Dental Enamel Defects in Celiac Disease

Purpose: Dental enamel defects reflect disease processes occurring during the period of enamel formation. European studies have demonstrated that defects are seen in patients with celiac disease (CD). We conducted a case control study in children and adults to assess this association in the US. Methods: Biopsy proven CD patients and controls were recruited from a private dental practice and CD support groups. The cohort was divided into two groups adults (≥16 years) and children (≤16 years) because there are very few restorations and enamel defects can be picked up easily in virgin teeth. A single dentist examined the oral cavity for dental enamel defects, aphthous ulcers and decayed missing and filled teeth (DMFT). Significant Caries Index (SCI), signifying prevalence of caries, was calculated. Enamel defects were graded as 0 (absent) through 4 according to Aine's classification. All grades were combined for this study. Chi-square test was used to compare dichotomous variables. Linear regression was used for DMFT correlation. Results: The cohort consisted of 67 CD patients (67% adults, 33% children; 79% females, 21% males) and 37 controls (46% adults, 54% children; 65% females, 35% males). Mean age in years for CD patients (adults 47.2 ± 14.4, children 9.18 ± 3.11) and controls (adults 38.5 ± 14.5, children 10.5 ± 2.56). Dental defects were identified in 26 children and 18 adults. Only grade 1 and 2 defects were seen, no grade 3 or 4 defects. The prevalence of dental defects was higher in CD 51% compared to controls, 27% p= 0.033. However, only children with CD had statistically significant higher prevalence of enamel defects (73% compared to 27% in controls, p= 0.0012). Among adults the prevalence was 83% in CD and 68% in controls (p= 0.35). There was a statistically significant correlation of dental defects and aphthous ulcers with CD, when combined (p < 0.0001) or presence of either one (p= 0.045). There was no significant correlation of aphthous ulcers with dental defects (p= 0.37). There was positive correlation of DMFT with age (p < 0.001) and negative correlation with dental defects (p < 0.001). Association of SCI with CD was not significant. Conclusions: Celiac disease is associated with dental enamel defects in childhood, most likely due to the onset of CD during enamel formation. In adults, dental defects are common and celiac disease does not exert an influence. Dentists need to be aware of these associations.