In people with celiac disease, eating gluten can wreak havoc on oral health. In fact, eighty-five percent of people with celiac disease have problems with their tooth enamel. And mouth symptoms from eating gluten- especially discolored teeth and canker sores- can be the first signs of celiac to show up in children. Gluten sensitivity may pose a problem for oral health too. There are telltale signs of celiac disease that show up first in the mouth. You don’t want to miss these, especially if you have children. Who could imagine something like wheat gluten would take such a toll on the mouth?
Celiac disease is an autoimmune disease triggered by eating wheat gluten. Gluten is a protein found in wheat, rye, and barley that gives bread its chewy consistency. In celiac disease, when a person eats gluten, the immune system attacks the body and slowly destroys the gut lining, which makes it hard to absorb vitamins and minerals. If it goes untreated, celiac disease can lead to other autoimmune diseases. A gluten-free diet can turn it all around. Approximately 1 in 100 people in the US have celiac disease but some sources say it may be up to 2 in 100. There are many people walking around who don’t yet know they have celiac disease. Eighty-three percent of people with celiac disease are undiagnosed- or even misdiagnosed with the wrong condition. Gluten sensitivity, which we discuss later, is less well understood and may impact 0.6% to 13% of people.
“85% of people with celiac disease have tooth enamel defects.”
Since the celiac disease affects the gut and many other systems of the body, its effects spill over into the mouth. The gut and the mouth are kissing cousins, as I explain in my book, Heal Your Oral Microbiome. They share the same lining and structure and immune system. If you have chronic mouth sores, discolored teeth, a swollen, red tongue, dry mouth, or other mouth problems, don’t write off gluten as a possible cause. And be on high alert for these symptoms in children! We will discuss the signs and symptoms to look for, testing, treatments, and how the oral microbiome is imbalanced in celiac disease.
How Does Celiac Disease Affect Your Mouth?
Since mouth symptoms can be the only clues of hidden celiac disease, it’s important to pay attention to the mouth. Teeth enamel defects and canker sores are telltale signs. These are the ways that celiac disease and gluten can harm the mouth…
Celiac Disease Mouth Sores
Celiac disease can cause canker sores or mouth sores, also known as aphthous ulcers. These sores can show up on the inside of your cheeks and cause pain, especially if you eat something sour or salty. Mouth sores are not to be ignored. And don’t write them off thinking that you just ate too much citrus foods. They are telling you something is off with your oral health. Canker sores are common in celiac disease. If your mouth sores don’t resolve easily or keep coming back, it could be that you have undiagnosed celiac disease or that gluten is causing your mouth sores.
Gluten exposure in celiac disease can also cause angular cheilitis mouth sores. These sores can be found at the edge of your mouth, where your lips meet. They can be painful and unsightly cracked sores. Although they might look like cold sores, they are not the same thing.
Mouth sores can also be caused by inadequate B vitamins or other vitamins, which I review in my blog, Vitamins for Oral Health.
Teeth Enamel Problems
One of the most important signs of celiac in the mouth is changes to teeth enamel. Dentists call these “enamel defects” or “hypoplasia.” You’ve seen them. Teeth can be discolored. They may look yellow or brown. Teeth may have white, yellow, or brown spots on them. Celiac disease teeth may show little pits on them or bands across them. Teeth enamel may be mottled or translucent-looking. In celiac disease, teeth are damaged by the immune reaction to eating gluten and the nutritional deficiencies that occur until the person goes on a gluten-free diet.
Eighty-five percent of people with celiac disease have problems with their tooth enamel. For adults, this could mean “bad teeth,” extractions, cavities, and tooth loss. Dry mouth is another symptom of celiac disease, which can change the microbiome in the mouth and encourage cavities in teeth that already have weak enamel.
Swollen, red, smooth tongue (known as atrophic glossitis) can make it painful to swallow and eat. If celiac is affecting the texture and look of your tongue, you will surely notice it. It will have a smooth or slick look to it. You won’t see the characteristic little bumps or the crease that goes down the middle of the tongue. Geographic tongue, which earns its name because the tongue has shapes on it like a world map, is more common in celiac disease. Geographic tongue is caused by inflammation but is considered harmless.
Mouth Lining Inflammation
Your dentist or hygienist might notice you have inflammation of your oral mucosa or mouth lining. Known as oral lichen planus, it can appear as white patches, redness, or swelling. It might be noticeable as a lacy network on the inside of your cheeks. Your mouth lining may feel painful, uncomfortable, or like its burning. There may be open sores. While many sources say there is no cure, they may not be investigating the root causes of inflammation, such as gluten exposure in someone who has celiac disease or who is gluten-intolerant.
Celiac disease patients who are not strictly avoiding gluten get more head and neck cancers than those who are following a gluten-free diet. These are more common in untreated celiac disease: mouth cancer, esophageal cancer, larynx cancer, and lymphoma. The risk is estimated to be 10x higher in people with celiac disease who do not follow a gluten-free diet, compared to those that do.