Dental patient Bill Radley, 62, says he scheduled an appointment because he had persistent bad breath despite constant brushing and mouth rinsing.
During a routine oral exam, his dentist noticed that Radley’s gums were red, inflamed, and bleeding. The dentist recommended that Radley see his doctor right away. A subsequent series of diagnostic blood tests found that Radley had diabetes, which his dentist had suspected based on Radley’s oral symptoms.
Radley said he was shocked, having seen himself as healthy and active, but, really, he was lucky. He hadn’t seen his dentist in more than two years, and it had been even longer since he had a physical exam. Still, his dentist caught Radley’s diabetes was caught early, and treatment brought it under control before the condition did serious damage.
Diabetes is just one of many diseases whose first manifestation could be in your mouth. As such, your dentist may be the first healthcare provider to diagnose a systemic condition or disease you have. That’s partly because you, like Radley, probably see your doctor far less, and only when you have an obvious problem.
More than 90 percent of all systemic diseases have oral manifestations, says Delta Dental, an insurance company that told Radley’s story online. Oral symptoms of systemic problems include swollen gums, ulcers, dry mouth, and “excessive gum problems.” These can be signs of diseases such as diabetes, osteoporosis, leukemia, oral cancer, pancreatic cancer, heart disease, and kidney disease.
Other oral symptoms you might have can indicate many other health problems, including HIV or AIDS, anemia, and gastroesophageal disease. There is some evidence that tooth loss before middle age might be a associated with the development of Alzheimer’s disease. Mouth sores can even be a sign of gluten intolerance, syphilis, and other conditions. X-rays of your mouth don’t just reveal problems with your teeth; they also can detail the first evidence of atherosclerosis in your carotid arteries. If your dentist finds such damage, he or she can refer you for further medical evaluation.
That your mouth may show the first indications of systemic disease may surprise you. If you’re an average person, you tend to see your mouth as somehow detached from the rest of your body.
But, think about it. Your mouth shares the same blood system with the rest of your body. That’s as close as a biological connection can get. Microorganisms in your mouth can be found in the rest of your body as well.
“The oral cavity is frequently involved in conditions that affect the skin or other multi-organ diseases,” write the authors of an article published by Clinical Advisor. “Most of these manifestations are nonspecific, but should alert the clinician to the possibility of a concurrent systemic disease or a latent systemic disease that may develop.
“Some disease manifestations identified in the oral cavity may be specific enough to make a definitive diagnosis. Oral involvement often precedes the occurrence of other symptoms or development of lesions at other locations. A thorough oral examination is critical for proper patient care and early diagnosis.”
You are also probably unaware that oral disease, particularly periodontal (gum) disease, can adversely affect systemic diseases such as heart disease, stroke, diabetes, and bacterial pneumonia. Research also has found a connection between oral disease and preterm, low birth-weight babies. These findings are generally connected to the transfer of harmful bacteria from your mouth into the rest of your body.
The research of Bradley Bale, MD, and Amy Doneen, RLNP, the innovators behind the Bale Doneen method of heart attack and stroke prevention, helped show the oral-systemic connection. It’s laid out in their book “Beat the Heart Attack Gene.” These pioneers demonstrated the science that proves oral bacteria are significant in the development of heart disease and may even trigger a heart attack.
Marjorie Jeffcoat, DMD, a professor at the University of Pennsylvania, has done considerable research on preterm birth. In one revealing study she found that pregnant women with periodontal disease who used an antimicrobial mouth rinse at prescribed intervals had fewer preterm births than women in a control group.
As a patient, you can influence your dentist to work with your doctor simply by asking questions about the oral-systemic connection. Your work also includes improving your oral hygiene at home and maintaining regular dental and medical visits. Remember, your mouth can work two ways when disease is involved. While it can make a systemic disease you might have worse, it can also help detect disease before it becomes serious.
April 12, 2015
Christopher Nystuen, MD, MBA