Dental Hygiene for People with Celiac Disease

The oral health of people with celiac disease manifests in specific symptoms they must pay attention to and try to prevent, if possible. Today's article will discuss what they can do to protect their gums and teeth.
Dental Hygiene for People with Celiac Disease

Last update: 22 September, 2021

It may seem like there’s no relationship between oral hygiene and celiac disease, but people with this condition must actually pay special attention to their dental hygiene. This is because we’re now aware that this condition affects dental structures.

In fact, some people actually begin to show signs of oral decay before they even experience those typical of celiac disease. Thus, dentists must consider it to make a proper diagnosis and prescribe treatment as soon as possible. This is mainly about dietary restrictions.

In this regard, oral hygiene for people with this condition is part of the preventive therapy of the side effects of gluten intolerance. An individual must explore and find a proper diet following their specific requirements. This is so they’ll be able to adopt it and relieve any future complications.

Every capable adult must be responsible for care for their teeth, gums, and soft tissues, but those with celiac disease must be particularly dedicated to it. As you’re about to see in this article, the disorder can deteriorate tooth enamel, gums, and lips.

How does celiac disease affect dental health?

To assess the necessary oral hygiene in people with celiac, one must first recognize the effects of this condition in the mouth. These can begin at an early age and even lead to the development of bacteria. Hence the importance of detecting any changes during children’s consultations.

The effects of celiac disease on tooth enamel

This is a relatively serious problem in people with celiac and the damage is irreversible because it’s difficult to address. An early diagnosis usually prevents major complications.

Nutritional deficiencies are the main theory regarding the cause of this problem. Celiac disease is an allergy, an inadequate response of the immune system and intestinal villi to the gluten present in wheat, oats, barley, and rye. In short, it’s a reaction to a food protein.

As time goes by and the allergy worsens the intestinal villi flatten and lose the capacity to absorb as they should. Thus, several nutrients fail to enter the body, even if the person with this condition is consuming them. Thus, a chronic deficit might explain enamel decay.

At the same time, considering there’s an exaggerated reaction of the immune system, it could be that cross-reactive antibodies attack the enamel and destroy it. Furthermore, this problem will alter the proper development of all the tissues that make up the dental element if it begins during childhood.

People with celiac disease have belly aches when they eat gluten.
The deficit in the absorption of nutrients in celiac disease results in a lower intake of substances that the enamel needs to develop.

Poor dental development

Children with celiac disease may experience poor development of their temporary and permanent teeth. This is partly due to what we explained above. The good news is an appropriate diet could reduce the negative effect in this case.

Ok but, how do you detect it? Well, the most obvious sign is the delay in tooth eruption and replacement. That is to say, the organism of a child won’t stick to the established timeline for a given dental element to pop up in the mouth.

Dry mouth and Sjögren’s syndrome

It’s common for other conditions to manifest as they have the same basis of immune system reactivity due to the autoimmune component of celiac disease. For instance, some people with this condition also develop Sjögren’s syndrome.

This syndrome takes place when antibodies destroy body glands responsible for lubricating tissues. That is they attack the lacrimal and salivary glands as well as those involved in perspiration. It means mouth dryness, as there’s not enough saliva to keep the space moist.

You may not be aware of it but the negative effects multiply when there’s no saliva. In fact, there’s a greater prevalence of harmful bacterial colonization that leads to more aggressive, larger cavities that manifest sooner than usual.


Beyond Sjögren’s syndrome, cavities are more prevalent in celiac disease. This is why oral hygiene is of vital importance for people with celiac. That is they must reduce sugar intake to also decrease the presence of bacteria linked to fermentation.

As mentioned above, there are defects in the enamel, which promotes cavities. The enamel is a hard layer, but not strong enough to withstand environmental attacks when not formed correctly.

At the same time, nutrient deficiencies due to poor intestinal absorption condition the defense power of the balance of the oral environment to prevent cavities. Deficiencies of calcium and vitamin D are common in these people. Thus, both substances are essential for the development of bones and teeth.

Oral thrush

Nutritional deficiencies are also behind canker sores in celiac disease. In particular, vitamin B12 and folate deficiency are the direct culprits. Not to mention the oral mucosa is part of the same one that extends into the intestine. So no wonder a reaction in the lower part of the digestive system also manifests in the upper part.

