Gluten in Your Mouth
When you think about symptoms of gluten sensitivity, your mind might immediately go to digestive disturbances – things like acid reflux, bloating, or diarrhea. Or you might think of other symptoms like skin disturbances or migraines. But did you know that signs of gluten sensitivities can show up in the mouth? It’s true, and in fact, it’s been found that oral health problems are more commonly experienced in adult patients with celiac disease than those without.
There are several different ways that gluten exposure can manifest as oral health issues, and each can also have compounding effects on the rest of your health. We’ll dig into this discussion below and also provide some actionable tips for you to optimally manage your oral health.
Signs and Symptoms of Gluten Exposure in the Mouth
Numerous published papers have underlined how specific oral signs and symptoms can be classified as risk factor signals for celiac disease. In fact, the American Dental Association notes that specific oral manifestations observed in childhood may actually help to identify patients with early celiac disease before serious disease progression and harm develop. The following are common oral manifestations of gluten exposure:
- Aphthous ulcers (canker sores)
Also known as canker sores, aphthous ulcers are small ulcers with a red base and a yellow layer that usually appear on the tongue or inside the cheeks or lips. A 2010 study by Columbia University found that aphthous ulcers were more prevalent in people with celiac disease than those without. Another study published in BMC Gastroenterology found that recurrent mouth sores can be the only symptom of celiac disease.
- Enamel defects in the teeth leading to cavities
In a study of children diagnosed with celiac disease, which included both children recently diagnosed and not yet on a gluten-free diet and also children who had been following a gluten-free diet for a long period of time, there was a higher prevalence of enamel hypoplasia found in the children with untreated celiac disease. The plaque index was also significantly lower in the children who had been following a gluten-free diet.
In addition, studies have reported cross-reactivity of antibodies to gluten with enamel proteins, and one study even tested the ability of anti-gliadin IgG, which is produced in an untreated celiac disease patient, to recognize enamel organ structures and found high reactivity.
- Bacterial changes
Changes in oral health can also be caused by, or contribute to, an imbalance of oral bacteria. One study of children and teens found a statistically significant difference in the prevalence of salivary mutans streptococci and lactobacilli colonization between those diagnosed with celiac disease and those confirmed without celiac disease.
- Gingivitis (inflammation of the gums)
Celiac disease can cause inflammation throughout the body, including the gums. People with gluten sensitivity and celiac disease often have inflamed, red, swollen, painful gums. In fact, one study looked at the gum health of a group of children and adolescents, both with and without celiac disease. It found that the periodontal treatment need of children and adolescents with celiac disease was high and most of them (60.01%) needed treatment of gingivitis. Only a few children and teens with celiac disease that were studied had healthy gums.
- Xerostomia (dry mouth)
Complaints of dry mouth are common in those with celiac disease. One study in Brazil studied celiac and non-celiac individuals and found that those with celiac had an increased likelihood of dental enamel defects and dry mouth sensation. It suggested that an oral examination could be an important auxiliary tool for the identification of cases of the disease.
- Tonsil stones with halitosis (bad breath)
Though not thoroughly studied, in my clinical experience, tonsil stones are a common manifestation in those with gluten sensitivity, and when many patients implement a gluten free diet, tonsil stones often resolve. A leading sign of tonsil stones for many is the presence of lingering bad breath, which can indicate that tonsil stones are present.
Downstream Effects: Nutritional Deficiencies
As we know, gluten sensitivity can also cause nutritional deficiencies, and these deficiencies can lead to further complications when it comes to oral health. You can see how one complication can quickly lead to another, resulting in a domino effect, with gluten sensitivity at the root of it all.
The following are examples of how nutrient deficiencies can lead to oral health concerns.
- Iron deficiency can cause angular stomatitis, a condition in which saliva collects at the corners of the mouth. This can cause a buildup of microorganisms at the corners of the mouth which can lead to painful burning sores and dry lips.
