What your mouth can tell you about your health

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Walk in for a routine checkup, walk out with information that could save your life.

Dentists and dental hygienists are looking at more than your pearly whites when they tell you to open wide. Researchers are discovering an association between poor oral health and certain diseases, such as diabetes, heart disease, Crohn’s disease, cancer and stroke. And more than a family doctor, who may not be as familiar with the many intricacies of the mouth, your dentist has the training, the tools and the eye to spot more than just a cavity.

“The mouth is the mirror of the body, and reflects signs of diseases that may be occurring,” says Dr. Euan Swan, Manager of Dental Programs at the Canadian Dental Association in Ottawa. For example, according to the Association, some 3,200 Canadians are diagnosed with oral cancer annually, and about one-third of those will die from it. But reports that claim there’s a link between poor oral hygiene and such conditions as rheumatoid arthritis, osteoporosis, acid reflux and dementia, “are a bit of a stretch,” says Swan. “There’s not a cause-and-effect relationship.”

The following diseases and conditions, however, often are reflected in your mouth, and will have your dentist probing further.

Gingivitis, periodontitis

Signs and symptoms: Red, swollen, sensitive gums that bleed when you brush or floss are an indication of gingivitis, a mild form of gum disease. Left untreated, gingivitis can progress to periodontitis, or periodontal disease, characterized by inflammation around the teeth, receding gums, loose teeth and bone loss.

Solution: Nearly half of all Canadians who have avoided the dentist in the past year have some form of gum disease, says the Association. Brush and floss twice a day, particularly after eating, and get regular exams and cleanings. Smokers have another reason to butt out, since smoking is one of the bigger risk factors for gum disease.

Diabetes

Signs and symptoms: Dry mouth, bleeding and receding gums and loose teeth. “A patient with gum disease that doesn’t respond to treatment, and/or delayed wound healing in the mouth, is characteristic of diabetes,” says Swan. “Also, fruity breath is a sign they have low blood sugar.” Dr. Iona Leong, oral pathologist and Assistant Professor in the Faculty of Dentistry at the University of Toronto, says, “Fruity breath would be unusual because that would be type 1 diabetes, which is a less common type of diabetes. That person would have to have a condition called ketoacidosis [not enough insulin]. The diabetes would have to be so poorly controlled that they would have accumulations of these chemicals in their blood that would produce a fruity breath.”

Solution: Like all diseases, prevention is key, especially for the often under-diagnosed diabetes. Exercise, healthy diet and weight (especially in the abdomen) can put the bite on diabetes, but if your dentist suspects you’re already there, he or she would urge you to get a blood sugar test.

Bulimia nervosa

Signs and symptoms: Enamel erosion caused by gastric acid in the mouth from frequent vomiting, a characteristic of bulimia. “The vomit’s low pH can cause erosions, usually on the lower teeth and facing to where the vomit would come from, the tongue-facing surfaces of the teeth,” says Leong. Acid from reflux, however, “does not go that far forward” to cause erosion, she adds. “There’s also not so much of it, and the saliva neutralizes it. A lot of clinicians blame acid reflux for a lot of things but there’s no evidence for [enamel erosion] currently.”

Solution: Since bulimia is a mental illness and very personal, Swan says it could be awkward for a dentist to broach. Still, he says he would refer the patient to a physician for diagnosis and treatment, since frequent binging and purging puts stress on the body, not only causing rapid tooth decay, but potential heart trouble.

Anemia

Signs and symptoms: Pale, light pink mouth, too-smooth tongue, canker sores. “Some patients with iron- deficiency anemia or a deficiency in folate or vitamin B12 may produce multiple canker-like sores in their mouth,” says Leong. A pale pink mouth or a too-smooth tongue, as well as grey skin pallor, she says, would be a sign of advanced anemia.

Solution: According to the Mayo Clinic, many types of anemia can’t be prevented, but you can avoid iron- and vitamin-deficient anemias with a nutrient-rich diet or multivitamin supplement. Anemia is caused by too few red blood cells, so your dentist would likely recommend a screening.

Oral cancer

Signs and symptoms: Lesions that aren’t healing; white or red patches, often in the throat; numbness or tingling; small lumps on the tongue, roof and floor of the mouth, cheeks or gums. Smoking or chewing tobacco, as well as heavy alcohol use, can cause not only oral cancer, but a variety of other cancers. In addition, the human papillomavirus (HPV), responsible for cervical cancer, has been linked to head and neck cancers, and many dentists now look for that in patients over the age of 14. But it’s important to note, says Leong, “Many people become infected with HPV and never develop what we call oropharyngeal cancer, [which occurs] at the back part of the mouth. HPV does not have a strong role in cancer of the mouth, although in other parts of the oral cavity, the oropharynx, it would.”

Solution: “As part of their routine exam, dentists will check the soft tissue of the palette, cheeks and tongue, looking for abnormal lesions or swelling,” says Swan. If they suspect cancer, or even HIV/AIDS, which also presents with oral lesions, they will advise you to seek medical attention and likely biopsy post-haste, since early detection results in higher survival.

Heart disease

Signs and symptoms: Gum disease in an otherwise healthy, frequent tooth brusher and flosser. Chronic inflammation; swollen, bleeding gums; overweight; family history. Although it’s been reported that people with gum, or periodontal, disease have three times the risk of heart attack or stroke, Leong stresses that you can’t diagnose heart disease by looking in someone’s mouth; you can only look at the signs in conjunction with other symptoms and conditions.

Solution: Healthy lifestyle, good oral hygiene, along with regular exams and cleanings for prevention, since a reduction in gum disease means a reduction in heart disease risk. See your family doctor or cardiologist to determine your risk.

Crohn’s disease

Signs and symptoms: Painless bumps anywhere in the mouth, recurring canker sores, and, less common, swollen lips. “Canker sores, what we call aphthous-type ulcerations, tend to be common in children and young individuals, but uncommon in older adults,” says Leong. “When older adults start developing these multiple sores they may be a sign of some kind of systemic disorder. For example, they might be linked to certain blistering skin conditions, sometimes to problems with the gastrointestinal tract, like Crohn’s [inflammatory bowel] disease. They can also signal problems with the immune system, an autoimmune disease or a suppressed immune system. They could be related to certain vitamin deficiencies. In some patients, they might be related to a thinning of the lining of the mouth, allergies or intolerances to certain components of their diet.”

Solution: Some 20 per cent of people with inflammatory bowel disease have mouth lesions, along with abdominal cramps and diarrhea. A dentist may suggest topical corticosteroids to reduce the inflammation and/or a trip to a gastroenterologist.