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First dental visit for 3-year-old celiac - summary

Hi everyone,

Here finally is my summary of the replies I got about what to ask my
dentist to look for when my 3-year-old goes for her first dental visit.

Aside from asking about the GF status of all the cleaning products and
washes, people warned me that some celiacs react strangely to the local
anesthetics and that I might consider even getting my daughter tested by
an allergist for whatever dental anesthetic is going to be used on her.

I saved a note sent to the list a while ago from someone who has a list
of GF toothpastes. Can provide it if anyone's interested.

Also saved a note sent to the list by Scott Adams some time ago, and
have given this to my dentist who was very grateful to see it BEFORE my
daughter's appointment.

It reads as follows:

"Research Report on Dermatitis Herpetiformis" by Elaine I. Hartsook,
Ph.D.,R.D. (Gluten Intolerance Group of North America,1993) :

        Dental enamel defects similar to those previously seen in both
children
and adults with celiac sprue (Aine, 1989; Aine,1990) have been shown to
be present in adults and children with DH (Aine, 1991; Aine,1992).

        These enamel defects occur while the crowns of the teeth are forming,
that is, usually before the age of 7 years. Celiac-type enamel defects
are found on 'matched' teeth on both sides of the mouth (that is, they
are symmetrical) and they appear in the same location on the
tooth surface, showing that they occurred at same time (that is, they
are chronologically matched).

        Enamel damage has been classified by Aine and her coworkers as : Grade
1 = enamel lesions include defects in the color of the enamel; Grade 2
slight structural defects with a rough enamel surface and horizontal
grooves or shallow pits; Grade 3 evident structural defects with part of
all of the surface of the enamel rough and filled with deep horizontal
grooves varying in width or with large vertical pits; and Grade 4
severe structural defects in which the shape of the tooth has also
changed.

        Celiac-type dental defects were shown to be, overall, less severe in
those with DH than those with celiac sprue.

        Eighty-three percent of 40 adult subjects with celiac sprue were shown
to have enamel defects in Aine's 1990 study. Children with celiac sprue
had the most severe defects, with 11% showing Grade 4 enamel defects
(Aine, 1986).

        In Aine's 1992 study, 53% of the 30 adult study subjects with DH had
celiac-type dental defects, while only 2% of the 66 control subjects
showed these types of defects. The defects in those with DH were mild,
Grade 1 and Grade 2. Severity of enamel defects did not relate to the
degree of damage to the lining of the small intestine in these DH
subjects.

        When the total number of affected teeth were counted, 51% of the 793
teeth in DH subjects showed dental enamel defects as opposed to only 18%
of the 1,780 teeth from the normal control group.

        Enamel defects are thought to be caused by nutritional or
immunological
factors.

BIBLIOGRAPHY:

*Aine, L.: Dental enamel defects and dental maturity in children and
adolescents with coeliac disease. Proceedings of the Finnish Dental
Society, 82 (Suppl 3), pges 1-71, 1986

*Aine, l., Maki,M., Collin,P., and Keyrilainen, O.: Dental enamel defects
in celiac disease. Journal of Oral Pathology and Medicine. Vol. 19, pges
241-245, 1990

*Aine, L., Reunala, T., and Maki, M.,: Dental enamel defects in children
with dermatitis herpetiformis. Journal of Pediatrics. Vol. 118, pges
572-574, 1991.

*Aine, L., Maki, M., and Reunala, T.: Coeliac-type dental enamel defects
in patients with dermatitis herpetiformis. Acta Derm Venereol (Stockh).
Vol. 72, pges25-27, 1992.

Thanks everyone for all your help.

Kate Johnson, Montreal