<<Disclaimer: Verify this information before applying it to your situation.>> 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