Oral Pathology in Celiac Disease: What’s New?

The first description of dental enamel defects in celiac disease (CD) dates back to 1990 [1]. Since then several authors have reported an association between oral pathology and CD. In recent years, two literature reviews have shown recurrent aphthous stomatitis (mouth ulcers) and dental enamel defects in a wide range of 4-41% and 10-96% of patients with CD [2,3]. In 2012 were published the new pediatric guidelines on CD [4]. CD is currently defined as an immune-mediated systemic disorder elicited by gluten and related prolamines in genetically susceptible individuals and characterized by the presence of a variable combination of gluten-dependent clinical manifestations, CD-specific antibodies (against transglutaminase, endomysium and deamidated forms of gliadin peptides), HLA-DQ2 or HLA-DQ8 haplotypes, and enteropathy [4]. CD has thus shifted from a gluten-sensitive small bowel disorder with only gastrointestinal symptoms, to a multisystem disease with a very broad spectrum of intestinal and/or (just) extra intestinal symptoms, including oral manifestations. For the first time a combination of suggestive symptoms, (high levels of) specific antibodies and genetic findings may be sufficient, in children, to make the diagnosis of CD, regardless the histology features. Furthermore, a specific HLA profile may be useful as a first-line test for at-risk population such as relatives of CD patients, or children with autoimmune (especially type 1 diabetes and thyroiditis) or chromosomal aberrant (Down, Turner, Williams) disorders. Currently CD has a worldwide prevalence of 0.72% in the general population, and 0.4-1.3% in the pediatric population [5]. However, many cases are still undiagnosed. At any age, CD may be difficult to recognize because of the variability of the symptoms and signs, and the possibility of silent forms.