Adult Celiac Disease: Association between Oral Microflora, Caries and Saliva

Objectives: To investigate whether the oral microflora in adults with celiac disease (CD) differs from that in healthy persons and to test if changes in the oral microflora are associated with high caries experience and reduction in saliva flow rates. Methods: Nineteen patients with CD (mean age 50.5±14.9 years, 15 women and 4 men) and 10 age- and gender matched healthy controls (47.8±16.8 years) underwent an oral examination with registration of the DMFT/DMFS, plaque- and gingival indices, followed by measurement of unstimulated, paraffin-chewing-stimulated whole saliva and citric-acid-stimulated parotid saliva flow rates, determination of salivary Streptococcus mutans and lactobacilli counts (Dentocult® SM Strip mutans and LB) and Candida smear from the dorsal part of the tongue. Results: Unstimulated, chewing-stimulated and stimulated parotid saliva flow rates, DMFT/DMFS, plaque- and gingival indices did not differ between the CD patients and the healthy controls. Streptococcus mutans and lactobacilli counts of more than 10.000 CFU/ml (colony forming unit/ml saliva) were more prevalent in patients with CD than in the healthy controls (58% versus 20% and 53% versus 20%). Candida hyphae were found in 26% of the patients, but in none of the healthy controls. Candida spores were present in 37% of the CD patients and in 20% of the healthy controls. DMFT/DMFS were associated with age in both groups, but nor with salivary flow rates or bacterial counts. Conclusion: Our results indicate that whole saliva and parotid saliva flow rates are not reduced in adults with CD and caries experience is not increased compared to that of healthy controls. However, the patients showed higher counts of Streptococcus mutans and lactobacilli and a higher number of Candida hyphae which may be ascribed to changes in the local and systemic immunological response to oral bacteria and fungi. The study was supported by the Danish Dental Association.