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Oral manifestations in celiac disease: prevalence, symptoms, and associated factors

Learn about the most common oral manifestations of celiac disease, their prevalence, risk factors, and how early diagnosis and a gluten-free diet can help improve symptoms.

Oral manifestations in celiac disease

Celiac disease can develop at any age and present with a wide variety of symptoms. While it is often associated with gastrointestinal issues, it can also cause extraintestinal symptoms, including those that appear in the mouth. These include dental enamel defects (DED), recurrent aphthous ulcers (RAS), and glossodynia (burning mouth).

A recent study from Finland examined the prevalence of these manifestations and the factors linked to them in adults with celiac disease.

Study objective

To assess how common oral manifestations are in adults with celiac disease and identify clinical factors associated with these conditions.

Methodology

The study included:

  • 873 adults with biopsy confirmed celiac disease or dermatitis herpetiformis
  • 563 non-celiac controls
  • Recruitment in Finland (2006–2010)

Participants completed structured interviews and questionnaires that measured:

  • Dental enamel defects (DED)
  • Recurrent aphthous ulcers (RAS)
  • Glossodynia (burning mouth)
  • Gastrointestinal symptom severity using the Gastrointestinal Symptom Rating Scale (GSRS)
  • Quality of life using the Psychological General Well-Being Index (PGWB)

Key findings

Key findings

  • Oral manifestations were significantly more common in celiac patients than in controls, both at diagnosis and while on a gluten-free diet
  • Dental enamel defects: 27% of celiac patients vs. 4% of controls
  • Recurrent aphthous ulcers (RAS): experienced by 56% before diagnosis, with 69% improving on a gluten-free diet
  • Glossodynia: more common on a gluten-free diet (14% vs 6%)

Associated factors

• Dental enamel defects: long diagnostic delay, diagnosis before 1990, abdominal symptoms • Recurrent aphthous ulcers: female sex, abdominal symptoms • Glossodynia: female sex, abdominal symptoms

Quality of life

Patients with persistent oral symptoms on a gluten-free diet reported more severe gastrointestinal symptoms and poorer quality of life.

Conclusion

Oral manifestations are common in adults with celiac disease, especially among women and those with classical abdominal symptoms. Early diagnosis and adherence to a gluten-free diet may prevent long-term oral damage.

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Sources

Manninen J, Paavola S, Kurppa K, et al. Prevalence of oral manifestations in coeliac disease and associated factors. BMC Gastroenterol. 2025;25(1):126. Published 2025 Mar 3. doi:10.1186/s12876-025-03699-0