Did you know that it is possible to diagnose celiac disease with a smile?

Damage from gluten starts in the mouth, and today the Gluten Free RN explores the important role dentists can play in identifying undiagnosed celiac disease. She outlines the symptoms of celiac disease that present in the mouth, the follow-up questions dentists should ask when they notice dental enamel defects or aphthous ulcers, and the nature of the tongue as an indicator of overall health.

This episode covers how the plastics in orthodontic retainers might contain gluten and what to do if you are accidentally exposed. Nadine also explains the relationship between fat-soluble vitamins and celiac disease, as well as the nutrient deficiencies a potential celiac patient should test for. You’re never fully dressed without a smile, so listen in to understand how to keep your mouth healthy—and prevent the accumulation of complications from celiac disease with a whole food, gluten-free diet!

What’s Discussed: 

How the GI tract functions

  • Starts at mouth, ends at rectum
  • Allows us to consume food, liquid
  • Only extract what body needs
  • Expel the rest

How damage from gluten presents

  • Malabsorption of nutrients
  • Inflammation
  • Autoimmune issues
  • Type 1 diabetes
  • ALS
  • Lupus
  • MS
  • Sjögren’s
  • Leaky gut

How dentists can play an important role in identifying undiagnosed celiac disease

The symptoms of celiac disease that present in the mouth

  • Dental enamel defects
  • Aphthous ulcers (canker sores)
  • Cheilosis (cracks, open sores where upper and lower lip join)
  • Dry, cracked lips
  • TMJ—temporal mandibular joint disorder
  • Pain where jaws meet
  • Inflammation of the jaw
  • Clicking
  • Lock jaw
  • Mouth pain, burning
  • Oral lesions
  • Tongue pain, tingling
  • Redness, swelling of the tongue
  • Tongue sores
  • Changes in taste, smell
  • Diminished sensory input
  • Dry mouth
  • Sore throat
  • Difficulty swallowing
  • Increased thirst
  • Bleeding gums
  • Delayed eruption of teeth
  • Pyrosis
  • Oral lichen planus
  • Glossitis (inflammation of tongue)
  • Clearing throat
  • Sinus infections
  • Redness, swelling of the uvula

How Nadine treats gluten exposure

  • Activated charcoal
  • Drink water

The grains to look for in personal care products (e.g.: lip balm)

  • Wheat
  • Barley
  • Rye
  • Oats

The relationship between fat soluble vitamins and celiac disease

  • Gluten causes malabsorption
  • Vitamins A, D, E and K are fat soluble
  • Under 40 in vitamin D may indicate deficiency in all

How we tested for celiac disease in children in the early 20th century

  • Fecal fat score
  • Pale stool that floats suggests malabsorption of A, D, E and K

Why parents should be tested for celiac disease prior to pregnancy

The fetal development issues that may present if an expectant mother is unable to absorb nutrients

  • Dental enamel defects
  • Smaller jaw formation
  • Smaller airway passages

Why Nadine advocates for a mass screening

How gluten in plastics, personal care products can prevent celiac patients from healing

The questions dentists should ask when they notice dental enamel defects, aphthous ulcers

  • Other clinical celiac symptoms (abdominal pain, diarrhea, weight loss, anemia, fatigue)
  • Associated disorders (type 1 diabetes, thyroiditis, etc.)
  • Family history of celiac disease

Why we need to get much better at recognizing celiac signs and symptoms

  • Even in Canada, diagnosis takes 11.7 years

Why Eastern medicine examines the tongue as an indicator of overall health

The genes that indicate a predisposition to celiac disease

  • HLA-DQ2
  • HLA-DQ8

Why it is acceptable to adopt a gluten-free diet if your antibody test is negative for celiac disease

The deficiencies a potential celiac patient should test for

  • Calcium
  • Magnesium RBC
  • Vitamin D
  • Zinc
  • Folic acid

Why thrush may be an indicator of celiac disease or gluten sensitivity

Why one negative test for celiac disease doesn’t rule anyone out

The importance of early diagnosis

  • Symptoms accumulate over the years

The Paleo diet Nadine suggests for celiac and gluten-sensitive patients

  • Whole food
  • Focus on local, fresh
  • 100% grass-fed meat (no antibiotic, no hormone)
  • Fish and eggs
  • Nuts and seeds
  • 100% organic fruits and vegetables

Resources:

 “An Orthodontic Retainer Preventing Remission in Celiac Disease”  in Clinical Pediatrics

“Oral Manifestations of Celiac Disease: A Clinical Guide for Dentists” in the Journal of the Canadian Dental Association

Gluten Free RN Podcast EP027: Type 1 Diabetes and Celiac Disease

“The Association Between Celiac Disease, Dental Enamel Defects, and Aphthous Ulcers in a United States Cohort” in the Journal of Clinical Gastroenterology

“Small-Bowel Changes in Recurrent Ulceration of the Mouth” in Hepatogastroenterology

“Oral Signs and HLA-DQB1*02 Haploytypes in the Celiac Paediatric Patient: A Preliminary Study” in Autoimmune Diseases

“The Oral Manifestations of Celiac Disease: Information for the Pediatric Dentist” in Pediatric Dentistry

“Oral Aphthous Ulcers and Dental Enamel Defects in Children with Coeliac Disease” in Acta Paediatrica

“Oral and Dental Manifestations of Celiac Disease” in the New York State Dental Journal

“Jejunal Mucosal Abnormalities in Patients with Recurrent Aphthous Ulceration” in The British Medical Journal

“Dental Enamel Defects in Adult Coeliac Disease” in the European Journal of Internal Medicine

“Screening for Celiac Disease in Children with Dental Enamel Defects”  in ISRN Pediatrics

“Celiac Disease Associated with Recurrent Aphthae” in Gut

“Importance of Oral Signs in the Diagnosis of Atypical Forms of Celiac Disease” in Recenti Progressi in Medicina

Connect with Nadine: 

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Contact via Email

‘Your Skin on Gluten’ on YouTube

Melodies of the Danube Gluten-Free Cruise with Nadine

Books by Nadine:

Dough Nation: A Nurse’s Memoir of Celiac Disease from Missed Diagnosis to Food and Health Activism

Posted by Nadine Grzeskowiak, RN

Nadine is a 'food is medicine’ activist and is very proud of her work to educate all people about the power of food in health and wellness. Nadine is an expert consultant, professional speaker with over 1500 lectures to date, author of DOUGH NATION: A Nurse's Memoir of Celiac Disease From Missed Diagnosis to Food and Health Activism, podcaster, mom and former emergency/trauma/critical care nurse. Nadine is co-authoring her next book on the science of celiac disease.

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