there's a mouth attached to the rest of the gi tract

Celiac diseaseand

Oral healthTrey L. Petty, DDS, FADI, FAGD

Holy Cross Hospital CentreCalgary Alberta Canada

• Oral Manifestations:• Recurrent aphthous stomatitis, canker sores

celiac Disease & Oral health

Atrophic glossitis

Xerostomia - dry mouth

Squamous cell carcinoma

Enamel defects

celiac Disease & Oral health

Oral Manifestations:

celiac Disease & Oral health

• Oral Manifestations:• Enamel defectsRange:•Symmetrical spots of hypocalcification on incisors•Severe structural defects

celiac Disease & Oral health

• Oral Manifestations:• Enamel defects

• North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) - 2006Jan

• Included as symptom of Celiac Disease

• Oral Manifestations:• Enamel defects

celiac Disease & Oral health

Due to malabsorption during formation of teethTooth calcification:

• Primary teeth: 14wk - 11mo in utero• Adult teeth: 3mo - 25yrs

celiac Disease & Oral health

• Oral Manifestations:• Enamel defects

Often first step to diagnosis of CDMay be only presenting manifestation

• Oral Manifestations:• Enamel defects

celiac Disease & Oral health

Differential diagnoses:• Dental fluorosis• Amelogenesis imperfecta• Dentinogenesis imperfecta• Osteogenesis imperfecta

• Oral Manifestations:• Enamel defects

celiac Disease & Oral health

NEGLECT... ABUSE ...

Differential diagnoses:

• Oral Manifestations:• Enamel defects

celiac Disease & Oral health

Permanent; requires restoration• Bonding, veneers, crowns

celiac Disease & Oral health

Dental Materials

Do they contain gluten?• Some do...• Some don’t...

www.withoutthewheat.com/Dental_Products.html

celiac Disease & Oral health

Dental Materials

Do they contain gluten?Problem is: SORBITOL• Artificial sweetener• Typically corn derived• MAYBE wheat derived

celiac Disease & Oral health

Dental Materials

Do they contain gluten?Most companies are willing to make a clear Yes/No statementOthers cannot rule-out presence

• Do not control raw materials

celiac Disease & Oral health

Dental Materials

Do they contain gluten?

In general, dental filling materials do NOT contain gluten

celiac Disease & Oral health

Dental Materials

Do they contain gluten?

In general, toothpaste does NOT contain gluten

celiac Disease & Oral health

Dental Materials

Do they contain gluten?In general, denture adhesives MIGHT contain gluten, butDenture cleaners do NOT

celiac Disease & Oral health

Dental Materials

Do they contain gluten?

In general, local anesthetics & topical anesthetics do NOT contain gluten

celiac Disease & Oral health

Dental Materials

Do they contain gluten?

In general, SOME mouth rinses MAY contain gluten

• Caregivers:• Educate the local dental community on CD

• Dentists, Dental Hygienists

• Common oral conditions

• Referral pathways

celiac Disease & Oral health

- Pediatric- Hospital-based- Oral Medicine

Caregivers:• Identify Dental Champions in your area

• Referral of frustrated people living with CD

• Knowledge base of gluten-free dental materials

celiac Disease & Oral health

People living with Celiac Disease:• Find a dentist aware of CD

• Awareness; lack of stigmatization

• Gluten-free dental materials

• You may have to educate about CD...

celiac Disease & Oral health

Oral ulcerations

Dry mouth

Enamel defects

People living with Celiac Disease:Find a dentist to manage symptoms

celiac Disease & Oral health

- caution: $$$

Celiac diseaseand

Oral health

Trey L. Petty, DDS, FADI, FAGD

Holy Cross Hospital CentreCalgary Alberta Canada

trey.petty@gmail.com

Primum non Primum non nocere...nocere...