Oral ecosystem alterations in celiac children: a follow-up study

The aims of this work were (1) to assess the oral health status of children with celiac disease (CD) with or without compliance with a gluten-free diet and in non-celiac children in a follow-up study and (2) to identify oral ecosystem changes that could be used as non-invasive monitoring methods for CD patients.

An 18-month follow-up study in children of both genders, who were 4-12 years old during the study period, was performed. Decayed-missing-filled in temporary (dmft) and permanent teeth (DMFT), enamel alterations, oral hygiene, and gingival index were measured. Oral smears were collected by brushing. Flow rate, calcium, phosphate, pH, buffer capacity, fluoride, and Ca/P ratio were measured in saliva. Salivary protein profiles were performed.

Most CD patients (80%) presented typical symptoms between 12 and 24 months old. Children with CD had a significantly low frequency of enamel alterations (30%) (p=0.0001). A high percentage of patients (63.15%) reported having had aphthous ulcers at several times. The celiac group showed significantly more polymorphonuclear neutrophils (PMNs) in smears (20% PMNs per area, p=0.0459) than the control group (0% PMNs per area) at baseline. In CD children, 90% of the samples that showed PMNs at baseline did not present them after 18 months. However, 10% of the smears of CD patients presented PMNs at the end of this study. Compliance with the gluten-free diet was controlled to detect the maintenance or worsening of signs and symptoms during the medical controls.

The main differences amongst CD children who did or did not comply with a gluten-free diet and control children are the presence of PMNs in oral mucosa and protein salivary patterns; these findings could be considered as markers for CD, in conjunction with other signs and symptoms.