Pediatric Update: Celiac disease and dental problems

Refuat Hapeh Vehashinayim. 2011 Oct;28(4):12-8, 37.

The relationship between celiac disease (CD) and dental problems

Perez-Davidi M.

Abstract

With a prevalence of 1% in western populations, Celiac disease (CD) is one of the most common inflammatory disorders of the small intestine. CD is often assumed to have its onset in childhood, but it has recently been suggested that adults can also develop CD. Clinical manifestations vary according to age group: infants and young children present with diarrhea, abdominal distention, and failure to thrive, whereas adults that develop CD not only present with diarrhea, but also with silent manifestations such as anemia, osteoporosis, or neurological symptoms. In the small intestine of celiac disease patients, dietary wheat gluten and similar proteins in barley and rye trigger an inflammatory response. While strict adherence to a gluten-free diet induces full recovery in most patients, a small percentage of patients fail to recover. In a subset of these refractory celiac disease patients, an (aberrant) oligoclonal intraepithelial lymphocyte population develops into overt lymphoma. Celiac disease is strongly associated with HLA-DQ2 and/or HLA-DQ8, as both genotypes predispose for disease development. mmunohistochemistry of the small intestine of patients shows villous atrophy, crypt hyperplasia, and elevated levels of intraepithelial lymphocytes (IELs). The only therapy until now is a gluten-free diet, which will normalize the clinical and histological manifestations and allows the patients to live an otherwise normal life. part of the symptoms are oral manifestations as dental enamel defects, aphthous ulcers and Atrophic Glossitis. The prevalence of caries in CD patiens is law as compared to the healthy population and in some cases the normal eruption sequence of the teeth was damaged. Part of the undiagnosed CD patients are among our patients and the enamel defects they present are misdiagnosed as tetracycline pigmentation or white spot lesions it is the practitioners responsibility to add CD as a possible cause to the findings and refer the patient to further examination. The case report in this paper presents a 47 years old female patient who was a patient in my practice for 25 years. When she became 40 she was diagnosed as CD and treated accordingly over the years enamel defects were treated conservatively. As the lesions became more frequent and unpredictable the patient demanded a full mouth solution that would restore both the functional and esthetical problems she had with her dentition. A full Porcelane Fused to Metal (PFZ) crowns were fabricated and the patient got a solution to both here demands. The crowns used were 3M Lava zirconia crowns and the case is presented as step by step sequence.

Source: Dept. of Prosthodontics, The Hebrew University Hadassah, Faculty of Dental Medicine, Jerusalem, Israel.

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