- Vitamin D deficiency can cause enlarged adenoids (the tissue just behind the nose that is part of the lymphatic system and needed to clear away infection and keep body fluids in balance), compromised tooth integrity, and abnormal patterns in the alveolar bone (the part of the jaw that supports the teeth). In children, Vitamin D deficiency has also been associated with adenotonsillar hypertrophy, a major contributor to childhood sleep disordered breathing.
- Zinc deficiency can cause loss of sensation in the tongue, loss of taste, dry mouth, and susceptibility to gum disease.
- Vitamin B1, B2, and B3 deficiency can cause inflammation of the tongue and cheilosis – a condition where the corners of the mouth become inflamed, which can lead to cracking and pain at the corners of the mouth. The cracks can split and bleed; they can also make it difficult to yawn, chew, or talk.
- Vitamin B6 deficiency can lead to periodontal disease, anemia, sore tongue, and burning in the mouth.
- Vitamin B12 deficiency can lead to bone loss around the teeth, hemorrhagic gingivitis, detachment of periodontal fibers, and painful ulcers in the mouth, and angular cheilosis.
- Vitamin C deficiency can cause irregular formation of dentin (the layer beneath tooth enamel), alterations of the dental pulp (the center of the tooth made up of living connective tissue and cells), bleeding gums, delayed wound healing in the mouth, and defective collagen formation.
- Vitamin A deficiency can cause impaired tooth formation, enamel hypoplasia, and decreased epithelial tissue development.
Unmanaged gluten sensitivity can also cause vomiting, particularly in children which can further exacerbate oral symptoms. Vomiting creates an acidic environment in the mouth which can cause dryness, soreness, redness, chronic sore throats, and erosion of your tooth enamel. Erosion can cause further complication as it increases the risk of decay, causing more sensitivity and cavities.
In addition, overall poor nutrition can lead to tooth decay and subsequent loss when the body isn’t getting the nutrients it needs for proper oral health. Tooth decay and loss exacerbate concerns around malnutrition as they cause issues with chewing and the mechanical aspects of digestion. Poor digestion and absorption of nutrients creates even more malnutrition.
What Can You Do?
So what can you do to support the health of your mouth? Here are some actionable tips for optimal oral health:
- Avoid gluten: one of the most straightforward tactics is simply to remove gluten from your diet, just as you would to manage other manifestations of celiac disease
- Avoid antibacterial mouthwashes: just like antibiotics, antibacterial mouthwashes can’t tell the difference between good and bad bacteria and just kill it all. This can damage the balance of bacteria in your oral microbiome and ultimately do more harm than good
- Take probiotics: probiotics can not only help support the balance of bacteria in your gut, they can also support the balance of bacteria in your mouth, lowering the chance of bad breath, cavities, gum disease and even tooth loss
- Avoid acidic foods: if oral lesions exist, acidic foods can exacerbate discomfort and inhibit healing.
- Try intermittent fasting: intermittent fasting allows you to limit the amount of sugars and other particles in your mouth, and the time they spend there. This helps to naturally reduce the amount of bacteria that causes plaque, which can lead to inflammation of the gums. Keeping your mouth free of food for 12-16 hours or more also gives your mouth a break and allows it time to heal any sores or lesions that exist. Keeping your mouth free of food for 16 to 24 hours is like a daily detox for the gums and teeth.
- Consider nutrient testing and supplementation: since celiac disease and gluten sensitivity can lead to nutritional deficiencies which can exacerbate oral health concerns, consider testing your levels of key nutrients and supplementing as needed to get your levels back into healthy ranges where needed.
- Test for food sensitivities: your sensitivities may extend beyond gluten. Ask your doctor for a comprehensive food sensitivity test to identify other foods that may be contributing to compromised health – whether in your mouth, your gut, or elsewhere!
While your oral health symptoms may seem like something you want to bring up at the dentist, the truth is, they may very well be a sign of a deeper rooted health concern, like celiac disease or gluten sensitivity. Be proactive in supporting your oral health with the steps outlined above, ask your dentist to perform a thorough exam and share any changes or abnormalities, and discuss your oral health concerns with your health provider as further data into the state of your health.