Autoimmune disease oral mucosa
The purpose of this review is to highlight the common oral manifestations of celiac disease and to provide practising dentists with clinical guidelines for managing patients suspected of having this disorder.
Celiac disease can develop at any age when solid foods are introduced into the diet; however, if it appears in children while the permanent teeth are developing, i.e., before 7 years of age, abnormalities in the structure of the dental enamel can occur. These defects are seen most commonly in the permanent dentition and tend to appear symmetrically and chronologically in all 4 quadrants, with more defects in the maxillary and mandibular incisors and molars. Both hypoplasia and hypomineralization of the enamel can occur. A band of hypoplastic enamel, often with intact cusps, is common. A hiatus in enamel and dentin formation can occur at a developmental stage corresponding to the onset of gastrointestinal symptoms. Dental enamel defects are common in children who develop symptoms of celiac disease before 7 years of age. Such defects are not seen as frequently in adults with celiac disease, as they may have developed symptoms at a later age or have had severely affected abnormal teeth altered or extracted.11
The exact mechanism leading to these defects is not clear, but immune-mediated damage is suspected to be the primary cause.14, 15 Nutritional disturbances, including hypocalcemia, may also play a role.16 Stimulation of naïve lymphocytes by gluten in the oral cavity has also been hypothesized.15
The overall prevalence of systemic dental enamel defects in celiac disease patients with mixed or permanent dentition ranges from 9.5% to 95.9% (mean 51.1%); in patients with deciduous teeth, prevalence is 5.8% to 13.3% (mean 9.6%).14 This difference can be explained by the fact that the crowns of permanent teeth develop between the early months of life and the seventh year (i.e., after the introduction of gluten in the diet) whereas the development of deciduous teeth occurs primarily in utero. The involvement of deciduous teeth in some cases supports the hypothesis that immunologic and genetic factors are more important in the etiology of the defects than nutritional deficiencies. Dental enamel defects are also found in healthy first-degree relatives of patients with celiac disease, further supporting an immunogenetic basis for causation.17
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Rheumatoid arthritis can be accompanied by another autoimmune disease called Sjogren's syndrome. Among other nasty things, it causes severe dry eyes, mouth, vag.
Sjogren's can occur on it's own, but is far more likely to accompany lupus or RA. If she doesn't have those, it is unlikely she has Sjogren's.
I had a big issue with dryness during pregnancy.
Bleeding during sex and severe bleeding during periods is something she should take up with her doctor. Good thing she's having regular visits with her ob/gyn.
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