2. Oral tissue inflammation
“Oral symptoms that suggest celiac disease may be present include aphthous ulcers, otherwise known as canker sores,” states Dr. Maureen Leonard, clinical director at the Center for Celiac Research and Treatment at Massachusetts General Hospital. “Dental enamel hypoplasia or tooth discoloration can be a sign, which generally affects children younger than 7 years of age. Finally, patients may present with glossitis or inflammation of the tongue.”
Recurrent aphthous stomatitis
Recurrent aphthous stomatitis (RAS) is relatively common, affecting about 10 to 20 percent of the population. These mouth ulcers can be particularly painful and affect the ability to eat, brush teeth properly, speak or swallow. Family history, injury to the mouth, stress, immune system changes, hormones and nutritional deficiencies may increase the risk of developing RAS.
Research shows that RAS can also be a sign of undiagnosed celiac disease. A 2008 study found that these mouth sores were found more frequently in children with celiac (22.7 percent vs. 7.1 percent of healthy controls). Other studies have found similar results. A 2014 study showed that RAS was more common in patients with celiac who didn’t have other gastrointestinal symptoms. They may also result from dietary deficiencies that have developed due to celiac. “Mouth sores may be due to immune or inflammatory conditions, or from a secondary folate deficiency, which can occur due to malabsorption in celiac disease,” notes Leonard.
Geographic tongue (GT), a form of glossitis, causes chronic or long-term inflammation of the tongue. A healthy tongue is covered in pink-white bumps called papillae. But in those with GT, some of these papillae are missing, and the tongue is instead covered in red, patchy areas. These areas can heal and then reappear on other areas of the tongue. The condition is called geographic tongue because the red regions give the appearance of a map. Symptoms of GT may be mild and might only be noticeable when eating spicy or acidic foods.
GT may be more common in those with celiac, research suggests. A 2016 study found that nine out of 60 (15 percent) of patients with GT were later diagnosed with celiac. Study authors noted that, like RAS, many of the patients diagnosed with celiac did not suffer from other gastrointestinal symptoms. GT may develop from nutritional deficiencies found in those with newly diagnosed celiac disease, notes Leonard. “Tongue inflammation is most likely secondary to a vitamin B12 deficiency, which is a secondary problem due to malabsorption.”