Diagnosing celiac disease in children using oral manifestations

• Published in: BMC gastroenterology Vol. 24; no. 1; pp. 332 - 7
• Main Authors: Cicekci, Aysegul Verim, Demir, Aysegul Dogan, Bakkal, Meltem
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30.09.2024; BioMed Central; BMC
• Subjects: Adolescent; Analysis; Aphthous stomatitis; Biopsy; Case-Control Studies; Causes of; Celiac disease; Celiac Disease - diagnosis; Child; Child development; Children; Constipation; Dental enamel; Dental Enamel Hypoplasia - diagnosis; Dentistry; Dentists; Developmental enamel defects; Diagnosis; Diseases; Female; Genetic screening; Gluten; GTP-Binding Proteins - immunology; Histocompatibility antigen HLA; HLA-DQ Antigens - blood; HLA-DQ Antigens - genetics; Humans; Immunoglobulin A; Immunoglobulin A - blood; Lesions; Male; Mineralization; Molar incisor hypomineralization; Nutrition; Oral manifestations of general diseases; Pediatric research; Pediatrics; Protein Glutamine gamma Glutamyltransferase 2; Questionnaires; Serological tests; Statistical analysis; Stomatitis, Aphthous - diagnosis; Transglutaminase 2; Transglutaminases - immunology; Turkey; Celiac disease; Children; Developmental enamel defects; Molar incisor hypomineralization
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-024-03431-4

Celiac disease (CD) may be frequently undiagnosed due to the absence of characteristic gastroenterologic symptoms in many CD patients. Our objective was to diagnose CD by utilizing documented oral manifestations such as Recurrent Aphthous Stomatitis (RAS) and Molar-Incisor Hypomineralization (MIH). The study comprised sixty children who presented with complaints of RAS lesions. The MIH group consisted of 40 children, while the control group comprised 20 children without MIH lesions, ranging in age from 7 to 13 years. After the dental examination, all children were given a questionnaire to assess whether they had any previous history of general symptoms related to CD. Following that, diagnostic testing for celiac disease were conducted, including serological tests such as Tissue transglutaminase IgA (tTG-IgA), Endomysium Antibody (EMA), and Total IgA, as well as genetic tests for HLA-DQ2 and HLA-DQ8. The statistical analysis, conducted using Fisher's Exact, Yates' Continuity Correction, Fisher Freeman Halton, and Student's t tests, revealed no significant differences between the groups (p < 0.05). Within the MIH group, 3 children exhibited border tTG-IgA values, while another 3 had positive tTG-IgA results. Two of these 6 children had also positive EMA and HLA results. Following a biopsy procedure, these two children were ultimately diagnosed with celiac disease (CD). In this study, while children initially presented to the clinic with complaints of recurrent aphthous stomatitis (RAS), 2 children (5% of the MIH group) were diagnosed with CD shortly after the onset of MIH lesions. CD enhanced the likelihood of observing some oral manifestations particularly recurrent aphtous stomatitis and developmental enamel defects. We recommend that dentists be cautious about diagnosing CD when RAS lesions and DEDs and/or MIH lesions are present, whether or not other indications of this systemic disease exist.