There's a Mouth Attached to the Rest of the GI Tract

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There's a Mouth Attached to the Rest of the GI Tract

  1. 1. Celiac disease and Oral health <ul><li>Trey L. Petty, DDS, FADI, FAGD </li></ul><ul><li>Holy Cross Hospital Centre </li></ul><ul><li>Calgary Alberta Canada </li></ul>
  2. 2. <ul><li>Oral Manifestations: </li></ul><ul><ul><li>Recurrent aphthous stomatitis, canker sores </li></ul></ul>celiac Disease & Oral health <ul><ul><li>Atrophic glossitis </li></ul></ul><ul><ul><li>Xerostomia - dry mouth </li></ul></ul><ul><ul><li>Squamous cell carcinoma </li></ul></ul>
  3. 3. celiac Disease & Oral health <ul><li>Oral Manifestations: </li></ul><ul><ul><li>Enamel defects </li></ul></ul>
  4. 4. celiac Disease & Oral health <ul><li>Oral Manifestations: </li></ul><ul><ul><li>Enamel defects </li></ul></ul><ul><li>Range: </li></ul><ul><li>Symmetrical spots of hypocalcification on incisors </li></ul><ul><li>Severe structural defects </li></ul>
  5. 5. celiac Disease & Oral health <ul><li>Oral Manifestations: </li></ul><ul><ul><li>Enamel defects </li></ul></ul><ul><li>North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) - 2006Jan </li></ul><ul><li>Included as symptom of Celiac Disease </li></ul>
  6. 6. <ul><li>Oral Manifestations: </li></ul><ul><ul><li>Enamel defects </li></ul></ul>celiac Disease & Oral health <ul><li>Due to malabsorption during formation of teeth </li></ul><ul><li>Tooth calcification: </li></ul><ul><ul><li>Primary teeth: 14wk - 11mo in utero </li></ul></ul><ul><ul><li>Adult teeth: 3mo - 25yrs </li></ul></ul>
  7. 7. celiac Disease & Oral health <ul><li>Oral Manifestations: </li></ul><ul><ul><li>Enamel defects </li></ul></ul><ul><ul><li>Often first step to diagnosis of CD </li></ul></ul><ul><ul><li>May be only presenting manifestation </li></ul></ul>
  8. 8. <ul><li>Oral Manifestations: </li></ul><ul><ul><li>Enamel defects </li></ul></ul>celiac Disease & Oral health <ul><ul><li>Differential diagnoses: </li></ul></ul><ul><ul><ul><li>Dental fluorosis </li></ul></ul></ul><ul><ul><ul><li>Amelogenesis imperfecta </li></ul></ul></ul><ul><ul><ul><li>Dentinogenesis imperfecta </li></ul></ul></ul><ul><ul><ul><li>Osteogenesis imperfecta </li></ul></ul></ul>
  9. 9. <ul><li>Oral Manifestations: </li></ul><ul><ul><li>Enamel defects </li></ul></ul>celiac Disease & Oral health <ul><ul><ul><li>NEGLECT </li></ul></ul></ul><ul><ul><ul><li>... ABUSE ... </li></ul></ul></ul><ul><ul><li>Differential diagnoses: </li></ul></ul>
  10. 10. <ul><li>Oral Manifestations: </li></ul><ul><ul><li>Enamel defects </li></ul></ul>celiac Disease & Oral health <ul><ul><li>Permanent; requires restoration </li></ul></ul><ul><ul><ul><li>Bonding, veneers, crowns </li></ul></ul></ul>
  11. 11. celiac Disease & Oral health <ul><li>Dental Materials </li></ul><ul><ul><li>Do they contain gluten? </li></ul></ul><ul><ul><ul><li>Some do... </li></ul></ul></ul><ul><ul><ul><li>Some don’t... </li></ul></ul></ul>www.withoutthewheat.com/Dental_Products.html
  12. 12. celiac Disease & Oral health <ul><li>Dental Materials </li></ul><ul><ul><li>Do they contain gluten? </li></ul></ul><ul><ul><ul><li>Problem is: SORBITOL </li></ul></ul></ul><ul><ul><ul><ul><li>Artificial sweetener </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Typically corn derived </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>MAYBE wheat derived </li></ul></ul></ul></ul></ul>
