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. 2024 Feb 28;13(5):1382. doi: 10.3390/jcm13051382

Table 1.

Descriptive summary of item selection.

Author (Year) Type of Study Sample Size Age Type and Gravity of the Defects Type of Analysis Performed Outcomes
Bulut et al. (2023) [38] Clinical study 78 P 4 to 15 y.o. Enamel defects as per Aine’s classification observed in 34.5% of patients (Grade 1 in most cases, Grade 2 in 3.8%).

  • OE

  • DMFT

  • Dental plaque

  • DED

  • Analysis of unstimulated salivary flow rate and PH value

 One group had higher dental decay scores with no differences in salivary metrics, 34.5% had mild enamel defects, and aphthous stomatitis was more common in recently diagnosed individuals.
Coelho et al. (2023) [40] Cross-sectional study 146 CD P 10.5 years RAS, DC, and DO

  • Online questionnaire for parents

  • Oral health behaviors

  • History of oral manifestations

 RAS (46.6%), DC (45.2%), and DO (39%) was the most reported oral manifestation among CD P.
Elbek-Cubukcu et al. (2022) [79] Prospective cohort study 62 CD P, 64 CP n.r. MIH, RAS, poor oral hygiene, and dental status

  • OE

  • DMFS

  • DFS

  • MIH assessment

 Prevalence of DED: in the group with CD: 61% (MIH); in the control group 65.6% (no MIH).
Ludovichetti et al. (2022) [80] Ob S 114 P 6–14 y.o. DEDs, specifically hypoplasia; Severity classified by Aine’s classification (Grade 0, Grade I, Grade II/III)

  • OE

  • Fischer’s Test

 DEDs were present in 31.6% Grade 0, 34.2% Grade I, 23.7% Grade II/III in the celiac disease (CD) group.

  • In the non-CD group, 60.5% had no defects, 31.6% Grade I, 7.9% Grade II/III.

  • Control group mostly had no defects (71.1%).
Ahmed et al.
(2021) [1]		 Prospective CC study 118 P 20–37.23 DED observed in 66.9% of patients with CD, specific/bilaterally symmetrical more common in treatment-naïve and GFD-treated patients compared to controls (20%)

  • Statistical analysis using GraphPad Prism 8 software, with χ2 test or Fisher’s exact test

 Significantly higher percentage of CD patients (68.6%) reported xerostomia/dry mouth sensation compared to controls (7.5%), DED 8.1 (95% CI 3.4–19.2), xerostomia 27 (95% CI 7.8–93.2).
Villemur Moreau et al. (2021) [81] Ob S 28 CD and 59 CP 3–12 y.o. DEDs graded according to Aine’s classification (grades I to IV)

  • OE

 CD children had significantly more enamel defects and recurrent aphthous stomatitis than the control group (67.9% vs. 33.9% for ED, and 50.0% vs. 21.8% for RAS, respectively).
No significant delay in dental eruption was observed in CD children.
EDs in CD children were more severe than in the control group (p = 0.04).
Khalaf et al. (2020) [82] CC 23 CD P, 23 CP 39.1 ± 14.4 years Dental enamel hypoplasia, aphthous ulcers, dental caries (DMFT)

  • OE

  • Rx evaluation

  • Saliva test

 Significant inverse relationship between MIH and age at diagnosis of celiac disease: Marsh 2 damage type in celiac disease is associated with an increased risk of dental caries.
Reduced buffering capacity of saliva in children with celiac disease.
Kuklik et al. (2020) [83] Prevalence study 40 CD P
40 CP		 16.5 y.o. MIH with demarcated opacities, post-eruptive breakdown (PEB), atypical restoration

  • OE of teeth under natural light using a flat mirror and a blunt tip

 Out of 80 participants, 10 had MIH (12.5%).
Among the 40 celiac patients, 8 had MIH (20%).
Among the 40 individuals without CD, 2 had MIH (5%).
Celiac disease increased the likelihood of MIH occurrence by 4.75 times compared to the CG.
Pereira Macho et al. (2020) [84] CC 160 P 6–18 y.o. Mainly symmetrical enamel defects characterized by pitting, grooving, and loss of enamel

  • OE

 Grade I and Grade II defects were observed in both groups, but significantly higher in celiac group (p = 0.002, p = 0.003). Symmetric enamel defects were more prevalent in celiac group, particularly in first upper molars, first lower molars, lateral upper incisors, and central upper incisors (p < 0.05).
Shahraki et al. (2019) [85] Prospective Ob S 65 CD P
60 CP		 Ages 3–16 y.o. DED symmetric and non-symmetric; Grades I–IV based on Aine’s criteria

