Prevalence of oral manifestations in coeliac disease and associated factors

Background: Various oral manifestations are associated with coeliac disease in children, whereas data on adults are scarce. Moreover, possible individual factors predisposing to these manifestations remain unresolved. The aim of this study was to investigate these issues in a large cohort of adult coeliac disease patients both at diagnosis and while on gluten-free diet (GFD). Methods: This population-based study involved 873 adult patients with coeliac disease and 563 non-coeliac controls. Patients and controls were interviewed and structured questionnaires were used to assess the severity of gastrointestinal symptoms and quality of life at the time of the study. All participants were systematically asked about oral manifestations, including dental enamel defects, recurrent aphthous ulceration and glossodynia. Coeliac disease-related data were collected from medical records. Possible individual factors associated with oral manifestations were studied using logistic regression analysis. Results: Dental enamel defects were more common among patients than among non-coeliac controls (27% vs. 4%, p < 0.001). Prior to the coeliac disease diagnosis, 56% of the patients had experienced recurrent aphthous ulceration and GFD brought relief to 69% of them. While on GFD, coeliac disease patients had higher prevalence of recurrent aphthous ulceration than did the controls (17% vs. 13%, p = 0.040), but this significance disappeared after adjusting for gender. Glossodynia on GFD was more prevalent in the coeliac cohort than in the controls (14% vs 6%, p < 0.001). Oral manifestations at diagnosis and on GFD were associated with the presence of abdominal symptoms at the time of coeliac disease diagnosis, long diagnostic delay and female gender. At the time of the study, patients with oral symptoms had more severe gastrointestinal symptoms and poorer quality of life than those without these symptoms. Conclusions: Oral manifestations were more prevalent, at diagnosis and on GFD, in patients with coeliac disease than in the controls, and they were associated with long diagnostic delay, abdominal symptoms, female gender and impaired quality of life. A GFD was shown beneficial in relieving recurrent aphthous ulcerations in patients with coeliac disease.