Hygienist's personal story reinforces need for dietary assessments
by Suzanne Hubbard, RDH
I loved my dental hygiene job traveling across Colorado temping in dental offices. It gave me the freedom to see new and different practices and gain much needed experience. However, after several months into the position I found that I was growing very tired. I chalked it up to the miles I was driving, the on-the-road meals, and the fact that I was putting in nine- to 10-hour days.
At the end of each day, I found comfort in my beloved couch and heating pad. Symptoms such as headaches, diarrhea, and fatigue settled into my body. Day after day the symptoms grew worse, until one morning I woke up to painful reddish-purple sores all over my body. Sitting in my dental chair that day was not comfortable, and the eight to 10 bouts of diarrhea I was experiencing each day wasn't either.
Canker sores were the norm for me, so when they appeared each month I just assumed it was stress or caffeine. I visited a general physician and was sent home with a prescription of dicyclomine. My diagnosis: irritable bowel syndrome, IBS. Once again, I felt the pangs of defeat. I can't tell you how many times over the years I have been diagnosed with this vague and highly overdiagnosed condition. I was hospitalized in 1997 with severe cramping, bloating, ulcerative stools, and a diagnosis of IBS. I was hospitalized in 2002 with the same symptoms, and again in 2007.
I had a flex-sigmoid scope that was prescribed by a gastroenterologist, and the tests came back normal. Each episode I received the same diagnosis, IBS, and the same prescription. It wasn't until a year ago that I had had enough. I was sick and tired of being sick and tired. So I started a dietary assessment and realized that something more sinister was playing a role. I started the assessment by documenting everything I had to eat and drink, including vitamins and prescription drugs, and wrote down every ingredient that was in each meal.
I wrote down dates and times and even assessed my canker sores, including when, where, and how long they were there. Were they related to my diet? I addressed my bowel habits to see if there was a correlation. I evaluated my skin conditions, including when, where, and how long they were there. This tedious task eventually led me to the culprit: wheat. Each assessment led me to an allergy to wheat.
Finding the right diagnosis
I gathered my assessments and researched and read dozens of articles and books. I then headed to a gastroenterologist to ask for a blood test and endoscopy to evaluate my small intestine. The result was celiac disease, an autoimmune disease that affects the small intestine. Celiac disease is triggered by consumption of the protein gluten, which is found in wheat, barley, rye, and oats.
When people with the disease consume foods containing gluten, their immune system responds by damaging the fingerlike villi of the small intestine. When the villi become damaged, the body is unable to absorb nutrients into the bloodstream, which can lead to malnourishment. Some symptoms include fatigue, diarrhea, constipation, bloating, skin irritations (dermatitis herpetiformis), canker sores, mouth sores, malnutrition (leading to osteoporosis and brittle bones), anemia, joint and muscle pain, irritability, and infertility.
From my research1, I found that 1) celiac disease is rapidly on the rise, especially in middle age, 2) one in 133 people will be diagnosed with celiac disease; however, 97% will remain undiagnosed, 3) over three million people have celiac disease, 4) celiac disease is often misdiagnosed under the umbrella of IBS, and 5) often women experience no symptoms, but their bone density tests reveal nutrient deficiency that leads to osteoporosis, a unique subset of symptoms to celiac disease.
As I gathered my research, I was amazed to find out how many dental implications were observed with celiac disease in both adults and children – burning tongue syndrome as a result of anemia and/or vitamin deficiency, glossitis, dry mouth, canker sores, ulcerative mouth sores, tooth discoloration, and loss of tooth enamel. Over the past year I have had to reconstruct my diet, and you wouldn't believe where wheat is found - vitamins, soy sauce, peanut butter, tuna, gravy, soups – and that doesn't include all the delicious breads, pastas, and pastries. But I feel so much better not eating wheat!
I have had to redirect my life and my choices. In that, I have had the wonderful privilege of using my own story to instruct several of my dental patients in their own discovery of celiac disease. One patient in particular presented with mouth sores, and upon reviewing her medical history we were able to reconstruct her history of IBS, mouth sores, and a new diagnosis of osteoporosis. By "clustering" her medical history, we were able to piece together a systemic link that needed further evaluation from a medical doctor. Sure enough, her diagnosis was celiac disease.
Accurately diagnosing celiac disease is difficult because it mimics other autoimmune diseases such as Crohn's disease, irritable bowel syndrome, inflammatory bowel disease, ulcerative colitis, and a host of other bowel conditions. However, as dental providers, we are on the front lines and have the necessary tools in our toolbox to assess for these autoimmune diseases. We can achieve awareness and guidance by evaluating and clustering patients' medical and dental histories, we can assist in providing dietary assessments, we can provide a thorough clinical examination of the oral cavity, and we can look for clues – the thread woven from beginning to end to interpret the causative imbalances and overall systemic link.
For more information on celiac disease, contact the Celiac Disease Foundation at www.celiac.org.
Suzanne Hubbard, RDH, works in Greeley, Colo., at Greeley Dental Health Centers.
1. Celiac Disease Foundation www.celiac.org.
Past RDH Issues