  • OE

 Half of the patients with celiac disease exhibited enamel defects, predominantly mild but including some severe cases, with a higher incidence of tooth decay in baby teeth, more frequent dry mouth symptoms, but not in adult teeth, despite reduced sugar intake compared to the control group.
Zoumpoulakis et al. (2019) [86] Comparative, Cross-sectional 45 CD P, 45 CP 10.3 ± 4.1 y.o. Systemic and non-systemic DED

  • OE

  • DMFT

 Prevalence of systemic DED was significantly higher in CD patients (51.1%) compared to controls (11.1%).
Amato et al. (2017) [87] CC 49 CD P
51 CP		 CD P: 31.8 ± 11.58 y.o., CP: 30.5 ± 8.7 y.o. Enamel Hypoplasia: Aine Grade 1 (4 patients), Aine Grade 2 (3 patients); Non-specific Tooth Wear: Smith and Knight Index Grade 1 (4 patients), Grade 2 (3 patients), Grade 3 (2 patients)

  • Saliva Analysis,

  • DMFT

 RAS: CD Patients 53.0%, Controls 25.5%; Aphthosis during visit: CD Patients 0%, Controls 0%; Atrophic Glossitis: CD Patients 0%, Controls 0%; Enamel Hypoplasia: CD Patients 14.3%, Controls 0%; Non-specific Tooth Wear: CD Patients 18.3%, Controls 5.9%.
de Queiroz et al. (2017) [88] Retrospective Ob S 45 CD p Age range: 2–15 y.o. DED Grades I-IV based on Aine’s criteria
55.6%

  • OE

  • DEDs phenotype determination using Aine classification

 DED prevalence 55.6%.
Cantekin et al. (2015) [65] RS 25 CD P, 25 CP P 8.94 ± 2.08 (CD) and 9.66 ± 4.26 (CP) y.o.; DED prevalence was higher in CD children (48%) than healthy children (16%). Enamel defects were generally symmetrical and mostly observed in anterior teeth.

  • DDMFT scores

 DMFT scores were significantly higher in CD children (3.75 ± 2.62) compared to the control group (1.83 ± 1.78). RAS prevalence was higher in CD children (44%) compared to the control group (0%). Significant differences were found between CD and control groups for both enamel defects (p = 0.01) and DMFT scores (p < 0.01).
de Carvalho et al. (2015) [89] CC 52 CD P and 52 CP; additional 50 DEDs 2 to 15 y.o. DEDs graded according to Aine’s classification (grades I to IV)

  • DEDs

  • RAS

  • dental caries experience

  • salivary parameter

  • analysis of primary enamel molars using energy dispersive x-ray spectroscopy and Fourier transform infrared spectroscopy.

 Children with celiac disease had more dental enamel defects and mouth ulcers but fewer cavities, showed signs of altered enamel chemistry with lower salivary flow and altered calcium-to-phosphorus ratios, although their carbonate-to-phosphate ratios were comparable to those of a control group.
Bramanti et al. (2014) [90] Prospective Cohort 116 PP 2–16 years old Specific Enamel Defects (SED)—Grades I-IV (severity)
Unspecific Enamel Defects (UnSED)
Dental Caries (DMFT/dmft indices)
Dental Delayed Eruption (DDE)		 Cross-Sectional Study Anomalies found in oral hard tissues:

  • Delay in tooth eruption:

    • ○

      Group A: 38%

    • ○

      Group B: 42.8%

    • ○

      Group C: 11.1%

  • Specific enamel defects (SED):

    • ○

      Group A: 48%

    • ○

      Group B: 19%

    • ○

      Group C: Absent

  • The presence of SEDs in patients with established celiac disease is significantly higher than in patients with potential celiac disease (48% vs. 19%, p = 0.0328).
Shteyer et al. (2013) [91] PS 90 P, 30 in each group (newly diagnosed CD, CD treated with Gluten Free Diet, and control). 1.4 to 18 years; DEDs graded according to Aine’s classification (grades I to IV).

  • OE

  • Saliva sampling for bacterial and pH analysis

  • DMFT/dmft index

  • Plaque index.

 Higher prevalence of enamel hypoplasia in CD children (66%).
Trotta et al.
(2013) [48]		 Prospective Ob S 54 P 37 ± 13 years DED observed in 85.2% of CD P, predominantly Aine grade 1 type lesion (33.3%)

  • DED according to Aine (Table 1)

  • Chi square test for association with clinical type and age at diagnosis

 Severe DED (Aine grade 3 and 4) more common in classical CD (10/32) than non-classical CD (2/20), not statistically significant.