  13. 13. celiac Disease & Oral health <ul><li>Dental Materials </li></ul><ul><ul><li>Do they contain gluten? </li></ul></ul><ul><ul><ul><li>Most companies are willing to make a clear Yes/No statement </li></ul></ul></ul><ul><ul><ul><li>Others cannot rule-out presence </li></ul></ul></ul><ul><ul><ul><ul><li>Do not control raw materials </li></ul></ul></ul></ul>
  14. 14. celiac Disease & Oral health <ul><li>Dental Materials </li></ul><ul><ul><li>Do they contain gluten? </li></ul></ul><ul><ul><ul><li>In general, dental filling materials do NOT contain gluten </li></ul></ul></ul>
  15. 15. celiac Disease & Oral health <ul><li>Dental Materials </li></ul><ul><ul><li>Do they contain gluten? </li></ul></ul><ul><ul><ul><li>In general, toothpaste does NOT contain gluten </li></ul></ul></ul>
  16. 16. celiac Disease & Oral health <ul><li>Dental Materials </li></ul><ul><ul><li>Do they contain gluten? </li></ul></ul><ul><ul><ul><li>In general, denture adhesives MIGHT contain gluten, but </li></ul></ul></ul><ul><ul><ul><li>Denture cleaners do NOT </li></ul></ul></ul>
  17. 17. celiac Disease & Oral health <ul><li>Dental Materials </li></ul><ul><ul><li>Do they contain gluten? </li></ul></ul><ul><ul><ul><li>In general, local anesthetics & topical anesthetics do NOT contain gluten </li></ul></ul></ul>
  18. 18. celiac Disease & Oral health <ul><li>Dental Materials </li></ul><ul><ul><li>Do they contain gluten? </li></ul></ul><ul><ul><ul><li>In general, SOME mouth rinses MAY contain gluten </li></ul></ul></ul>
  19. 19. <ul><li>Caregivers: </li></ul><ul><ul><li>Educate the local dental community on CD </li></ul></ul><ul><ul><ul><li>Dentists, Dental Hygienists </li></ul></ul></ul><ul><ul><ul><li>Common oral conditions </li></ul></ul></ul><ul><ul><ul><li>Referral pathways </li></ul></ul></ul>celiac Disease & Oral health <ul><ul><ul><li>- Pediatric </li></ul></ul></ul><ul><ul><ul><li>- Hospital-based </li></ul></ul></ul><ul><ul><ul><li>- Oral Medicine </li></ul></ul></ul>
  20. 20. <ul><li>Caregivers: </li></ul>celiac Disease & Oral health <ul><li>Identify Dental Champions in your area </li></ul><ul><li>Referral of frustrated people living with CD </li></ul><ul><li>Knowledge base of gluten-free dental materials </li></ul>
  21. 21. <ul><li>People living with Celiac Disease: </li></ul>celiac Disease & Oral health <ul><li>Find a dentist aware of CD </li></ul><ul><li>Awareness; lack of stigmatization </li></ul><ul><li>Gluten-free dental materials </li></ul><ul><li>You may have to educate about CD... </li></ul>
  22. 22. <ul><li>People living with Celiac Disease: </li></ul>celiac Disease & Oral health <ul><li>Oral ulcerations </li></ul><ul><li>Dry mouth </li></ul><ul><li>Enamel defects </li></ul><ul><li>Find a dentist to manage symptoms </li></ul>- caution: $$$
  23. 23. Celiac disease and Oral health <ul><li>Trey L. Petty, DDS, FADI, FAGD </li></ul><ul><li>Holy Cross Hospital Centre </li></ul><ul><li>Calgary Alberta Canada </li></ul><ul><li>[email_address] </li></ul>Primum non nocere...

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