Researchers studied 97 children with celiac disease and 31 healthy children to understand how this condition affects their teeth and mouth. They found that children with celiac disease were much more likely to have tooth enamel problems and painful mouth sores compared to healthy kids. Interestingly, these mouth problems were connected to how much damage the disease had caused to their intestines. When children with celiac disease started eating a gluten-free diet, their mouth sores improved significantly. This discovery suggests that dentists and doctors can use these mouth signs to help identify children who might have undiagnosed celiac disease.

The Quick Take

  • What they studied: Whether children with celiac disease have more problems with tooth enamel (the hard outer layer of teeth) and painful mouth sores than children without the disease, and what causes these problems.
  • Who participated: 97 children ages 6-19 with confirmed celiac disease and 31 healthy children of similar ages. The celiac disease group included both newly diagnosed children and those already being treated.
  • Key finding: About 64% of children with celiac disease had tooth enamel problems compared to only 16% of healthy children. About 28% of celiac disease children had recurring mouth sores compared to 23% of healthy children. These problems were worse in children diagnosed later and improved when they followed a gluten-free diet.
  • What it means for you: If your child has celiac disease, they’re more likely to experience tooth enamel damage and mouth sores. The good news is that mouth sores often improve with a gluten-free diet. These mouth problems might also help doctors identify celiac disease earlier in children who haven’t been diagnosed yet.

The Research Details

This was a research study that compared two groups of children: those with celiac disease and those without. The researchers looked back at medical records and conducted dental examinations to find out how common tooth and mouth problems were in each group. They measured tooth enamel defects and counted how many children had recurring mouth sores. They also looked at blood tests and intestinal biopsies (small tissue samples) to understand the connection between mouth problems and the severity of celiac disease in the intestines.

The study included detailed information about when each child was diagnosed with celiac disease and whether they were following a gluten-free diet. A single dentist examined all the children’s mouths without knowing which children had celiac disease, which helps prevent bias in the results. The researchers also looked at genetic markers and nutrient levels in the blood to understand why these mouth problems happen.

Understanding how celiac disease affects the mouth is important because these visible signs could help doctors catch the disease earlier. Many children with celiac disease don’t have obvious stomach symptoms, so mouth problems could be an important clue. By studying the connection between intestinal damage and mouth problems, researchers can better understand how celiac disease affects the whole body.

This study had several strengths: it compared children with celiac disease to a healthy control group, used confirmed diagnoses through intestinal biopsies, and had a single examiner to reduce bias. The study looked at multiple factors including blood tests and tissue samples. However, the study was relatively small (128 children total), and the researchers collected some information by looking back at old medical records rather than following children forward in time. The study was published in a peer-reviewed medical journal, which means other experts reviewed it before publication.

What the Results Show

Children with celiac disease had significantly more tooth enamel defects than healthy children—about 64% compared to 16%. This means that if you saw 100 children with celiac disease, roughly 64 would have visible damage to their tooth enamel, while only about 16 out of 100 healthy children would have the same problem.

The severity of tooth enamel damage was directly connected to how much damage the celiac disease had caused to the intestines. Children whose intestines were more severely damaged by celiac disease tended to have worse tooth enamel problems. This suggests that the same disease process that damages the intestines also affects tooth development.

Children who were diagnosed with celiac disease at an older age had more tooth enamel problems than those diagnosed earlier. This makes sense because the longer the disease goes untreated, the more damage it can cause.

Recurring mouth sores (painful ulcers inside the mouth) were most common in children who had just been diagnosed and hadn’t started treatment yet—about 47% of newly diagnosed children had these sores. However, when these children started following a gluten-free diet, their mouth sores improved dramatically and mostly went away.

The study found that tooth enamel defect severity was connected to low calcium levels in the blood. This makes sense because calcium is essential for building strong teeth. Children with celiac disease often have trouble absorbing nutrients like calcium because of intestinal damage, which can weaken their developing teeth. The study also noted that the genetic marker HLA-DQ2, which is present in most celiac disease patients, was associated with these oral problems, suggesting a genetic component to why celiac disease affects the mouth.

Previous research has suggested that celiac disease can affect the mouth, but this study provides clearer numbers about how common these problems are. The finding that mouth sores improve with a gluten-free diet confirms what smaller studies have suggested. This research adds important information by showing the direct connection between intestinal damage severity and tooth enamel problems, which hadn’t been clearly demonstrated before.

The study was relatively small with only 97 children with celiac disease, so the results might not apply to all children with this condition. Some information came from old medical records rather than being collected specifically for this study, which could affect accuracy. The study was done at a single medical center, so the results might be different in other populations. The researchers couldn’t determine whether the mouth problems were caused directly by celiac disease or by nutritional deficiencies that result from the disease. Additionally, this is a snapshot in time rather than following children over many years to see how their mouth problems develop.

The Bottom Line

If your child has celiac disease, ask your dentist to monitor their teeth carefully for enamel damage. Make sure your child follows a strict gluten-free diet, as this appears to help prevent mouth sores and may help protect tooth development. Ensure adequate calcium and nutrient intake, as these are important for tooth health. If your child has recurring mouth sores, discuss this with their doctor as it may indicate the celiac disease isn’t well-controlled. These recommendations are supported by this research, though more studies are needed to determine the best ways to prevent these problems.

Parents of children with celiac disease should pay attention to these findings and watch for tooth and mouth problems. Dentists should be aware that tooth enamel defects and mouth sores can be signs of undiagnosed celiac disease, especially in children. Doctors diagnosing celiac disease should ask about mouth problems as part of their evaluation. Children who have unexplained tooth enamel damage or recurring mouth sores might benefit from being tested for celiac disease. However, these findings don’t apply to adults with celiac disease, as tooth development is different in adults.

Mouth sores in newly diagnosed children may improve within weeks to a few months after starting a gluten-free diet. Tooth enamel damage that has already occurred won’t repair itself, but preventing further damage is important. The intestinal healing that reduces enamel defect severity typically takes several months to a year on a gluten-free diet. Parents should expect to see improvements in mouth sores relatively quickly but understand that tooth enamel protection is a long-term process.

Want to Apply This Research?

  • Track the frequency and severity of mouth sores on a weekly basis using a simple 1-5 scale. Note the date each sore appears and disappears. Also record gluten-free diet adherence to correlate dietary compliance with mouth sore improvements.
  • Use the app to set reminders for strict gluten-free diet adherence and log daily meals to ensure no accidental gluten exposure. Create a photo log of any mouth sores to show your dentist and doctor, and track calcium and nutrient-rich foods consumed daily to support tooth and mouth health.
  • Establish a monthly check-in where you photograph any visible tooth enamel changes and document mouth sore frequency. Track this data over 3-6 months to see if gluten-free diet adherence correlates with improvements in mouth health. Share this information with both your dentist and gastroenterologist at regular appointments.

This research summary is for educational purposes only and should not replace professional medical advice. If your child has celiac disease or shows signs of tooth enamel damage or recurring mouth sores, consult with your pediatrician and dentist for proper evaluation and treatment. Diagnosis of celiac disease requires medical testing and should only be done by qualified healthcare providers. Always follow your healthcare team’s recommendations for managing celiac disease and oral health.