By Jane Anderson 

 Medically reviewed by Robert Burakoff, MD

Your teeth and gums play an important role in your digestive system. But it might come as a surprise to learn that celiac disease—which most people associate more frequently with symptoms a bit lower in the digestive tract—can seriously impact your mouth.

In fact, it's possible for your teeth and gums to show signs of celiac disease even before you develop other symptoms, such as diarrhea or constipation, bloating, chronic tiredness or a very itchy skin rash. And these mouth-related problems can hang around even after you start the gluten-free diet.

So what should you and your dentist be on the lookout for? Here's a rundown of how celiac disease affects your mouth.

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Effects on Children's Teeth

Celiac disease can develop and be diagnosed at any age, in anyone from a toddler to an older adult. But if it first develops when a child's permanent teeth are developing, which generally occurs before age seven, then those permanent teeth may not develop properly.1

A celiac child's teeth may not have enough enamel on them, which can make them look patchy and white, yellowish or brownish in color. This condition, called "enamel hypoplasia" by dentists, can lead to more cavities and sometimes to increased sensitivity in teeth.2

Teeth also may appear ridged or pitted in some children with celiac disease, and in the most severe cases, they may have a visible horizontal groove across them.

Grooves are a more serious form of enamel defect. Since permanent teeth start to form long before they ultimately push baby teeth out and take their place in the gum line, dentists believe these horizontal grooves occur in those permanent teeth as the child first develops celiac disease.

Enamel defects aren't limited to children with celiac disease—poor nutrition, infections, genetic disorders, and even some medications can affect enamel development. But studies have shown that enamel defects are more common in those with celiac disease than in people who don't have the condition.3

Causes of Enamel Defects in Celiac Disease

It's not clear why children with celiac disease develop these enamel defects—researchers just aren't sure. There are two theories: it's possible that the nutritional deficiencies that occur with celiac's destruction of the small intestinal lining cause the problem indirectly, or the child's immune system may damage the developing teeth directly.

There's another piece of evidence pointing to some sort of direct immune system damage: dental enamel defects also are found in close relatives to people who have been diagnosed with celiac disease, but who haven't been diagnosed with the condition themselves.1 That indicates the cause of these enamel defects is some malfunction in your immune system, rather than the nutritional deficiencies that develop due to gluten-induced small intestinal damage.

Unfortunately, once the damage has occurred, there's no way to reverse it. That's one of the reasons early diagnosis of celiac disease is so important in children—the damage may be less severe if the child is diagnosed quickly and begins following the gluten-free diet.

There are remedies for people whose adult teeth were badly affected by the undiagnosed celiac disease in childhood. Talk to your dentist about the use of dental sealants or bonding, which can protect teeth from damage. In the most severe cases, your dentist may recommend crowns or even dental implants.

Slower Dental Development

There's also some evidence that children with celiac disease may have delayed dental development—in other words, their baby teeth and permanent teeth don't erupt on schedule.

One study that looked at the so-called "dental age" (in other words, the age teeth normally appear in children) in children with celiac disease found that celiac children do seem to have slower dental development, just as they may be shorter than non-celiac children.

The study's authors reported that the gluten-free diet may help teeth catch up, just as it helps some children gain more height.

Cavities

It's not uncommon to hear people who just have been diagnosed with celiac disease talk about their "bad teeth," with multiple cavities, or to discuss how, just before they were diagnosed, they suddenly had several new cavities. As it turns out, there may be some truth to this, although studies have been mixed.

If you have had undiagnosed celiac disease since childhood, you may have developed enamel defects, which can leave you prone to cavities. Researchers believe these enamel defects may occur well before you develop other obvious symptoms of celiac disease.4

In addition, low levels of vitamin D—which commonly afflict people with celiac disease—may increase your risk for cavities. Other nutritional deficiencies in celiac disease, such as calcium deficiency, may play a role as well.1 People who have celiac disease are prone to numerous nutritional deficiencies since their small intestine isn't working well to absorb the nutrients in the foods they eat.5

Once your dentist has diagnosed and treated a cavity, you can't reverse it. However, following a strict gluten-free diet with no cheating should help to improve your dental health if you have celiac disease.

Mouth Sores

If you've ever had mouth sores or canker sores—known in medical parlance as aphthous ulcers—you know how painful they are.

These white sores, which can occur on the inside of your lips and elsewhere on your gums or on your tongue, may develop if you've had some injury to your mouth (such as accidentally biting your cheek or lip). They also can develop seemingly randomly. Aphthous ulcers generally last for seven to 14 days and can make talking and eating difficult.6

Research shows that people with celiac disease are more prone to develop frequent aphthous ulcers than people without the condition. In fact, one large survey showed that 16% of children with celiac and 26% of adults with celiac reported having recurrent oral ulcers.78

As with other dental problems that occur in conjunction with celiac disease, it's not clear why celiac would cause an increase in oral ulcers. One possibility is (again) nutritional deficiencies—specifically, deficiencies in iron, folate and vitamin B12, all of which tend to be low in those with celiac.1

That being said, there are numerous other potential causes for frequent aphthous ulcers, including inflammatory bowel disease and lupus. And, in most people these ulcers aren't associated with any condition—they're just an annoyance without an underlying cause.