Canker sores are self-limiting oral sores or ulcerations. They usually last a week and the healing process leaves no permanent marks. However, they’re quite annoying and make chewing painful. This is why they often alter the diet of people who are already under strict restrictions.

Why do people with celiac disease have dental problems?

As we mentioned above, celiac disease conditions the absorption of nutrients. This is because the gluten allergy flattens the intestinal villi and they lose functionality.

Also, this problem doesn’t distinguish too much when it comes to malabsorption. Thus, it reduces the intake of substances as varied as minerals and vitamins into the body. Similarly, digestive symptoms can condition caloric intake, leading to weight loss and a reduction of the body’s defense capabilities.

A deficiency of calcium and vitamin D will directly affect the teeth. Both substances are key in the development of dental structures and the repair of hard tissues.

Anemia in people with celiac disease has often contributed to oral health, though indirectly. Thus, these individuals have less oxygen supply in their tissues, which include the gums. Moreover, less oxygen means less ability to repair and heal, and canker sores and trauma don’t heal as they should.

The autoimmune part is yet another factor to consider in the relationship between an oral condition and celiac disease. Concomitant immune disorders are frequent, as with Sjögren’s syndrome. As you can see, the presence of antibodies that attack one’s own tissues is counterproductive for body structures.

The enamel might just be the paradigmatic case to explain why celiac patients have dental problems from an early age. The first seven years of life constitute the critical period for the formation of this layer. A child with celiac malnutrition and with antibodies that destroy what the body’s trying to repair is likely to reach adulthood with poorly developed decayed teeth.

Dental hygiene in people with celiac disease

These people must address it with a professional. Thus, dentists must be attentive to early diagnosis but also exercise special care in their offices.

Professional dental hygiene for people with celiac disease

As it turns out, the dental office isn’t gluten-free. That is, a person with celiac disease could be indirectly exposed to gluten without consuming it during a visit to an oral health professional.

You may not know it but some kinds of toothpaste and even certain plastic items contain gluten. Dental floss could also have this protein and cause bad reactions in a person. Thus, the dentist must be aware of the actual ingredients of any products they use.

A dentist at work.
Dentists often have gluten-containing materials and substances.

General standards for the life of a person with gluten intolerance

Reducing exposure to gluten will result in benefits to the entire digestive tract and the overall health of an individual. This is actually the main recommendation and best therapeutic approach for this disease. Thus, it’s impossible to move towards other care guidelines if without adopting the right diet.

Considering the increased risk of cavities, a nutritional plan must limit sugars, as these are the substrate for bacteria to generate the acid that damages the enamel. In addition, the caloric balance must prevent extreme weight loss.

As for brushing and flossing, the recommendations are the same as for the general population. Meeting the minimum standards will reduce the risk of cavities. Also, people must brush their teeth three times a day, especially after meals.

Finally, visits to the dentist must take place once a year — more frequently if there are problems or if there’s a recent diagnosis or specific comorbidities, such as Sjögren’s syndrome. A specialized check-up can detect problems that, perhaps, one can solve before they become major problems.

Prevention of aphthous ulcers as part of dental hygiene in celiac patients

Canker sores are frequent in people with celiac disease so they must complement oral hygiene by paying special attention to ulcer-promoting foods. Usually, these are spicy and acidic products.

Those who can’t prevent them and have a recurrent problem must resort to certain medications that can soothe the discomfort. Ideally, a dentist must prescribe them — even if they’re over-the-counter. Be sure to read the list of ingredients as many of these contain gluten.

Dry mouth relief

A person with gluten intolerance that also has Sjögren’s syndrome will have to reduce the dryness of their mucous membranes. This is because it’ll prevent cavities and help them better digest the foods allowed in the nutritional plan.

Hydrating throughout the day and not going thirsty is crucial. A person might require more depending on the dysfunction of the salivary glands. A dentist may also prescribe substitute saliva and it has specific indications.

Similarly, some kinds of toothpaste and mouthwashes on the market are specifically for treating dry mouth. They have elements against xerostomia in their composition and can counteract the most common negative effects.

Oral hygiene for people with celiac disease is a matter of general health

People with celiac disease cannot separate oral hygiene from their overall health. Thus, a gluten-free diet, regular checkups, matching nutrition to requirements, vitamin supplementation, and prevention of complications are all linked to oral health.

Finally, ongoing professional advice is important so finding a dentist you can trust is of utmost importance. Opt for one who can evaluate and record changes over time and prescribe the necessary products for every circumstance.

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