Mechanism behind tooth enamel disorder in coeliac disease

Dental Tribune International

Wed. 13. December 2023

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KUOPIO, Finland: It is well established that coeliac disease can adversely affect oral health, yet the underlying mechanisms are not fully understood. A recent study has uncovered a connection between tooth enamel development disorders, commonly seen in patients with certain autoimmune diseases, and autoantibodies targeting proteins involved in the formation of tooth enamel.

With a prevalence of around 1% of the general population, coeliac disease is the most common genetically induced food intolerance in the world, according to the Celiac Disease Foundation. The prevalence among children is higher than in adults. Although initially it was reported from countries with predominantly Caucasian populations, it now has been reported from other parts of the world.

In addition to gastro-intestinal symptoms, one often overlooked aspect of coeliac disease is its impact on oral health. Previous research has established a link between coeliac disease and various oral health issues, including delayed tooth eruption, tooth enamel disorders and oral aphthae. These oral manifestations can serve as valuable indicators for early screening of the disease, making it important for dental professionals to be aware and refer their patients to a general practitioner for follow-up.

The international collaborative study involved researchers from the Czech Republic, Israel, Norway, Hungary and Finland. The University of Eastern Finland reported in a press release that the study included 48 adults and 21 children with coeliac disease, and 28 patients with autoimmune polyglandular syndrome type-1 (APS-1).

The small intestine protein transglutaminase 2 (TGM2) plays a key role in triggering coeliac disease by modifying a component of gluten in the diet. This modification prompts the immune system in coeliac patients to produce antibodies.

Up until now, it was believed that the oral manifestations in coeliac disease are primarily caused by malabsorption resulting from gut inflammation. However, the researchers found that the antibodies bind to the proteins which are responsible for tooth enamel formation, hence causing disorders. This is caused by tooth enamel proteins showing similar binding sites for antibodies as, for example, for the protein TGM2.

The study, titled “Autoimmune amelogenesis imperfecta in patients with APS-1 and coeliac disease”, was published online on 22 November 2023 in Nature, ahead of inclusion in an issue.

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