10 Health Conditions Hiding in Plain Sight of the Dentist
The mouth really is connected to the body. Here’s what your dentist can see looking at those sparkling teeth!
Let’s face it: the idea of a dental visit can be a lot to chew! The heckling about flossing; the dozens of questions your dentist asks while wads of cotton sit between your cheeks and your teeth; the age-old question of ‘if I poke you, will you bleed?’ (Although, that last one gets me laughing every time as the patient.)
But those visits to the dentist are important! — and not just for their comedic value or the resultant sparkly, clean teeth 😊 Beneath the plaque and calculus, and monotone dictation of numbers for a chart, your dentist is evaluating your medical health. She is reading your teeth like a road-map, considering your oral and overall health today and over the past few months or years.
She is looking to your mouth and teeth to support a healthy you!
And in one visit, your dentist may be able to help you assess where you stand when it comes to these 10 systemic health criteria (and even more!). Let’s count them down!
10. Diabetes Mellitus
Diabetes is a medical state where you have too much sugar in the blood. In a healthy individual, after a meal, the body jumps into action. It uses a hormone called insulin to transfer sugar molecules from the blood to the cells. The cells can then use these sugar molecules for energy or store them for later use.
In an individual with diabetes, the system goes awry.
In Type I Diabetes, a condition often first diagnosed in childhood, the breakdown occurs at the starting gate — well, the pancreas to be precise. Cells that normally produce insulin no longer function, and the sugar molecules can’t move from the blood to the cells.
In Type II Diabetes, the pancreas does produce insulin, but cells that are supposed to respond to this hormone no longer react, again leaving the sugar in the blood.
But what do the teeth have to do with it — other than helping to get all that sugar in the body in the first place?
At an extreme, your dentist may actually ‘smell’ diabetes. Individuals with Type I Diabetes, similar to individuals with prolonged alcoholic ketoacidosis or malnutrition, can develop an acetone scent to their breath.
Think nail polish remover on the tongue.
But taking a step back, before the ketoacidosis presents, your dentist CAN see your diabetes. With decreased immune strength, individuals with diabetes are at greater risk for developing infections in the mouth. Individuals with diabetes, especially if blood sugar is uncontrolled, are also more prone to gum disease with bone loss in the mouth — periodontitis — and more severe forms of this gum disease.
9. Nutritional Status
Yes, your dentist will be able to assess your nutritional status just from having you open your mouth — and I am not just talking about that leftover piece of lunch between your two front teeth.
Your teeth carry a road-map to the vitamins and minerals in your diet, and deficits in these minerals can lead to clear oral presentations.
For starters, are you getting enough Calcium? The teeth are made of this substance, as is the bone. Without it, your teeth lack the minerals that give them strength. Vitamin D, too, is necessary for proper absorption of Calcium from that yummy yogurt you had at breakfast.
Further, Vitamin K — the lettuce wedged between your central incisors — works in the healing process and blocks the breakdown of bone.
And certainly, from the staining on your teeth, your dentist may detect your coffee or tea habit. Additionally, from the level of decay and the location of decay on your teeth, your dentist may just be able to tell how frequently you have been snacking on sugary foods and beverages.
In fact, the frequency with which you consume sugary snacks poses greater risk for dental decay than the quantity of sugar you consume.
8. Psychological Status
This one is a bit more difficult to detect, but some aspects of psychological status can be seen in a simple assessment of your mouth.
For starters, dental anxiety will manifest in your interactions with the dentist. Which is a good thing, because there is a lot your dentist can do with you to address this anxiety and make the appointment more manageable — check out these tips to manage dental anxiety.
With elderly patients, the dentist may detect signs of depression in the patient’s affect or social history, as depression is a prevalent condition in the geriatric population. The dentist, too, may conduct a test to quickly evaluate short-term recall of information and direct you to appropriate providers for more thorough evaluation and care for dementia or Alzheimer’s.
Patients with Bulimia Nervosa may appear at an average or above average weight; however, they can have a pattern of tooth wear reflective of repetitive vomiting. The only other condition with similar wear is gastroesophageal reflux disease (GERD). The acidic coating from rising stomach content wears the enamel surface of the tooth until the yellowing of the inner dentin shows. This dentin layer communicates with the nerves of the tooth in the pulp to create increased sensitivity.
Patients of any age with depression, too, can show dental signs of their mental state. The individual with depression has low motivation for activities of daily living.
Getting out of bed. Brushing and flossing. Eating healthy. All of the great behaviors that can prevent tooth decay and clear plaque come to a startling halt.
And the gum will notice, responding with blood and inflammation.
Whether you caught a bug last week or you have been facing a diagnosis of HIV for years, your dentist may be key in monitoring your overall health.
Certain viral infections, like that pesky herpes simplex virus type 1, seem to arise at the most inopportune times!
Your dentist, of course, won’t have to do much searching to see the huge cold sore that just surfaced.
Even more importantly, your dentist can know where on a spectrum of severity your HIV load lies using indications of your oral health. Do you have fungal infections grasping at the opportunity to infect an immunocompromised host? Do you have Kaposi sarcoma, Herpes Simplex Virus Type 8, making itself known with a blue, brown, purple, or red patch in the mouth?