Therefore, you can't assume that you have celiac disease simply because you frequently get aphthous ulcers. However, if you're concerned about them, you should talk to your healthcare provider or dentist about potential causes and solutions.

Various over-the-counter gels and pastes may help to blunt the pain of mouth sores, although they probably won't help them heal faster. Using cough drops that contain zinc gluconate also may help. In severe cases, your healthcare provider or dentist may prescribe a mouthwash containing antibiotics.

Dry Mouth

It's not uncommon for people with celiac disease to complain of dry mouth, which can result in tooth decay. As it turns out, one major cause of chronic dry mouth—Sjögren's syndrome—is linked to celiac disease.

Sjögren's syndrome is an autoimmune condition that causes your immune system to attack the glands that produce the moisture needed for your eyes and mouth. The result is unnaturally dry eyes and a mouth with significantly less saliva. Since saliva controls the growth of bacteria that lead to tooth decay, people with Sjögren's syndrome are prone to sometimes-catastrophic tooth decay and tooth loss.9

Although there's a lot of overlap between the two conditions, nowhere near everyone with Sjögren's syndrome has celiac disease (or vice versa). Some studies estimate that about 15% of those with Sjögren's syndrome also have celiac disease.10

Nonetheless, if you've been diagnosed with celiac disease and you suffer from dry mouth or dry eyes, you should talk with your healthcare provider about the possibility of Sjögren's syndrome. If it turns out you have both, prescription medicines are available that can help stimulate the flow of saliva and protect your teeth.

 Sources

Rashid M, Zarkadas M, Anca A, Limeback H. Oral manifestations of celiac disease: a clinical guide for dentists. J Can Dent Assoc. 2011;77(b39):1-6.

Cervino G, Fiorillo L, Laino L, et al. Oral Health Impact Profile in Celiac Patients: Analysis of Recent Findings in a Literature Review. Gastroenterol Res Pract. 2018;2018:7848735. doi:10.1155/2018/7848735

Amato M, Zingone F, Caggiano M, Iovino P, Bucci C, Ciacci C. Tooth Wear Is Frequent in Adult Patients with Celiac Disease. Nutrients. 2017;9(12). doi:10.3390/nu9121321

Trotta L, Biagi F, Bianchi PI, et al. Dental enamel defects in adult coeliac disease: prevalence and correlation with symptoms and age at diagnosis. Eur J Intern Med. 2013;24(8):832-834. doi:10.1016/j.ejim.2013.03.007

Wierdsma NJ, van Bokhorst-de van der Schueren MAE, Berkenpas M, Mulder CJJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients. 2013;5(10):3975-3992. doi:10.3390/nu5103975

Tarakji B, Gazal G, Al-Maweri SA, Azzeghaiby SN, Alaizari N. Guideline for the diagnosis and treatment of recurrent aphthous stomatitis for dental practitioners. J Int Oral Health. 2015;7(5):74-80.

Rashid M, Cranney A, Zarkadas M, et al. Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children. Pediatrics. 2005;116(6):e754-e759. doi:10.1542/peds.2005-0904

Cranney A, Zarkadas M, Graham ID, et al. The Canadian Celiac Health Survey. Dig Dis Sci. 2007;52(4):1087-1095. doi:10.1007/s10620-006-9258-2

Maarse F, Jager D-H-J, Forouzanfar T, Wolff J, Brand H-S. Tooth loss in Sjögren’s syndrome patients compared to age and gender matched controls. Med Oral Patol Oral Cir Bucal. 2018;23(5):e545-e551. doi:10.4317/medoral.22545

Harpreet S, Deepak J, Kiran B. Multiple autoimmune syndrome with celiac disease. Reumatologia. 2016;54(6):326. doi:10.5114/reum.2016.64911

Additional Reading

Condò R, Costacurta M, Maturo P, Docimo R. The dental age in the child with coeliac disease. Eur J Paediatr Dent. 2011;12(3):184-188.

Majorana A, Bardellini E, Ravelli A, Plebani A, Polimeni A, Campus G. Implications of gluten exposure period, CD clinical forms, and HLA typing in the association between celiac disease and dental enamel defects in children. A case-control study. Int J Paediatr Dent. 2010;20(2):119-124. doi:10.1111/j.1365-263X.2009.01028.x

By Jane Anderson
Jane Anderson is a medical journalist and an expert in celiac disease, gluten sensitivity, and the gluten-free diet.