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The Association Between Celiac Disease, Dental Enamel Defects, and Aphthous Ulcers in a United States Cohort

Cheng, Jianfeng MD, PhD*; Malahias, Ted DDS*; Brar, Pardeep MD; Minaya, Maria Teresa DDS; Green, Peter H. R. MD

Journal of Clinical Gastroenterology: March 2010 - Volume 44 - Issue 3 - p 191-194
doi: 10.1097/MCG.0b013e3181ac9942
ALIMENTARY TRACT: Original Articles

Goals and Background European studies have demonstrated that dental enamel defects and oral aphthae are observed in celiac disease (CD). We investigated this association in a US population.

Study Biopsy proven CD patients and controls were recruited from a private dental practice and from CD support meetings. History of aphthae was taken and dental examination was performed by a single dentist. Teeth were photographed and enamel defects graded according to the Aine classification. A second dentist reviewed all photographs.

Results Among patients (n=67, mean age 34.8±21.6 y) compared with controls (n=69, mean age 28.1±15.7 y), there were significantly more enamel defects [51% vs. 30%, P=0.016, odds ratio (OR) 2.4, 95% confidence interval (CI) 1.2-4.8]. This was confined to children (87% vs. 33%, P=0.003, OR 13.3, 95% CI 3.0-58.6), but not adults (32% vs. 29%, P=0.76, OR 1.2, 95% CI 0.5-2.8). This was reflected in defects being observed in those with mixed dentition compared with those with permanent dentition (68.4% vs. 29.6%, P<0.0001). The degree of agreement between the 2 dentists was good (κ coefficient=0.53, P<0.0001), aphthous ulcers were more frequent in CD than controls (42.4% vs. 23.2%, P=0.02).

Conclusions This study supports that CD is highly associated with dental enamel defects in childhood, most likely because of the onset of CD during enamel formation; no such association was found in adults. Our study also supports the association between CD and aphthous ulcer. All physicians should examine the mouth, including the teeth, which may provide an opportunity to diagnose CD. In addition, CD should be added to the differential diagnosis of dental enamel defects and aphthous ulcers.

*Department of Medicine, New York Medical College (Sound Shore Medical Center), New Rochelle

Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY

The authors have no conflict of interest to disclose.

Funding sources: none.

Reprints: Peter H. R. Green, MD, Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue, Harkness Pavilion, Suite 956, New York, NY 10032 (e-mail

Received for publication January 1, 2009

accepted April 30, 2009

© 2010 Lippincott Williams & Wilkins, Inc.