Relative risk of oral manifestations with celiac disease: a systematic review and meta-analysis

BACKGROUND: Celiac disease (CD) may present with extraintestinal features, including oral manifestations. However, the prevalence and associated risks of these manifestations have not been systematically quantified. This study aimed to estimate the relative risk of oral manifestations in CD patients. METHODS: This review followed the PRISMA guidelines and was registered in the PROSPERO database. A comprehensive literature search was conducted in PubMed, Embase, and Web of Science from inception through March 2025. Pooled prevalence estimates and RRs with corresponding 95% confidence intervals (CIs) were calculated using a random-effects model in R statistical software (version 4.4.0). Between-study heterogeneity was assessed using the I² statistic, and publication bias was evaluated via funnel plot asymmetry and Egger’s test. RESULTS: A total of 22 observational studies were included. The pooled prevalence of oral manifestations in patients with CD was 21.41% (95% CI, 13.85%–31.73%). The pooled RR for recurrent aphthous stomatitis (RAS) was 2.45 (95% CI, 1.67–3.60), and for dental enamel defects (DED), it was 2.49 (95% CI, 2.12–2.93). Xerostomia was significantly more common among patients with CD (RR, 5.99; 95% CI, 3.16–11.35). Delayed dental eruption (RR, 2.09; 95% CI, 1.23–3.54) and dental caries (RR, 1.56; 95% CI, 1.01–2.40) were also associated with increased risks. CONCLUSION: Oral manifestations, particularly RAS, Xerostomia, and DED, are significantly more common in patients with CD. These findings underscore the diagnostic value of oral signs in the early detection of CD and support the need for interdisciplinary screening strategies among at-risk populations.