Celiac Disease, also known as Gluten Sensitive Enteropathy (GSE), is an autoimmune disorder of the digestive system that triggers an immune response to Gluten. Gluten is a mixture of two proteins that are found in wheat, rye and barley. This immune response leads to inflammation and damage to the lining of the small intestines preventing absorption of some nutrients. Recent studies suggest that the disease may be an underdiagnosed condition.
Symptoms can vary widely from person to person. The most common symptoms are related to poor food absorption, leading to a variety of gastrointestinal symptoms such as diarrhea, excessive gas, weight loss and a distended abdomen. A less common symptom, but one that all dental and medical professionals should be aware of, is aphthous ulcers (canker sores). A chronic occurrence of canker sores is also called Recurrent Aphthous Stomatitis (RAS). A study published in BMC Gastroenterology published in 2009 reported that RAS may, at times, be the sole symptom of Celiac Disease. The study concluded that Celiac Disease should be considered in those who suffer from chronic canker sores, especially those who are unresponsive to conventional treatment.
Other potential oral symptoms include atrophic glossitis and dry mouth syndrome. Decreased absorption of calcium can lead to low bone density, affecting alveolar bone health. Poor calcium absorption in children can cause defects in enamel formation. The Celiac Disease Awareness Campaign of the National Institute of Health states, "Dental enamel problems stemming from celiac disease involve permanent dentition and include tooth discoloration—white, yellow, or brown spots on the teeth—poor enamel formation, pitting or banding of teeth, and mottled or translucent-looking teeth. The imperfections are symmetrical and often appear on the incisors and molars." Adopting a Gluten-free diet does not resolve enamel defects and may require cosmetic and/or restorative intervention.
While further research is needed to determine the extent, some studies indicate that those with Celiac Disease may be at an increased risk of developing certain types of cancer, such as squamous cell carcinoma of the pharynx and mouth. According to Dr. David Johnson, Professor of Medicine and Chief of Gastroenterology at Eastern Virginia Medical School, Celiac disease is also associated with small-bowel cancers, adenocarcinoma, lymphoma, and esophageal cancer. Dr. Johnson states, "These diseases are potentially preventable if we recognize the (Celiac) disease up front."
It is important for healthcare professionals to be aware of the signs and symptoms of Celiac Disease, conduct a thorough medical history and refer to a Gastroenterologist if indicated.