Histology of primary incisor enamel in children with early onset celiac disease.

The manifestations of celiac disease are a result of nutritional malabsorption. An early onset of such malabsorption may jeopardize the primary enamel which is not mineralized. Prepared sections of 10 primary incisors from 10 children with early onset celiac disease were examined using polarized light microscopy to determine if enamel defects were present. Study of the tooth sections dry in air and after water imbibition revealed a normal neonatal line. Furthermore, both prenatal and pos tna tal enamel were found to have normal pore volume distribution. The absence of enamel disturbances suggests normal nutritional absorption during the period of primary incisor enamel mineralization. Celiac disease (CD) is a frequent cause of nutritional malabsorption in childhood, characterized by degenerative changes in small intestinal mucosa (Rasmussen and Espelid 1980; Lebenthal and Branski 1981). In Sweden, the incidence of CD is approximately 1:900 births (Berg and Lindberg 1979; Stenhammer and Johansson 1981). Gluten, a protein found in wheat, rye, barley, and oats, causes villous atrophy and the subsequent malabsorption in CD (Rasmussen and Espelid 1980; Lebenthal and Branski 1981). The classic clinical manifestations, including diarrhea, steatorrhea, abdominal distention, wasting of muscles, vomiting, irritability, and growth retardation, usually occur in the first 2 years of life (Lebenthal and Branski 1981; Andersson-Wenckert et al. 1984). However, growth failure alone may be the only demonstrable symptom (Verkasalo et al. 1978; Lebenthal and Branski 1981). A definitive diagnosis can be made only after histologic examination of 3 intestinal biopsies (Smith and Miller 1979; Lebenthal and Branski 1981; Anderson-Wenckert et al. 1984). Complete removal of dietary gluten results in remission of symptoms and reestablishment of normal small intestinal villi (Lebenthal and Branski 1981). Enamel abnormalities, presumably due to malabsorption of calcium, have been observed and reported in association with CD (Smith and Miller 1979; Rasmussen and Espelid 1980; Aine 1986). An enamel defect prevalence of 96% has been reported in CD children in Finland (Aine 1986). All investigations of enamel disturbances in subjects with CD have involved visual inspection in situ: only 2 teeth (permanent molars) have been examined histologically and reported (Smith and Miller 1979; Rasmussen and Espelid 1980). The early onset of CD symptoms indicates that primary tooth enamel may exhibit abnormalities; yet, to our knowledge, no histologic studies on primary teeth of children with confirmed CD are available. The purpose of this paper is to determine if histologic defects exist in the primary incisor enamel of children with early onset CD. Materials and Methods Exfoliated or extracted primary teeth were collected from 10 children with early onset of celiac disease residing in Ume~, Sweden. All children had a full-term, uneventful birth with normal presentation and weight. The sample included 4 maxillary central incisors, 4 maxillary lateral incisors, and 2 mandibular lateral incisors. The diagnostic criteria of 3 intestinal biopsies were met by all subjects. The table (next page) presents data concerning the children and their disease. Sagittal buccolingua180-100 ~tm-thick sections were prepared from teeth embedded in methylmethacrylate using a saw microtome (Leitz® 1600 low-speed saw microtome -Ernst Leitz Wetzler GmbH; Federal Republic of Germany; Nor6n and Engstr6m 1987). After polishing, the sections were examined dry in air and after water imbibition in a polarized light microscope (Olympus BH® polarizing light microscope-Olympus Optical Co, Ltd; Japan) employing strain-free objectives. Pediatric Dentistry: December, 1988 ~ Volume 10, Number 4 301