Canker Sores

The Gluten File

From Detecting Celiac Disease in Your Patients by Harold T. Pruessner, MD
"Angular cheilitis (Figure 6) and recurrent aphthous ulcers (Figure 7) are frequent in children and adults with celiac disease.13 These clinical findings should prompt the physician to consider the diagnosis of celiac disease."

PubMed Abstracts

The oral manifestations of celiac disease: information for the pediatric dentist.
PMID: 23265166  2012

Coeliac disease is an immune-mediated chronic inflammatory disorder of the small bowel caused by irritant gluten and, possibly, other environmental cofactors, in genetically prone people. Coeliac disease is characterized by no (or elusive or varied) symptoms. Oral clinical settings include aphthous stomatitis and dental enamel defects. Association with other signs in the oral mucosa (such as, for example, soreness, a burning sensation, erythema or atrophy) is much less common and, often, not considered by clinicians. We report on a 72-year-old woman with a four months history of oral burning sensation as a single clinical manifestation of coeliac disease. Clinical presentation and symptomatology are discussed in relation to the differential diagnosis of oral glossodynia. This case history highlights the importance of considering coeliac disease in managing cases of idiopathic glossodynia.
Glossodynia and coeliac disease.
PMID: 22268634  April 2012

Oral manifestations of celiac disease: a clinical guide for dentists.
PMID:21507289  April 2011

RESULTS: The levels of serum antigliadin IgA and IgG antibodies were not significantly higher in patients with RAU in comparison with the controls (P = 0.937 and P = 0.1854 respectively). The levels of serum anti-CMP IgA, IgG and IgE antibodies were significantly higher in patients with RAU in comparison with the controls (P < 0.005, P < 0.002 and P < 0.001 respectively). In general, the increased humoral (IgA or IgG) immunoreactivity to CMP was found in 32 of 50 patients, while 17 of them showed the increased levels of both IgA and IgG immunoreactivity to CMP. At the same time, 16 out of 50 patients had IgA, IgG and IgE immunoreactivity to CMP. CONCLUSION: These results indicate the strong association between high levels of serum anti-CMP IgA, IgG and IgE antibodies and clinical manifestations of recurrent aphthous ulcers. 
Humoral immunity to cow's milk proteins and gliadin within the etiology of recurrent aphthous ulcers?
PMID: 19563417  Nov 2009

CONCLUSIONS: This study supports that CD is highly associated with dental enamel defects in childhood, most likely because of the onset of CD during enamel formation; no such association was found in adults. Our study also supports the association between CD and aphthous ulcer. All physicians should examine the mouth, including the teeth, which may provide an opportunity to diagnose CD. In addition, CD should be added to the differential diagnosis of dental enamel defects and aphthous ulcers.  
The Association Between Celiac Disease, Dental Enamel Defects, and Aphthous Ulcers in a United States Cohort.
PMID: 19687752 Aug 2009

CONCLUSION: A significant minority (e.g. 2.83%) of RAS patients have GSE. This could be compared with the 0.9% prevalence of GSE in the general population of Iran. This study suggests that evaluation for celiac disease is appropriate in patients with RAS. Additionally, the unresponsiveness to conventional anti-aphthae treatment could be an additional risk indicator.
Gluten sensitivity enteropathy in patients with recurrent aphthous stomatitis.
PMID: 19534771  June 2009

CONCLUSIONS: The epidemiological association found between coeliac disease and aphthous-like ulcers suggests that recurrent aphthous-like ulcers should be considered a risk indicator for coeliac disease, and that gluten-free diet leads to ulcer amelioration.
PMID: 18063428  Feb 2008
Forty-six out of 197 coeliac disease patients (23%) were found to have enamel defects vs. 9% in controls (P < 0.0001). Clinical delayed eruption was observed in 26% of the pediatric coeliac disease patients vs. 7% of the controls (P < 0.0001). The prevalence of oral soft tissues lesions was 42% in the coeliac disease patients and 2% in controls (P < 0.0001). Recurrent aphthous stomatitis disappeared in 89% of the patients after 1 year of gluten-free diet.
Oral pathology in untreated coeliac disease.

PMID: 17919276  Dec 2007

Coeliac disease: Oral ulcer prevalence, assessment of risk and association with gluten-free diet in children.
PMID: 18063428  Dec 2007

Celiac disease presenting with chilblains in an adolescent girl.
PMID: 17014640  Sep 2006


Frequency and prognostic value of IgA and IgG endomysial antibodies in recurrent aphthous stomatitis.
PMID: 16874419  2006 

Long-standing oral aphthae - a clue to the diagnosis of coeliac disease. PMID: 10894972  2000

Oral mucosal changes in coeliac patients on a gluten-free diet.
PMID: 9786318 Oct 1998

Gliadin antibodies identify gluten-sensitive oral ulceration in the absence of villous atrophy. 
PMID: 1753350  Nov 1991

Twenty selected patients with recurrent aphthous stomatitis in whom celiac disease had been specifically excluded were placed on a gluten-free diet. Five patients (25%) showed a favorable response to gluten withdrawal and a positive gluten challenge. Jejunal morphology was normal in all patients indicating gluten sensitivity without enteropathy.
Gluten-sensitive recurrent aphthous stomatitis.
PMID: 7261838  Aug 1981

In the group, two patients were found to have coeliac disease and their recurrent aphthae cleared soon after starting a gluten free diet. This study confirms the presence of an increased prevalence of nutritional deficiency and of coeliac disease in aphthous patients.
Coeliac disease associated with recurrent aphthae.
PMID: 7399324  Mar 1980

All remitted completely on a gluten-free diet, both clinically and haematologically, and the aphthous ulceration did not recur.
Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration.
PMID:1247715  Jan 1976

We suggest that the high incidence of deficiencies found in this series and the good response to replacement therapy shows the need for haematological screening of such patients.
Recurrent aphthae: treatment with vitamin B12, folic acid, and iron.
PMID: 1148667  May 1975