Monday, January 15, 2018

The oral manifestations of celiac disease: information for the pediatric dentist


Article Title:  The oral manifestations of celiac disease: information for the pediatric dentist
Author(s): Ferraz EG et al
Journal: Pediatric Dentistry
Date: 2012; Vol 34 No 7 pg 485-8
Major Topic: Oral manifestations of Celiac Disease
Type of Article: Literature review
Main Purpose: This article aimed to present information about oral manifestations of celiac disease
Key Points: Oral complications of celiac disease may be related to nutritional deficiencies
Celiac Disease: enteropathy that affects individuals after gluten exposure
·      Gluten is present in proteins in wheat (gliadin), rye (secalin), and barley (hordein)
·      Autoimmune disorder that leads to injury in small bowel mucosa with crypt hyperplasia, villous atrophy of intestinal mucosa, inflammatory infiltrate in adjacent connective tissue. Largely affects proximal duodenum and jejunum
·      Permanent intolerance to gluten
·      Complications:
o   Poor digestion
o   Malabsorption of nutrients
o   Poor nutritional status (carbohydrates, proteins, fats, iron, calcium, zinc, vitamins D, E, K and B12, and folic acid occur in duodenum and jejunum)  
·      Clinical manifestations: diarrhea, weight loss, abdominal pain, iron deficiency anemia, malabsorption

Oral Manifestations
·      Enamel defects
o   Hypoplasia: circle or band or with minor cracks and usually brown or yellow. Associated with hypocalcemia, malnutrition, and vitamin D deficiency
o   Hypocalcification
o   Changes in calcium and phosphate metabolism due to celiac disease
·      Delayed tooth eruption (may be related to nutritional impairment)
·      Erosions
·      Recurrent aphthous stomatitis
o   Unknown cause but has been associated with stress, allergies, nutritional deficiencies, trauma, hormone deficiencies, infectious agents
o   Minor: most common; small sores; heal in 10-14 days
o   Major: large ulcers; may last 6 weeks; often scar
o   Herpetiform: multiple ulcers that may coalesce and last 7-10 days
·      Decreased tooth size
·      Angular cheilitis
·      Atrophic glossitis – related to vitamin B12, folate, and iron deficiencies

Remarks:
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Assessment of Article:  Level of Evidence/Comments: III

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