Oral health status and salivary properties in relation to gluten-free diet in children with celiac disease

BACKGROUND: Patients with celiac disease (CD) have a wide variety of symptoms, from being asymptomatic to having chronic diarrhea, abdominal pain, and extraintestinal symptoms. In the oral cavity, enamel defects and recurrent aphthous stomatitis are the most common symptoms. The aim of the study was to assess oral health, bacterial colonization and salivary buffering capacity of patients with CD at diagnosis were compared with patients with CD receiving a gluten-free diet (GFD) and healthy children. METHODS: Three groups were prospectively investigated: newly diagnosed CD, CD treated with GFD, and a control group. All of the children were examined by pediatric dentists, and saliva samples were collected for bacterial and pH analysis. RESULTS: Ninety children were enrolled in the study, 30 in each group. A higher prevalence of enamel hypoplasia (66%) was found in children with CD. Plaque index was significantly lower in the celiac-treated group, which correlated with oral health behavior: teeth brushing and frequency of eating between meals. Children receiving GFD brushed their teeth and used fluoride significantly more often than other children in the study. No difference between groups was found in snack consumption, mutans streptococci and lactobacilli counts in saliva, as well as pH and buffer capacity. CONCLUSIONS: A lower degree of plaque was found in children with CD receiving GFD. This finding could not be explained by salivary properties or bacteria, but rather by better oral hygiene. The results should raise the awareness of pediatric gastroenterologists toward oral health-related issues in children with CD.