Celiac Disease’s Toll on Your Teeth
The second theory points to the immune system: Celiac patients have a substance in the blood known as tTG antibodies, and those antibodies may have some kind of influence on the development of the enamel, he says. (Non-celiac gluten sensitivity and oral health problems have not been studied, says Green.)
Part of the reason why the celiac-oral health connection isn’t on the radar of many health professionals is that dental enamel defects and canker sores – the two most common ways celiac disease affects the mouth – have a number of other causes, too.
“Dental enamel defects could also could be due to excess fluoride, genetics or certain antibiotics [like tetracycline],” explains Alexandra Anca, a Toronto dietitian who co-authored the Canadian clinical guide for dentists, and is scientific adviser for the Canadian Celiac Association’s professional advisory board. “Because of this, I don’t think many dentists are fully aware that celiac disease might be an issue.”
Unfortunately, medical doctors may not yet be in the know either. Even Green, the medical director of a prominent celiac research and treatment center, only recently recognized the connection. “It’s a big step forward for me to develop insight [into this link,]” he admits.
“The mouth, unfortunately, is a bit of a ‘no man’s land’ for physicians. It’s considered to be in the realm of dentists and oral pathologists, and its place in general medicine and gastroenterology has been forgotten.” He adds: “It’s not often you would look in people’s mouths during an exam. Now my group does. We ask about canker sores now, too.”
Greater awareness of the issue may be on the horizon. When Dr. Ted Malahias, a dentist in Groton, Connecticut, who also co-authored the 2009 paper, talks to fellow dental professionals at conferences, he says they are receptive and excited about finding a new piece to the puzzle for patients with stubborn dental issues. “It gets their curiosity going,” he says.
Your action plan
Problems like canker sores and atrophic glossitis (see “Watch Your Mouth,” for an explanation of specific celiac-related mouth troubles) are often related to vitamin and mineral deficiencies or immune response, says Malahias, and will likely improve once the celiac disease is addressed with the gluten-free diet.
Likewise, if a child who has dental enamel defects on his or her baby teeth is diagnosed with celiac disease before age 7 (when the enamel is forming on the permanent adult teeth), following a gluten-free diet should mean that dental enamel defects aren’t part of the adult teeth, he says.
However, if you’re an adult with dental enamel defects stemming from long-term, undiagnosed celiac disease, you are stuck with weakened tooth enamel. “The gluten-free diet can’t change the enamel,” he says.
If you have been diagnosed with celiac disease, you are following the gluten-free diet, and your teeth and mouth are fine, you have nothing to worry about, reassures Anca. (If you are diagnosed but cheat on your diet, oral health problems may be in your future, though.) And if, like Michelle B., you haven’t been diagnosed with celiac disease but have been battling bad teeth, it’s worth a conversation with your doctor, particularly if you have a close family member with celiac disease, or you have any possible celiac symptoms (classic symptoms include abdominal distension and pain, and chronic diarrhea).
This is especially true for kids. “There are many factors that can cause dental enamel defects, but if the medical history indicates there is something else is going on, or there’s a family history of celiac disease, we recommend parents talk to their family doctor about getting their child tested for celiac disease,” says Malahias.
“In kids, the dental enamel defects can be an early warning sign of celiac.” (Michelle B. is keeping a very close eye on her 8-year-old son’s dental visits, but so far all is well.)
Michelle B.’s advice: “You just have to keep on pursuing the truth. My gut, no pun intended, was telling me there was something else going on. If your doctor or dentist doesn’t want to take the time to help you find an answer, you have to find someone who will. Eventually I put the pieces together, but it was a very long road.”
See also: Celiac Disease: Watch Your Mouth