fig 1

fig 2

Aphthous lesions in a celiac population: an epidemiological study

Antonia Sinesi (1), Savino Cefola (2) , Riccardo Botta (3), Ruggero Francavilla (4), Cinzia Casu (5).

1.Antonia Sinesi, RDH, Freelancer, Canosa di Puglia, Italy. 2.Savino Cefola, DDS, Private Dental Practice, Barletta, Bari, Italy. 3.Riccardo Botta, DDS, University of Milan, San Raffaele Vita-Salute, Milano, Italy 4.Ruggero Francavilla, Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy. 5.Cinzia Casu, DDS, Private Dental Practice, Cagliari, Italy.

Introduction. Oral aphthous ulcers are common lesions of the oral mucosa. When the patients have more than 3-4 episodes in a year of aphthous lesion we can diagnose the presence of Recurrent Aphtous stomatitis (RAS). RAS is characterized by multiple recurrent small, round or ovoid ulcers with circumscribed margins, erythematous haloes and yellow or gray floors, typically presenting first in childhood or adolescence. There are three forms of recurrent apthous stomatitis (RAS) : minor (>70% of cases), major (10%), and herpetiform (10%). Celiac disease (CD), is an autoimmune disease in which individuals exhibit damages in the small intestine villi as a consequence of an abnormal immune response subsequent to the ingestion of gluten. The aim of this work is to report the percentage of aphthous lesions in a celiac population of 212 patients.

Material and Methods. Inclusion criteria were CD assessed with histological examination, patients aged between 6 and 12 years. Patients who showed aphthous lesions at the moment of the oral examination were recorded and the patients were interviewed to find out if they had had other episodes of ulcers in the last 2 years.

Results. 84 patients had no episodes of mouth ulcers during the last 2 years (39.5%) while 128 had at least one episode of canker sores (60.5%) (fig 1). In 45 these are localized in the upper vestibular mucosa (35%), in 31 in the lower vestibular mucosa (24%). In 25 patients, lesions were localized in the tongue (20%), in 15 patients on the cheek (11.5%) and in 12 cases in the floor of the mouth (9,5%) (fig.2).

Discussion. Saraceno et al. found that RAS appear in 69% of the CD patients, compared to the 43% in the control group. In a work of Campisi et al. the prevalence of oral soft tissues lesions was 42% in the coeliac disease patients and 2% in controls. Recurrent aphthous stomatitis disappeared in 89% of the patients after 1 year of gluten-free diet. In a turkish work on 25 patient recurrent apthous stomatitis was found in 11/25 (44%) CD group, while no RAS was detected in the control group. Some authors suggest that RAS can be considered a sign of the atypical or the silent forms of CD. Sometimes oral lesions appeared before the diagnosis of the systemic pathology.

Conclusion. The results of our study is partially in accordance with previous epidemiological studies. The difference in Italian diet could be explain the difference of the epidemiological values in the literature. The importance of the correlation between aphthous lesion and CD is the basis of study protocols that include observation of the oral cavity as a means of screening for celiac disease.

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