Volume 8 • 2021 • Issue 2

General Information and Dental Implications: Celiac D isease D r. Melissa Ing describes the healthy lining of the small intestine as hundreds of millions of finger‑like projections called villi, so that “it has the appearance of a plush carpet,” she says. Villi increase the surface area of the intestine to allow for better absorption of nutrients. In a person who has celiac disease, gluten causes an immune response that leads to villi deterioration. “When the villi atrophy, the plush carpet is flattened out to a hardwood floor, so to speak,” says Dr. Ing. When the villi are damaged, the small intestine can no longer effectively absorb nutrients—such as folic acid, calcium and other essential vitamins. Besides being an autoimmune disease, celiac is also a malnutrition disease. Celiac disease is on the rise; it’s estimated to affect about 1% of the population, or globally about 91 million people. In 2018, Health Canada statistics showed approximately 1 in 114 Canadians had celiac disease. “In the past, celiac disease was assumed to be more common in White people and children,” says Dr. Ing. “But we now know that it affects all ethnicities, and is found in both children and adults. In fact, it’s now found more frequently in adults with an average age of diagnosis of 46.” Yet, according to Health Canada statistics, about 90% of those affected with celiac disease remain undiagnosed. “On average, it takes between 6 to 10 years to get a diagnosis,” says Dr. Ing. Diagnosis is difficult because celiac disease can manifest itself with more than 250 symptoms. About 50% of people with celiac disease have the classic gastrointestinal (GI) symptoms such as diarrhea, bloating and stomach discomfort. “But some patients may present with anemia,” says Dr. Ing. “Others may have more atypical symptoms such as osteoporosis, fatigue, foggy brain, neurological symptoms, infertility or a skin rash due to having a variety of celiac called dermatitis herpetiformis. Newly diagnosed celiac patients may also be lactose intolerant because their damaged gut linings are unable to break down lactose molecules. The symptoms vary in severity and scale.” It’s possible that untreated celiac disease can lead to cancer, including lymphoma, non-Hodgkin’s lymphoma, enteropathic T-cell lymphomaandevencancer of the small bowel. Celiac disease can also be associated with gluten ataxia, a disorder that affects the cerebellum and leads to problems with balance and gait. Role for Dentists “It’s important for dental clinicians to have a holistic approach and assist physicians in treating the whole patient,” says Dr. Ing. “We could be the first clinicians to spot the clues in our patients and help in the celiac diagnosis.” The two main oral manifestations of celiac disease in both adults and children are dental enamel defects and recurrent aphthous ulcers. In fact, pediatric celiac disease’s main symptom could be dental enamel defects, including thin enamel or mottled enamel appearances. “We might not see the dental enamel defects as much in adults since these defects may have been ‘corrected’ by adulthood with veneers or bonding,” says Dr. Ing. Other oral symptoms can include xerostomia, glossitis and geographic tongue. Dentists should include intestinal and nutritional health questions when taking patients’ medical histories. Dr. Ing suggests asking questions such as: “Do you have a family history of celiac disease? Are you sensitive to gluten? Do you have type I diabetes?” Celiac has a strong hereditary correlation. It is correlated with type I diabetes and other autoimmune diseases. Indeed, type I diabetes and celiac share some of the same genes. “In addition,” says Dr Ing, “if a patient comes to the office complaining of unexplained anemia and fatigue, they may be clues that point toward celiac disease.” “Remember that the eyes are the window to the world and the mouth is the window to the body,” says Dr. Ing. “We are recognizing the significant interrelationships between bodily and 35 Issue 2 | 2021 |