First published in Allergic Living’s Winter 2012 magazine.
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 38-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.
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.
Next: What to Watch For