title: The association between celiac disease, dental enamel defects, and aphthous ulcers in a United States cohort.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 (kappa 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.
authors.affiliation: Department of Medicine, New York Medical College (Sound Shore Medical Center), New Rochelle, New York, NY, USA.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Cheng
authors.forename: Ted
authors.initials: T
authors.lastname: Malahias
authors.forename: Pardeep
authors.initials: P
authors.lastname: Brar
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Minaya
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications* / Q000503:physiopathology; D002648:Child; D003743:Dental Enamel / Q000002:abnormalities*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography; D013281:Stomatitis, Aphthous / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult