Over half term we visited the dentist as many of you with kids will have no doubt done too!
I had several questions for her since our coeliac daughter has started to get her ‘grown-up’ teeth through since the last visit. I was shocked, however, to be told something that I wasn’t aware of.
Right at the back of her mouth some adult molars have come through. I was aware that they were there and had found them pretty challenging to reach with a toothbrush.
When the dentist, therefore, called me over to ‘show me something’, I thought I was going to get told off for not cleaning her teeth properly.
Instead what she told me was that one of the molars has very poor enamel…and that it has nothing to do with lack of brushing or eating the wrong foods.
She explained that these problems with teeth are often associated with an illness or medication in the child whilst the teeth were forming in the gums. Fine I thought. My daughter had more than her fair share of horrible illnesses when she was young…but I had a voice in my head shouting coeliac disease!
The first thing I did when I had a spare moment was to research tooth enamel problems and coeliac disease. Lo and behold, I found numerous studies that link the two together…which stands to reason if teeth are being formed when nutrients are in short supply because of the disease.
It is, however, something that doesn’t seem to be raised as an issue and certainly not something that I had ever been prepared for.
We now have to visit the dentist every 3 months so that she can keep and eye on things. In the meantime I just hope that her other adult teeth are ok and that the one affected tooth does not cause her any issues.
I am now on a mission to raise awareness of this link. Dentists do not seem to be aware of it unyet it could be the first step in diagnosing children in particular, with coeliac disease.
In March Coeliac UK covered this issue in their magazine. This is what they said:
Tooth enamel is the hard substance that covers the visible outer part of the tooth; it plays an important role to protect the teeth. If there are problems with the tooth enamel this can cause sensitivity, defects and even decay.
The National Institute for Health and Care Excellence (NICE) (2009) guideline for the ‘Recognition and assessment of coeliac disease’ reports a link between delayed diagnosis or undiagnosed coeliac disease and teeth problems in children. Furthermore, the NICE (2009) guideline also identified dental enamel problems as a factor that should lead to the consideration of testing for coeliac disease in both adults and children.
We believe dentists can play an important role in identifying those with tooth enamel problems who may have undiagnosed coeliac disease.
Tooth enamel problems have been described in those with coeliac disease. Research has explored the frequency of tooth enamel problems within adults and children with coeliac disease to show that tooth enamel problems were more frequently seen within those with coeliac disease compared to the general healthy population (1, 2). Furthermore, tooth enamel problems have been described to be associated with undiagnosed or delayed diagnosis of coeliac disease in children (3).
Research has shown that there are different signs of tooth enamel problems within coeliac disease. This can range from changes in the colour to defects in the structure of the tooth. Differences in the colour and/ or texture of the tooth can appear as yellow and/ or brown patches and/ or slightly rough, pitted or grooved tooth enamel. Occasionally the teeth may have deeper grooves or pits with areas showing a clearly identifiable thinning in the quantity of tooth enamel.
In coeliac disease, the exact cause and mechanism of tooth enamel problems remains largely unknown and is an ongoing subject of scientific discussion. Theories have suggested disturbances within mineral metabolism, which negatively influence the mineralization and formation of the tooth enamel. However, further research is needed to explore and understand the causes of dental enamel problems within coeliac disease.
Dentists have an important role in recognising and identifying tooth enamel problems that may be due to coeliac disease. The National Institute for Health and Care Excellence (NICE) (2009) guideline for the ‘Recognition and assessment of coeliac disease’ identified dental enamel problems as a factor that should lead to the consideration of testing for coeliac disease in both adults and children (3). However, it is also important to recognise that there may be other causes of tooth enamel problems, aside from coeliac disease. Furthermore, the symptoms of coeliac disease can vary from person to person; take a look at our page on symptoms. Therefore, it is important you discuss your symptoms and family history with your GP.
(1) Ferraz E.G. et al. (2011) The oral manifestations of celiac disease: information for the pediatric dentist. Pediatric Dentistry, 34(7) 485-488
(2) Pastore L. et al. (2008) Oral manifestations of celiac disease. Journal of Clinical Gastroenterology, 42(3) 224-232.
(3) NICE (2004) Recognition and assessment of coeliac disease – CG86. Accessed 11 February: http://guidance.nice.org.uk/CG86
(4) Coeliac UK (2014) Symptoms. Accessed 11 February: https://www.coeliac.org.uk/coeliac-disease/about-coeliac-disease-and-dermatitis-herpetiformis/symptoms
So I urge you…if you have a child who has problems with their teeth despite good oral hygiene and not too many sweets and sweet drinks (!) then consider taking them to your GP to get the blood test for coeliac disease. They may have no other symptoms but the long-term implications of undiagnosed coeliac disease are huge.
If you know of anyone who this applies to please pass this message on!
For further information on coeliac disease please visit Coeliac UK. For more information about the link between coeliac disease and poor teeth visit Coeliacs Matter who have a number of articles about this issue.
I have shared this with Gluten-Free Easily’s Gluten-free Wednesdays.