Department of Pediatric Dentistry, Bezmialem Vakif University, Vatan Cad, Istanbul, 34093, Turkey.
Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, 34093, Turkey.
BMC Gastroenterol. 2024 Sep 30;24(1):332. 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.
由于许多 CD 患者缺乏特征性的胃肠道症状，因此 CD 可能经常未被诊断。我们的目的是通过利用已记录的口腔表现（如复发性口疮性口炎（RAS）和磨牙切牙矿化不全（MIH））来诊断 CD。
该研究包括 60 名因 RAS 病变就诊的儿童。MIH 组由 40 名儿童组成，对照组由 20 名无 MIH 病变的儿童组成，年龄在 7 至 13 岁之间。进行牙科检查后，所有儿童都填写了一份问卷，以评估他们是否有任何与 CD 相关的一般症状的既往病史。然后，对 CD 进行了诊断性检测，包括组织转谷氨酰胺酶 IgA（tTG-IgA）、内肌抗体（EMA）和总 IgA 等血清学检测，以及 HLA-DQ2 和 HLA-DQ8 的基因检测。
使用 Fisher 精确检验、Yates 连续性校正、Fisher Freeman Halton 和学生 t 检验进行的统计分析显示，组间无显著差异（p<0.05）。在 MIH 组中，有 3 名儿童的边界 tTG-IgA 值升高，另有 3 名儿童的 tTG-IgA 结果阳性。这 6 名儿童中有 2 名的 EMA 和 HLA 结果也呈阳性。在进行活检后，这两名儿童最终被诊断为 CD。
在这项研究中，尽管儿童最初因复发性口疮性口炎（RAS）就诊，但在 MIH 病变出现后不久，有 2 名儿童（MIH 组的 5%）被诊断为 CD。CD 增加了观察某些口腔表现（特别是复发性口疮性口炎和发育性牙釉质缺陷）的可能性。我们建议，当存在 RAS 病变和 DED 以及/或 MIH 病变时，牙医应谨慎诊断 CD，无论是否存在这种全身性疾病的其他迹象。
