Dental Screening /research

[kickingfrog]

Dental Screening

(From CSA)

Case studies concerning enamel defects in children with celiac disease had been reported, but no large scale studies were published until 1986. In an examination of the teeth ....of 86 celiac children, 96% of those with permanent teeth were found to have enamel defects and 75% of their permanent teeth were affected as compared to 8% of the 150 controls. In two separate studies, 83% of adult celiacs were found to have dental enamel defects as compared with 4% of controls while 80% of dermatitis herpetiformis patients also had the typical defects associated with gluten intolerance. Overall, it appears that we may have had our most practical screening tool available all these years. We had to wait for an astute orthodontist to open our eyes and our mouths.
Dr. Lisa Aine gained interest in our dental problems because of her daughter's celiac classmate. After searching the literature for reports of enamel defects in other celiacs, she was inspired to choose this topic for her research and thesis. Her paper was published in the Finnish language along with an English abstract in the Proceedings of the Finnish Dental Society but we had been able to obtain the total work through the outreach program of the University of Missouri Dental Library in Kansas City. Hence, Dr. Aine's writings comprised a major source of our Celiac Sprue Awareness effort in 1989.
Updates of her work since that time were mailed out in March, 1992, to dental schools, state dental societies, and dental health officers of the various state health departments. We encourage each of or members to share the information from Lifeline concerning dental enamel defects with their own dentist. Contributing to the diagnosis of another celiac can be a special joy!

www.csaceliacs.org/searching.html

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Dental Enamel Defects and Screening for Celiac Disease

Acta Paediatr Suppl 1996 May;412:47-48

Martelossi S, Zanatta E, Del Santo E, Clarich P, Radovich P, Ventura A
Istituto di Clinica Pediatrica, Istituto per l'Infanzia IRCCS Trieste, Italy.

Celiac.com 12/18/2002 - Specific dental enamel defects (DEDs) in permanent teeth are frequently observed in celiac patients. We examined the permanent teeth in 6,949 secondary school children living in Trieste (78% of 8,724 children born between 1978 and 1982). Children with DEDs were tested for serum antigliadin antibodies (AGAs) and antiendomysium antibodies (AEAs), and those positive for serum AGAs and/or AEAs underwent intestinal biopsy. Specific DEDs were observed in 52 children (0.59% of the total population examined). Serum AGAs and/or AEAs were positive in 10 cases. Nine patients underwent intestinal biopsy (one refused) and in four cases a flat mucosa was documented (one with short stature, three completely asymptomatic).

The known incidence of CD in the study area was 1:1,000 before the study programme and 1:670 (an increase of 44%) after it. Dental enamel inspection may be utilized for detecting undiagnosed coeliac disease in symptom-free schoolchildren. This clinical test is probably less sensitive than serum AGA screening test, but deserves some consideration because it is cheap, easy to perform and well accepted by the population


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[kickingfrog]

Eur J Paediatr Dent. 2007 Mar;8(1):31-7.

Enamel hypoplasia in coeliac children: a potential clinical marker of early diagnosis.

Bossù M, Bartoli A, Orsini G, Luppino E, Polimeni A.
Source
Department of Pediatric Dentistry, University La Sapienza, Rome, Italy.

Abstract
AIM:
To assess at the scansion electron microscope (SEM) the structural aspects of enamel hypoplasia (EH) in coeliac disease (CD) with the aim to investigate our hypothesis of a possible significant difference between structural characteristics of EH in CD affected patients and EH of non-coeliac patients. If the presence of specific features of the EH associated with CD were demonstrated, these findings would represent for the dentist early non-invasive clinical markers of diagnosis of CD in case of suspected disease.

METHODS:
We analysed at SEM two samples of enamel fragments from hypoplasic teeth, both deciduous and permanent, harvested from 10 coeliac children (18 permanent teeth, 6 deciduous teeth; study group) and 10 non-coeliac children (16 permanent teeth, 4 deciduous teeth; control group) treated for dental caries, dental extractions for extensive caries lesions or deciduous teeth exfoliation.

RESULTS:
Significant structural differences were noted between EH of non-coeliac patients and same dental ? lesion in the group with CD. In the study group, EH defects were predominantly located on the central and lateral incisors, upper and lower, both deciduous and permanent, and on the first permanent molars, and were always simmetrical. EH of permanent teeth of CD affected patients was characterised by prisms more irregularly distributed with irregular margins and less interprismatic substance than observed in non-coeliac EH. The deciduous teeth of the study group showed shorter enamel prisms with a non-parallel direction up to convergence and less interprismatic substance than observed in the control group.

CONCLUSION:
This morphological analysis at SEM of the hypoplasic enamel defects of a group of coeliac children, the first published in literature, demonstrates that the EH of deciduous and permanent teeth in CD is highly hypomineralised with shorter prisms, more irregularly distributed and less interprismatic substance than observed in the non-coeliac EH. More data are needed to validate the significance OF our observations with the aim to assess if this simple, non-invasive microscopic analysis can be considered effective for the early identification of silent cases of CD that otherwise would not be diagnosed in the paediatric age.


www.ncbi.nlm.nih.gov/pubmed/17359212

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J Clin Gastroenterol. 2010 Mar;44(3):191-4.

The association between celiac disease, dental enamel defects, and aphthous ulcers in a United States cohort.

Cheng J, Malahias T, Brar P, Minaya MT, Green PH.

Source
Department of Medicine, New York Medical College (Sound Shore Medical Center), New Rochelle, New York, NY, USA.

Abstract
GOALS AND BACKGROUND:
European studies have demonstrated that dental enamel defects and oral aphthae are observed in celiac disease (CD). We investigated this association in a US population.

STUDY:
Biopsy proven CD patients and controls were recruited from a private dental practice and from CD support meetings. History of aphthae was taken and dental examination was performed by a single dentist. Teeth were photographed and enamel defects graded according to the Aine classification. A second dentist reviewed all photographs.

RESULTS:
Among patients (n=67, mean age 34.8+/-21.6 y) compared with controls (n=69, mean age 28.1+/-15.7 y), there were significantly more enamel defects [51% vs. 30%, P=0.016, odds ratio (OR) 2.4, 95% confidence interval (CI) 1.2-4.8]. This was confined to children (87% vs. 33%, P=0.003, OR 13.3, 95% CI 3.0-58.6), but not adults (32% vs. 29%, P=0.76, OR 1.2, 95% CI 0.5-2.8). This was reflected in defects being observed in those with mixed dentition compared with those with permanent dentition (68.4% vs. 29.6%, P<0.0001). The degree of agreement between the 2 dentists was good (kappa coefficient=0.53, P<0.0001), aphthous ulcers were more frequent in CD than controls (42.4% vs. 23.2%, P=0.02).

CONCLUSIONS:
This study supports that CD is highly associated with dental enamel defects in childhood, most likely because of the onset of CD during enamel formation; no such association was found in adults. Our study also supports the association between CD and aphthous ulcer. All physicians should examine the mouth, including the teeth, which may provide an opportunity to diagnose CD. In addition, CD should be added to the differential diagnosis of dental enamel defects and aphthous ulcers.

www.ncbi.nlm.nih.gov/pubmed/19687752

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