An orthodontic retainer preventing remission in celiac disease.

Abstract

Celiac disease is a gluten enteropathy that is treated with dietary elimination of gluten. Exposure to nondietary sources of gluten, which are used in the manufacture of products such as plastics, dental equipment, and cosmetics, can also trigger or exacerbate disease. We report the case of a 9-year-old child who presented with nonspecific abdominal discomfort with abnormal serology for celiac disease. She underwent duodenal biopsies that revealed Marsh 3B histopathology. Despite strict dietary elimination of gluten, she continued to be symptomatic and demonstrate positive serum markers for active disease. It was then discovered that the child was exposed to gluten from her orthodontic retainer that contained a plasticized methacrylate polymer. Gluten is a common additive in plastics. She discontinued its use and demonstrated symptom resolution and complete normalization of serology. All possible sources of gluten, including nondietary, must be considered when managing a child with celiac disease.

• Authors: Zebunnissa Memon, Susan S Baker, Abdur Khan, Humaira Hashmi, Daniel Gelfond
• Journal: Clinical pediatrics (Clin Pediatr (Phila)) Vol. 52 Issue 11 Pg. 1034-7 (Nov 2013) ISSN: 1938-2707 [Electronic] United States
• PMID: 24137038 (Publication Type: Journal Article)

Chemical References

• Plasticizers
• Polymethacrylic Acids
• Glutens

Topics

• Celiac Disease (classification, diet therapy, etiology, pathology)
• Child
• Diet, Gluten-Free
• Equipment Design
• Female
• Glutens (administration & dosage)
• Humans
• Intestine, Small (pathology)
• Materials Testing
• Orthodontic Retainers (adverse effects)
• Plasticizers
• Polymethacrylic Acids (adverse effects, chemistry)
• Remission Induction