Oral mucosal changes in coeliac patients on a gluten‐free diet

Abstract

Oral mucosal lesions or dental enamel defects may be the only presenting features of coeliac disease. A series of 128 patients with coeliac disease (CD) on a gluten-free diet (GFD), 8 patients with a newly diagnosed CD, and 30 healthy controls participated in a clinical and histopathological study of their oral mucosa. Oral mucosal lesions occurred in 71/128 GFD-treated CD patients. in 4/8 untreated and in 10/30 controls, and oral symptoms in 85/128, in 6/8 and in 10/30, respectively. Five CD patients had aphthous ulcers. Moderate to severe lymphocytic inflammation occurred in 36/117 and in 14/117 of the biopsy specimens of GFD-treated CD patients, in 1/8 and 2/8 of untreated CD patients, and in 3/30 and in 1/30 of controls, respectively. Intraepithelial T-cells were significantly more frequent in GFD-treated CD patients than in controls. There was no difference between untreated CD patients and controls. In the lamina propria of the GFD-treated CD patients, T-cells were more frequent than in the other groups. Mast cells were significantly more frequent in patients with GFD-treated CD. Nine GFD-treated CD patients had raised serum endomysium IgA antibody titres, although five of them reported to follow a strict GFD. A lack of strict compliance with a GFD may be related to the high prevalence of oral changes and symptoms. In addition, T-cell infiltration in the oral mucosa tends to increase with a longer duration of CD, independent of GFD-treatment. Clinically, it is important to study the oral cavity of patients suspected of having CD where the only clue to the disease may reside, since no less than 66% of the patients in this study had oral symptoms.

Celiac Disease and Its Impact on the Oral Health Status – Review of the Literature

“…According to Campisi et al, these changes may appear in the form of small multiple changes, or in the form of single larger aphtha [7]. Malnutrition is reported as a presumable cause of those changes, especially iron, folic acid and vitamin B12 deficiencies which are very frequent in patients who do not adhere to gluten free diet [12,33]. This thesis seems to be confirmed by the studies of Bucci et al and Campisi, who observed an improvement in the condition of the oral mucosa after the introduction of a strict gluten free diet [7,18].…”

“…However, attention should be paid to a possible link between aphthae and gluten intolerance, which is widespread in the human population, but frequently undiagnosed [3,21]. Apart from RAS, in patients with celiac disease other disturbances of oral mucosa such as ulceration, erythema, atrophic glossitis and subjective symptoms: pain and a burning sensation (particularly of the tongue) and dryness, were observed [7,33]. However, Lähteenoja et al did not note a strict dependence of gluten-free diet, and subsiding of the complaints [33].…”

Primary Sjögren’s syndrome in patients with celiac disease

“…Dental enamel defects in permanent and mucosal inflammatory lesions such as recurrent aphthous ulcers and angular cheilitis are common in CD (17)(18)(19). Moreover, dental caries due to the decreased salivary flow can be seen frequently in SS.…”

Systemic and Oral Aspects in Celiac Disease for Dentistry

“…In atypical pattern, digestive symptoms are not sharply expressed, and it is characterized by symptoms such as thyroid dysfunction, epilepsy, short stature, iron deficiency anemia refractory to iron replacement, infertility, constipation and herpetiformis dermatitis [12]. Despite these various possible symptoms, Lahteenoja et al [13] stated that the oral mucosal lesions or tooth enamel defects may be the only signs present in this pattern. In the silent pattern, patients are asymptomatic or mildly symptomatic, but they have positive serology, and exhibit changes in intestinal mucosa.…”