Enamel hypoplasia in coeliac children: a potential clinical marker of early diagnosis

Authors:

ABSTRACT

Aim

To assess at the scansion electron microscope (SEM) the structural aspects of enamel hypoplasia (EH) in coeliac
disease (CD) with the aim to investigate our hypothesis of a possible significant difference between structural characteristics of EH in
CD affected patients and EH of non-coeliac patients. If the presence of specific features of the EH associated with CD were
demonstrated, these findings would represent for the dentist early non-invasive clinical markers of diagnosis of CD in case of suspected
disease.

Methods

We analysed at SEM two samples of enamel fragments from hypoplasic teeth, both deciduous and permanent,
harvested from 10 coeliac children (18 permanent teeth, 6 deciduous teeth; study group) and 10 non-coeliac children (16 permanent
teeth, 4 deciduous teeth; control group) treated for dental caries, dental extractions for extensive caries lesions or deciduous teeth
exfoliation.

Results

Significant structural differences were noted between EH of non-coeliac patients and same dental ? lesion in the
group with CD. In the study group, EH defects were predominantly located on the central and lateral incisors, upper and lower, both
deciduous and permanent, and on the first permanent molars, and were always simmetrical. EH of permanent teeth of CD affected
patients was characterised by prisms more irregularly distributed with irregular margins and less interprismatic substance than observed
in non-coeliac EH. The deciduous teeth of the study group showed shorter enamel prisms with a non-parallel direction up to
convergence and less interprismatic substance than observed in the control group.

Conclusion

This morphological analysis at SEM
of the hypoplasic enamel defects of a group of coeliac children, the first published in literature, demonstrates that the EH of deciduous
and permanent teeth in CD is highly hypomineralised with shorter prisms, more irregularly distributed and less interprismatic substance
than observed in the non-coeliac EH. More data are needed to validate the significance OF our observations with the aim to assess if
this simple, non-invasive microscopic analysis can be considered effective for the early identification of silent cases of CD that otherwise
would not be diagnosed in the paediatric age.

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