After Michelle B. was diagnosed with celiac disease in early 2009, she made sure to tuck all nine of her extracted teeth into her handbag when she was referred to the Celiac Disease Center at Columbia University in New York. She wondered if the dental problems with which she had been plagued since her early twenties – repeated cavities, root canals, infections and extractions – could possibly have something to do with celiac disease.

“I kept all my teeth because I just knew something wasn’t right,” explains the 37-year-old resident of Maplewood, New Jersey.

The clinic examined them and found they all had abnormalities associated with celiac disease, like enamel defects, structural defects and calcium deficiency.

“I knew something bigger was wrong than just my teeth, but I was still shocked by the link.”

Celiac disease and teeth? Really? If that’s news to you, you’re not alone – it’s quite possible that your doctor, dentist and hygienist have never heard of that link either. Among celiac disease’s curious mix of symptoms, oral health problems have only recently been shown to be one of them.

The first American study that looked at a connection between celiac disease, dental enamel defects and canker sores was published in The Journal of Clinical Gastroenterology in 2009. Meantime, the very first clinical guidelines for dentists that outlined celiac disease and dental problems was published in 2011, in the Journal of the Canadian Dental Association.

It’s hard to pin down the number of celiac patients affected by oral health issues – the studies have been generally been small – but the 2009 study found that dental enamel defects were found in 87 percent of the children with diagnosed celiac disease compared to 33 percent of non-celiac kids, and that 42 percent of celiac patients, both adults and kids, had frequent bouts of canker sores, versus 22 percent of the non-celiac patients.

Why is it happening?

Just why celiac disease can do a number on your teeth and mouth is, like so much else associated with the frustrating condition, far from clear. “We don’t know what the exact mechanism is, but there are two theories,” says Dr. Peter Green, a gastroenterologist and director of the Celiac Disease Center, who co-authored the 2009 study.

First, because celiac disease means that the body has trouble absorbing key nutrients, including vitamin D and calcium, that could translate to poor tooth enamel formation in childhood.

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