Lucchese A, Di Stasio D, De Stefano S, Nardone M, Carinci F. Beyond the Gut: A Systematic Review of Oral Manifestations in Celiac Diseases. J Clin Med 2023; 12: 3875.

Oral ulceration and enamel defects are associated with celiac disease.

Celiac disease (CD) is characterised by an immunological response to the proteins in gluten, often resulting in diarrhoea, abdominal pain, weight loss and malabsorption, although some patients may be asymptomatic. 'Given that the mouth is the initial segment of the gastro-intestinal system,' oral manifestations of CD can contribute to diagnosis.

Thirty-three papers were reviewed, showing that 66% of patients affected by CD are female. Recurrent aphthous ulceration (RAS) was reported in 27 papers and dental enamel defects (DED) reported in 19 studies. Less frequently reported symptoms include delayed dental eruption, glossitis and geographic tongue, glossodynia, xerostomia, cheilitis and oral lichen planus.

The relationship between DED and CD may involve factors beyond nutritional deficiencies interrupting amelogenesis. An autoimmune response to amelogenins and amelobalstin suggests an interplay of genetic and (auto)immunological factors. Studies show that RAS has a higher prevalence in CD patients than healthy control subjects and a gluten-free diet may lead to a remission of associated RAS.

The authors suggest that understanding the oral manifestations of CD may enhance the management of oral disease through targeted CD therapy.