Oral manifestations of celiac disease: a clinical guide for dentists.

Celiac disease (gluten sensitive enteropathy) is a common disorder affecting both children and adults. As many people with celiac disease do not present with the classic malabsorptive syndrome, delays in diagnosis are common. Dental enamel defects and recurrent aphthous ulcers, which may occur in patients with celiac disease, may be the only manifestation of this disorder. When dentists encounter these features, they should enquire about other clinical symptoms, associated disorders and family history of celiac disease. In suspected cases, the patient or family physician should be advised to obtain serologic screening for celiac disease and, if positive, confi rmation of the diagnosis by intestinal biopsy. Dentists can play an important role in identifying people who may have unrecognized celiac disease. Appropriate referral and a timely diagnosis can help prevent serious complications of this disorder. 1; 7:b39 Oral Manifestations of Celiac Disease: A Clinical Guide for Dentists Mohsin Rashid, MBBS, MEd, FRCPC; Marion Zarkadas, MSc, RD; Alexandra Anca, MHSc, RD; Hardy Limeback, PhD, DDS Celiac disease is a permanent intolerance to gluten (a protein present in wheat, rye and barley) that results in damage to the small intestinal mucosa caused by an autoimmune mechanism in those who are genetically susceptible to the disease. Th e villous atrophy that ensues can lead to malabsorption of a variety of macroand micronutrients including iron, calcium, folate and fat-soluble vitamins. Celiac disease was thought to be a rare malabsorptive disorder of infancy and childhood; however, it is now considered to be a common, chronic, multi-system disorder that can present at any age when gluten is present in the diet. Celiac disease is one of the most common chronic gastrointestinal disorders in the world. Populationbased serologic studies estimate that 1% of North Americans may have it, and about 90% of these cases remain undiagnosed.1-3 Celiac disease is a “clinical chameleon.” Typical symptoms are abdominal pain, diarrhea and weight loss. However, many people present with non-gastrointestinal (atypical) symptoms including anemia, extreme weakness, short stature, osteoporosis, menstrual irregularities and infertility. Additional symptoms in children include delayed growth and puberty, vomiting and dental enamel defects. Dermatitis herpetiformis is “celiac disease of the skin.” It presents with a chronic, severely itchy, blistering rash that is poorly responsive to conventional therapies. A skin biopsy helps confi rm the diagnosis of dermatitis Clinical Review