Department of Medicine, New York Medical College (Sound Shore Medical Center), New Rochelle, New York, NY, USA.
J Clin Gastroenterol. 2010 Mar;44(3):191-4. doi: 10.1097/MCG.0b013e3181ac9942.
European studies have demonstrated that dental enamel defects and oral aphthae are observed in celiac disease (CD). We investigated this association in a US population.
Biopsy proven CD patients and controls were recruited from a private dental practice and from CD support meetings. History of aphthae was taken and dental examination was performed by a single dentist. Teeth were photographed and enamel defects graded according to the Aine classification. A second dentist reviewed all photographs.
Among patients (n=67, mean age 34.8+/-21.6 y) compared with controls (n=69, mean age 28.1+/-15.7 y), there were significantly more enamel defects [51% vs. 30%, P=0.016, odds ratio (OR) 2.4, 95% confidence interval (CI) 1.2-4.8]. This was confined to children (87% vs. 33%, P=0.003, OR 13.3, 95% CI 3.0-58.6), but not adults (32% vs. 29%, P=0.76, OR 1.2, 95% CI 0.5-2.8). This was reflected in defects being observed in those with mixed dentition compared with those with permanent dentition (68.4% vs. 29.6%, P<0.0001). The degree of agreement between the 2 dentists was good (kappa coefficient=0.53, P<0.0001), aphthous ulcers were more frequent in CD than controls (42.4% vs. 23.2%, P=0.02).
This study supports that CD is highly associated with dental enamel defects in childhood, most likely because of the onset of CD during enamel formation; no such association was found in adults. Our study also supports the association between CD and aphthous ulcer. All physicians should examine the mouth, including the teeth, which may provide an opportunity to diagnose CD. In addition, CD should be added to the differential diagnosis of dental enamel defects and aphthous ulcers.
欧洲的研究表明，在乳糜泻（CD）患者中可观察到牙釉质缺陷和口腔口疮。我们在美国人群中调查了这种关联。
从私人牙科诊所和 CD 支持会议招募了活检证实的 CD 患者和对照组。记录了口疮病史，并由一位牙医进行了口腔检查。拍摄了牙齿照片，并根据 Aine 分类对牙釉质缺陷进行分级。第二位牙医审查了所有照片。
与对照组（n=69，平均年龄 28.1+/-15.7 岁）相比，患者（n=67，平均年龄 34.8+/-21.6 岁）中牙釉质缺陷明显更多[51% vs. 30%，P=0.016，优势比（OR）2.4，95%置信区间（CI）1.2-4.8]。这种情况仅限于儿童（87% vs. 33%，P=0.003，OR 13.3，95% CI 3.0-58.6），但在成人中并非如此（32% vs. 29%，P=0.76，OR 1.2，95% CI 0.5-2.8）。这反映在混合牙列中观察到的缺陷与恒牙列中观察到的缺陷（68.4% vs. 29.6%，P<0.0001）。两位牙医之间的一致性很好（kappa 系数=0.53，P<0.0001），CD 患者中口疮性溃疡的发生率高于对照组（42.4% vs. 23.2%，P=0.02）。
本研究支持 CD 与儿童时期的牙釉质缺陷高度相关，这很可能是因为 CD 在牙釉质形成期间发生；在成年人中未发现这种关联。我们的研究还支持 CD 与口疮性溃疡之间的关联。所有医生都应该检查口腔，包括牙齿，这可能提供了诊断 CD 的机会。此外，CD 应被添加到牙釉质缺陷和口疮性溃疡的鉴别诊断中。
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