Volume 8 • 2021 • Issue 2

oral disease,” says Dr. Ing. “As dentists, we can make a positive impact on our patients’ total well-being, and not just working on their oral cavity.” Dentists may be the first medical professionals to recognize the symptoms of celiac disease in undiagnosed patients and counsel them to be tested for it. “Before patients are tested for celiac disease, it’s important that they are told not to change their diets at all,” says Dr. Ing. “If a suspected celiac patient were to begin a gluten-free diet prior to testing, that would interfere with the physician’s ability to properly diagnosis.” The first step in diagnosing a celiac patient begins with serology screening for certain antibody proteins that indicate an immune reaction to gluten. A positive blood test must then be confirmed with an endoscopy with several biopsies of the small intestine. Sometimes it’s necessary to include genetic testing for human leukocyte antigens to rule out celiac disease. “The sooner a diagnosis comes, the better,” says Dr. Ing. There is no cure for celiac disease, but it can be controlled in most cases by adhering to a lifelong gluten-free diet. Dr. Ing recommends that dentists have gluten-free offices to protect people who have undiagnosed celiac disease or who might be gluten sensitive. Dental materials, including restorative materials and prophy pastes, can be gluten-free. “Even think about your hand lotion and soap, which go on our hands as operators, because anything that might come in contact with a sensitive celiac patient’s mouth could affect them,” she says. Health Canada regulates that in order to be labeled a gluten- free food product, it must not exceed more than 20 parts per million (PPM) of gluten. A maximum of 20 PPM is considered a safe amount of gluten consumption for most celiac patients. In her research, Dr. Ing uses ELISA testing, an enzyme-linked immunosorbent assay test, to measure the amount of gluten in each of the products used in dental clinics. “Celiac disease can have serious health consequences,” says Dr. Ing. “If the dental team is aware of its symptoms, we not only make patients feel better, but we might be even be able to save a life.” Born in Canada, Dr. Melissa Ing is an associate professor in the Department of Comprehensive Care at Tufts University in Massachusetts. Besides having a very keen interest in studying celiac disease and its implications on oral health, she conducts research in the topics of educational research, infection control, cariology, dental materials, and public health. Sources: 1. Rashid M, Zarkadas M, Anca A, Limeback H. Oral Manifestations of Celiac Disease: A Clinical Guide for Dentists. J Can Dent Assoc 2011;77:b39. 2. Kelly C, Bai J, Liu E, Leffler D. Advances in Diagnosis and Management of Celiac Disease. Gastroenterology . 2015 May;148(6):1175-86. 3. Wasilenko, S. Testing for Celiac Disease. The Canadian Journal of Diagnosis . Vol 36, Oct 2019. 4. Health Canada. Celiac Disease — The Gluten Connection . 2018. Available: https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/ food-safety/celiac-disease-gluten-connection-1.html 5. Health Canada. Health Canada's Position on Gluten-Free Claims . June 2012. Available: https://www.canada.ca/en/health-canada/services/food-nutrition/food- safety/food-allergies-intolerances/celiac-disease/health-canada-position-gluten-free-claims.html Signs and Symptoms BODY: Approximately 50% of celiac patients will have typical bodily symptoms that include: diarrhea, bloating and stomach upset. About 30% of celiac patients have anemia. Other celiac patients can present with a myriad of atypical bodily symptoms, which can include fatigue, headaches, osteoporosis and infertility. ORAL: Both adult and pediatric celiac patients can present with dental enamel defects and recurrent aphthous ulcers. Patients may also have xerostomia, glossitis or other tongue irritations, and angular cheilitis. Oral lichen planus and oral cancers, such as squamous cell carcinoma of the esophagus, are less common, but have been found in celiac disease patients. S upporting Y our P ractice 36 | 2021 | Issue 2