; Tofani, E.; Defraia, E.; Giuntini, V.; Franchi, L (2017). Enamel defects and aphthous stomatitis in celiac and healthy subjects: Systematic review and meta-analysis of controlled studies. J. Dent. 65, 1–10.
42. Pastore, L., Carroccio, A., Compilato, D., Panzarella, V., Serpico, R., Muzio, L. L. (2008). Oral manifestations of celiac disease. Journal of clinical gastroenterology, 42(3), 224-232.
43. Paul, S. P., & Spray, C. (2014). Diagnosing coeliac disease in children. British Journal of Hospital Medicine, 75(5), 268-270.
44. Procaccini, M., Campisi, G., Bufo, P., Compilato, D., Massaccesi, C., Catassi, C., Muzio, L. L. (2007). Lack of association between celiac disease and dental enamel hypoplasia in a case-control study from an Italian central region. Head & face medicine, 3, 1-6.
45. Rasmusson, C. G., & Eriksson, M. A. (2001). Celiac disease and mineralisation disturbances of permanent teeth. International Journal of Paediatric Dentistry, 11(3), 179-183.
46. Rauen, M. S., De Vasconcellos Back, J. C., Moreira, E. A. M. (2005). Celiac disease’s relationship with the oral health. Revista de Nutricao-Campinas. 18(2), 271-276.
47. Rivera, E., Assiri A., Guandalini, S. (2013). Celiac disease. Oral Diseases. 19(7), 635–641.
48. Rodrigues, A. F., & Jenkins, H. R. (2006). Coeliac disease in children. Current Paediatrics, 16(5), 317-321.
49. Sandhu B, Onyeador N. Coeliac disease. In Sibal A, Gopalan S (eds) Textbook of Pediatric Gastroenterology, Hepatology and Nutrition. 1st edition. pp 125–136. India: Jaypee Brothers, 2015.
50. Sedghizadeh, P. P., Shuler, C. F., Allen, C. M., Beck, F. M., & Kalmar, J. R. (2002). Celiac disease and recurrent aphthous stomatitis: a report and review of the literature. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 94(4), 474-478.
51. Shteyer, E., Berson, T., Lachmanovitz O. (2013). Oral health status and salivary properties in relation to gluten-free diet in children with celiac disease. Journal of Pediatric Gastroenterology and Nutrition. 57(1), 49–52.
52. Sóñora C., Arbildi P., Rodríguez-Camejo C., Beovide V., Marco A., Hernández A. (2016). Enamel organ proteins as targets for antibodies in celiac disease: implications for oral health,” European Journal of Oral Sciences. 124 (1), 11–16.
53. D. Souto-Souza, M. E. da Consolação Soares, V. S. Rezende, P. C. de Lacerda Dantas, E. L. Galvão, and S. G. M. Falci (2018). Association between developmental defects of enamel and celiac disease: a meta-analysis. Archives of Oral Biology, 87, 180–190.
54. Theethira, T.G., Dennis, M. (2015). Celiac disease and the gluten-free diet: consequences and recommendations for improvement. Digestive Diseases. 33(2), 175–182.
55. Thom, S., Longo, B. M., Running, A., & Ashley, J. (2009). Celiac disease: a guide to successful diagnosis and treatment. The Journal for Nurse Practitioners, 5(4), 244-253.
56. Tsami, A., Petropoulou, P., Panayiotou, J., Mantzavinos, Z., Roma-Giannikou, E. (2010). Oral hygiene and periodontal treatment needs in children and adolescents with coeliac disease in Greece. European Journal of Paediatric Dentistry. 11(3), 122–126.
57. Wierink, C. D., van Diermen, D. E., Aartman, I. H., Heymans, H. S. (2007). Dental enamel defects in children with coeliac disease. International Journal of Paediatric Dentistry, 17(3), 163-168.