CELIAC PRESENTING AS ATYPICAL DENTAL DISEASE

Introduction-Celiac disease has immune based autoimmune disease which is noticed in genetically predisposed persons and isdue to gluten allergy. It was initially thought that it is disease of children and presents with typical or classical symptoms associated with gastro-intestinal tract like pain abdomen, diarrhoea or constipation. Now, it has been proven that it is commonly seen in adult age also and in half of cases presents with atypical or unclassical symptoms which are mainly due to nutrients or minerals deficiency. Thus, patients can have neurological, psychiatric, dental or reproductive problems. The dental problems have varied presentations like delayed eruption of teeth, dental enamel defects, dental decay, periodontitis etc. The dental involvement in celiac disease is mainly seen in children and may or may not respond to complete gluten restriction.

Case Report- We report a case of seven-year-old child who was asymptomatic but celiac disease was diagnosed recently in his father due to unexplained transaminitis and on family screening, he was diagnosed to be celiac and his dental examination showed dental enamel defect localized unilaterally in upper incisors and canines only. He was put on strict gluten restricted diet but even after follow up of one year, there was no improvement in teeth.

Conclusion- Celiac disease has varied atypical presentations like involvement of teeth which is commonly missed. It lays stress of its awareness among Dentists, Endocrinologists and General Physicians for timely diagnosis for avoiding permanent damage to teeth which have huge cosmetic value.

引言——乳糜泻（Celiac disease）是一种由麸质过敏引发、见于遗传易感人群的免疫介导性自身免疫性疾病。该病最初被认为仅见于儿童，典型临床表现为腹痛、腹泻或便秘等胃肠道症状。现已证实，乳糜泻也常见于成人群体，且约半数患者表现为非典型症状，此类症状多由营养物质或矿物质缺乏引发。因此患者可能出现神经系统、精神心理、口腔及生殖系统相关病变。其口腔表现多样，包括牙齿萌出延迟、牙釉质缺损、龋病、牙周炎等。乳糜泻的口腔受累情况主要见于儿童，且对严格麸质限制饮食的治疗响应存在个体差异。

病例报告——我们报告1例7岁无症状患儿：其父亲因不明原因转氨酶升高近期被诊断为乳糜泻，经家族筛查确诊该患儿亦罹患乳糜泻，口腔检查显示其单侧上颌切牙及尖牙存在局限性牙釉质缺损。予患儿严格麸质限制饮食干预，但随访1年后，其牙齿病变未见改善。

结论——乳糜泻存在多种非典型临床表现，如牙齿受累，此类情况常被漏诊。本研究强调需提高牙医、内分泌科医师及全科医师对该病的认识，以便及时诊断，避免对具有重要美容价值的牙齿造成永久性损伤。