Bertoldi C, Balli F, Tanza D, Bertolani P, Chiarini L
Istituto di Clinica Odontostomatologica, Università degli Studi, Modena.
Minerva Stomatol. 1995 Mar;44(3):95-105.
Celiac disease is characterized by gluten-dependent atrophy of the intestinal tufts. Aetiologically the genetic "habitus" of the subject has particular importance and, as rear as the pathogenesis is concerned, many theories, among which the most accredited one is "immunopathological", exist. According to what this last one provides, the cell-mediated immunity component is to be considered the true mediator of intestinal injury, whereas the antibody-mediated component and, in particular, anti-gliadin antibodies (AGA) and anti-endomysium antibodies (EMA), has a particular and pre-eminent diagnostic role. Just from this point of view the celiac disease appeared, with the progress of the studies, to be more and more fleeting, because of growing symptomatologic diversification. It is then interesting to take into account that the celiac disease seems to be able to maintain itself asymptomatic for the greatest part of life, perhaps, forever, configuring the appearance of silent celiac disease and contributing to specify the outline of the above-mentioned celiac "habitus". Recently, besides, close associations have been found between many different diseases and celiac disease. Even for such reasons we relied upon the indication of the ESPGAN in order to achieve a sure and standardized diagnosis of celiac disease. Early diagnosis of celiac disease is very important because it allows a normal psychophysical development and it avoids the strong incidence of lymphomas and other neoplasms of the gastrointestinal tractus which can characterize the natural story of celiac patients. From a more specifically odontological point of view, interesting manifestations exist in the ambit of celiac disease. This last may in fact appear associated particular signs, such as recurrent aphthae or plainly autoimmune diseases with even oral verification. There, however, a more frequent association between celiac disease and some lesions of the tooth enamel which occur in the period of the two stages of histodifferentiation and mineralisation, and they are, respectively, hypoplasias and opacities. Alteration of the enamel, in such stages, both in deciduous and in permanent sets of teeth may be caused by different "noxae"; hence it will be necessary to know how to distinguish between the dental lesions typical of celiac disease and the others. It is helpful the fact that the dental lesion, observed in the course of celiac disease, remembers conceptually the Chronologic Hypoplasia of the enamel. This pathologic form damages the enamel which is depositing, and evolving contemporaneously to the local or systemic "noxa" which is its remote cause.(ABSTRACT TRUNCATED AT 400 WORDS)
乳糜泻的特征是肠绒毛出现麸质依赖性萎缩。从病因学角度来看，个体的遗传“体质”尤为重要，就发病机制而言，存在多种理论，其中最被认可的是“免疫病理学”理论。根据该理论，细胞介导的免疫成分被认为是肠道损伤的真正介质，而抗体介导的成分，尤其是抗麦醇溶蛋白抗体（AGA）和抗肌内膜抗体（EMA），具有特殊且重要的诊断作用。从这一角度来看，随着研究的进展，由于症状越来越多样化，乳糜泻似乎越来越难以捉摸。考虑到乳糜泻在生命的大部分时间甚至可能永远保持无症状状态，从而形成隐匿性乳糜泻的表现，并有助于明确上述乳糜泻“体质”的轮廓，这一点很有意思。此外，最近还发现许多不同疾病与乳糜泻之间存在密切关联。正因如此，我们依据欧洲儿科胃肠病、肝病和营养学会（ESPGAN）的指导意见来实现乳糜泻的可靠且标准化诊断。乳糜泻的早期诊断非常重要，因为它能使患者实现正常的身心发育，并避免淋巴瘤和其他胃肠道肿瘤的高发病率，这些肿瘤可能是乳糜泻患者自然病程的特征。从更具体的牙科学角度来看，乳糜泻领域存在一些有趣的表现。事实上，乳糜泻可能会出现一些特殊体征，如复发性口疮，甚至是经口腔检查确诊的自身免疫性疾病。然而，乳糜泻与牙釉质的某些病变之间存在更常见的关联，这些病变发生在组织分化和矿化的两个阶段，分别是发育不全和浑浊。在乳牙和恒牙的这些阶段，牙釉质的改变可能由不同的“有害因素”引起；因此，有必要知道如何区分乳糜泻典型的牙齿病变和其他病变。在乳糜泻过程中观察到的牙齿病变在概念上类似于牙釉质的时间性发育不全，这一事实很有帮助。这种病理形式会损害正在沉积的牙釉质，并且与作为其远因的局部或全身“有害因素”同时发展。（摘要截选至400字）
