Numerous published papers have underlined how specific oral signs and symptoms can be classified as risk factor signals for celiac disease. In fact, the American Dental Associationnotes that specific oral manifestations observed in childhood may actually help to identify patients with early celiac disease before serious disease progression and harm develop. The following are common oral manifestations of gluten exposure:

Aphthous ulcers (canker sores)
Also known as canker sores, aphthous ulcers are small ulcers with a red base and a yellow layer that usually appear on the tongue or inside the cheeks or lips. A 2010 study by Columbia University found that aphthous ulcers were more prevalent in people with celiac disease than those without. Another study published in BMC Gastroenterology found that recurrent mouth sores can be the only symptom of celiac disease.

Enamel defects in the teeth leading to cavities
In a study of children diagnosed with celiac disease, which included both children recently diagnosed and not yet on a gluten-free diet and also children who had been following a gluten-free diet for a long period of time, there was a higher prevalence of enamel hypoplasia found in the children with untreated celiac disease. The plaque index was also significantly lower in the children who had been following a gluten-free diet.

In addition, studies have reported cross-reactivity of antibodies to gluten with enamel proteins, and one study even tested the ability of anti-gliadin IgG, which is produced in an untreated celiac disease patient, to recognize enamel organ structures and found high reactivity.

Bacterial changes
Changes in oral health can also be caused by, or contribute to, an imbalance of oral bacteria. One study of children and teens found a statistically significant difference in the prevalence of salivary mutans streptococci and lactobacilli colonization between those diagnosed with celiac disease and those confirmed without celiac disease.

Gingivitis (inflammation of the gums)
Celiac disease can cause inflammation throughout the body, including the gums. People with gluten sensitivity and celiac disease often have inflamed, red, swollen, painful gums. In fact, one study looked at the gum health of a group of children and adolescents, both with and without celiac disease. It found that the periodontal treatment need of children and adolescents with celiac disease was high and most of them (60.01%) needed treatment of gingivitis. Only a few children and teens with celiac disease that were studied had healthy gums.

Xerostomia (dry mouth)
Complaints of dry mouth are common in those with celiac disease. One study in Brazil studied celiac and non-celiac individuals and found that those with celiac had an increased likelihood of dental enamel defects and dry mouth sensation. It suggested that an oral examination could be an important auxiliary tool for the identification of cases of the disease.

Tonsil stones with halitosis (bad breath)
Though not thoroughly studied, in my clinical experience, tonsil stones are a common manifestation in those with gluten sensitivity, and when many patients implement a gluten free diet, tonsil stones often resolve. A leading sign of tonsil stones for many is the presence of lingering bad breath, which can indicate that tonsil stones are present.

To connect with Dr. Osborne visit:

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*These statements have not been evaluated by the Food and Drug Administration. This video is not intended to diagnose, treat, cure or prevent any disease. It is strictly intended for educational purposes only. Additionally, this information is not intended to replace the advice of your physician. Dr. Osborne is not a medical doctor. He does not treat or diagnose disease. He offers nutritional support to people seeking an alternative from traditional medicine. Dr. Osborne is licensed with the Pastoral Medical Association.

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