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Screening for celiac disease in children with dental enamel defects
Mostafa Abdel-Aziz El-Hodhod1, Iman Ali El-Agouza, Hala Abdel-Al
1Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt.
Insights
Celiac disease (CD) is significantly more common in children with dental enamel defects (DEDs). Screening for CD is recommended in children with DEDs, especially if underweight or with low calcium levels.
Area of Science:
- Pediatric Dentistry
- Gastroenterology
- Genetics
Background:
- Dental enamel defects (DEDs) are a known clinical manifestation associated with celiac disease (CD).
- The prevalence of CD among children presenting with DEDs requires further investigation.
Purpose of the Study:
- To determine the frequency of celiac disease (CD) in a cohort of children diagnosed with dental enamel defects (DEDs).
- To compare the characteristics and outcomes of DEDs in children with and without CD.
Main Methods:
- A case-control study involving 140 children with DEDs and 720 age- and sex-matched controls.
- Clinical evaluation, assessment of serum calcium, phosphorus, alkaline phosphatase, IgA, and tissue transglutaminase (tTG) IgG and IgA antibodies.
- Gluten-free diet (GFD) intervention for diagnosed CD patients.
Main Results:
- Celiac disease (CD) was diagnosed in 17.86% of children with DEDs, compared to 0.97% in controls (P < 0.0001).
- Children with CD exhibited a wider range of DED severity (grades 1-3) compared to non-celiac patients (grade 1).
- Lower serum calcium levels were a significant predictor of CD in this cohort.
Conclusions:
- Celiac disease (CD) is significantly more prevalent in children with dental enamel defects (DEDs) than in the general pediatric population.
- DEDs can be the sole presenting sign of CD, underscoring the need for screening.
- Screening for CD in children with DEDs, particularly those who are underweight or have hypocalcemia, is highly recommended.
Abstract:
Background. Dental enamel defects (DEDs) are seen in celiac disease (CD). Aim was to detect frequency of CD among such patients. Methods. This study included 140 children with DED. They were tested for CD. Gluten-free diet (GFD) was instituted for CD patients. A cohort of 720, age and sex-matched, normal children represented a control group. Both groups were evaluated clinically. Serum calcium, phosphorus, alkaline phosphatase, serum IgA, and tissue transglutaminase (tTG) IgG and IgA types were measured. Results. CD was more diagnosed in patients with DEDs (17.86%) compared to controls (0.97%) (P < 0.0001). Majority of nonceliac patients showed grade 1 DED compared to grades 1, 2, and 3 DED in CD. Five children had DED of deciduous teeth and remaining in permanent ones. After 1 year on GFD, DED improved better in CD compared to nonceliac patients. Gastrointestinal symptoms did not vary between celiac and nonceliac DED patients. Lower serum calcium significantly predicted CD in this cohort. Conclusion. CD is more prevalent among children with DED than in the general population. These DEDs might be the only manifestation of CD; therefore, screening for CD is highly recommended among those patients especially in presence of underweight and hypocalcemia.
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