Importance of celiac disease oral manifestations in pediatric patients: A systematic review

Abstract

BACKGROUND

Celiac disease (CD) is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals. It is more commonly diagnosed in children presenting typical clinical signs and symptoms but most of the CD patients diagnosed in the developed world are silent cases with no prominent gastrointestinal features. Thus, there are silent forms of the disease in which oral manifestations are the first sign. In the pediatric population oral health can affect growth and self-esteem and have a negative impact in their life quality.

AIM

To assess the prevalence and types of oral manifestations in pediatric patients with CD.

METHODS

We performed a comprehensive literature search in PubMed, Scielo, Cochrane Library and Lilacs databases from 2014-2024. Three independent researchers screened and extracted the information, applying the eligibility criteria and bias was assessed using Joanna Briggs Institute tools.

RESULTS

Of the initial 241 articles, 14 studies fulfilled the proposed objectives and were included in the review. The main oral manifestations found were recurrent aphthous stomatitis and enamel defects. Additionally, delayed tooth eruption, angular cheilitis, glossodynia and xerostomia were also reported.

CONCLUSION

Assessing oral manifestations is crucial, especially in underdiagnosed cases of children with CD. Recognizing these signs helps pediatricians or general practitioners identify them during routine exams, enabling early diagnosis and treatment to prevent negative impacts on the child’s and family’s quality of life.

Keywords: Oral manifestations; Celiac disease; Pediatric dentistry; Enamel defects; Oral aphthous

Core Tip: Celiac disease is a chronic enteropathy with atypical manifestations and complex etiopathogenesis, challenging clinicians. Understanding its oral manifestations can greatly improve patients' quality of life. These manifestations occur in the non-keratinized oral mucosa, impacting feeding, speech, swallowing, and tooth brushing. Dentists play a crucial role in treating oral consequences, identifying cases early, and referring patients for medical evaluation. Their involvement is essential for timely diagnosis and management. Multidisciplinary collaboration between dentists and physicians ensures comprehensive care, addressing both oral and gastrointestinal aspects. Early detection and intervention can significantly improve outcomes and prevent long-term complications for affected individuals.