None of these signs overpower the importance of regular testing for viral load, but these oral indications of infection offer such wealth of insight into your body’s capacity to fight off disease.
6. GI Upset
Is there blood in your feces? Do you find yourself going to the bathroom rather frequently? Do you wonder why a dentist would ask?
Gastrointestinal diseases like Chron’s Disease and Ulcerative Colitis have unique presentations that make themselves very apparent in a dental exam. The gum starts to look like the cobblestone streets of Boston’s Beacon Hill historic neighborhood. The lips and cheeks may swell with what is called orofacial granulomatosis. Secondary to nutrient deficits, the patient may exhibit raw, sore spots throughout the mouth that cause pain or sensitivity when eating.
And, similar to the tooth erosion seen in a patient with bulimia, a patient who repeatedly releases gastric acid due to reflux disease, GERD, will start to show signs of tongue-side tooth breakdown on the top, front teeth.
You were probably wondering when I would get to this massive topic. Because it is of massive importance — to the patient, to the patient’s family, to the dental exam.
A finding related to cancer can change the direction of treatment and management and can change a person’s life.
Certainly, systemic cancers will present in the mouth. Leukemia, a cancer of the blood, for instance, will result in a growth of the gum and bleeding from the gum. These findings can be hard to miss from even the untrained eye. Other systemic cancers can spread through the bloodstream to the mouth. Breast cancer, lung cancer, and many other cancers can result in what your dentist will see as dark spots in the otherwise radiographically white jaw bone on an x-ray. Cancer treatment can increase risk of dry mouth, cavities at the gum line, and mouth sores or infections.
With so many teeth growing in your mouth, and such high rates of turnover of the oral mucosa, cancer can also arise within the mouth itself. Oral cancer exams involve looking at all of the soft tissue surfaces of the mouth, palpating lymph nodes, and even raising the tongue to see what’s happening underneath that flexible organ. A primary tumor of the oral cavity could be benign, having no tendency to spread. But malignant conditions can also arise.
Your dentist is on the lookout for your health (and these suspicious finds.)
4. Hormone Levels
Your mouth tells a story about the hormones coursing through your body.
Hyperparathyroidism is linked to Brown Tumors. Severe hyperthyroidism, myxedema, can lead to swollen lips and a swollen tongue. Low cortisol can cause dark coloration of your oral tissue, while excess cortisol can lead to fragile bones and slow healing. Osteoporosis can be seen in the jaw bones, and progesterone from pregnancy or birth control medications can cause gum overgrowth and bleeding and a ‘gum boil’ called a pyogenic granuloma.
You may not have filled out your medication list before the dentist brought you from the waiting area to the dental chair, but your mouth is helping fill in the blanks. (Although, your dentist likely already asked you about your medications face-to-face in review of your medical history.)
Patients on birth control medications can have bleeding or swollen gums. Patients taking immunosuppresants, seizure medications, or calcium channel blockers can also have severe overgrowths of their gum, so much so that the gum grows over the teeth!
Many medications cause dry mouth, which can put you at risk for cavities.
Your medications make a difference in your mouth.
Perhaps most surprising, your dentist may be able to determine your level of stress.
Recurrent apthous stomatitis affects nearly 1/4 of the population, and is directly related to your stress levels. In this condition, oral ulcers come and go. These oral ulcers are seen most commonly in Caucasian individuals with high levels of education and, yes, high stress. In fact, the frequency of oral ulcers was found to increase as medical students progressed from their first year of education to their more stressful clinical years.
So when the dentist asks if you are stressed, remember, the mouth cannot tell a lie. (*Cue your mental list of every exception to this rule, like that one time you broke the vase… 😉*)
There’s much more to add to this list, but lets just end on this one, unfortunately prevalent condition:
1. Substance use
Many substances from sugars to drugs start their journey at the mouth.
They then go on to affect your entire body. First, though, they leave their stamp on the oral cavity so that your dentist knows at least a little of what is charging through your veins.
Substances like marijuana, for instance, mirror opioids and other medications in causing dry mouth. Dry mouth, in turn, results in increased susceptibility to tooth decay as you no longer have the cleansing, mineral-carrying, or immunologic properties of the saliva at work.
Tobacco smoking, as we have all heard, can lead to tooth staining, cancer, and so many systemic problems.
With all of that, the real cost for a pack of cigarettes is actually much higher than what you pay at the local store.
And for the individual who has consumed enough alcohol to present with liver disease, the gum tissue will not be spared when showing signs of clotting issues and jaundice. In fact, the gum may appear with small red spots or yellow coloration similar to that seen in the eyes of an individual with hepatitis.
Additionally, a smokeless tobacco habit can show itself in white-appearing lesions on your gums.
You may think this list is long; but wait… there’s more! There is so much your mouth can share about your overall health.
So bear with your dentist’s momentary lapse in judgment as she asks you a question with water in your mouth … that dental exam is providing insight into your whole-body health while doing your teeth and gums so much good!
Do you have a question about how your condition affects your mouth? Be sure to ask your dentist at that next dental visit!