Dental Symptoms Can Expose Health Issues

Without saying a word, your mouth can speak volumes about your general health. During an oral exam, dentists can find signs that point to everything from anemia to diabetes to heart or liver disease, diet deficiencies and eating disorders, gastrointestinal (GI) problems, arthritis, HIV, osteoporosis, some autoimmune diseases, and even some pregnancy risks.

"Your mouth can reveal an awful lot," says Lee M. Radke, DDS, an Assistant Professor of Surgery at the Medical College of Wisconsin. "The correlation, or at least the association, between systemic health and a healthy mouth is becoming more and more evident."

In fact, in February 2006, the American Dental Association and the American Medical Association held a first-ever joint news conference in New York titled "Oral and Systemic Health: Exploring the Connection." As one of the speakers put it: "The fact that the mouth is connected to the rest of the body is often overlooked." Among the points discussed was the need for greater communication between dentists and physicians to reduce patients' risks for heart disease and stroke, worsening diabetic control, lung infections, and even premature births - risks that can manifest themselves in the patients' mouths.

Dr. Radke serves as the hospital dentist at the Oral and Maxillofacial Surgery Clinic, part of the Froedtert & The Medical College's Sargeant Health Center. The role of a hospital dentist can vary among institutions, he says. In Dr. Radke's case, he evaluates and treats a variety of patients, including some who are medically compromised because of suppressed immune systems, fragile health status, or behavioral problems.

Most Diseases Have Oral Symptoms
An unhealthy mouth, he says, can exhibit symptoms like dryness, gum swelling or infection, slow healing of sores, or rapidly advancing tooth decay and gum disease. It is estimated that 90% of all systemic diseases produce oral signs and symptoms.

"That's probably true," Dr. Radke says. "If the mouth is pale-colored, rather than the normal healthy pink color, it could indicate anemia. Unusual bleeding could indicate liver disease, medication overdoses, or coagulation disorders. A red, smooth tongue can indicate GI problems or diet deficiencies, especially a lack of vitamin B12 or folate. Erosion of tooth enamel can point to reflux or eating disorders. Erosions and patchy lesions could indicate cancers or immune diseases."

By contrast, a healthy mouth is free of infection, tooth decay, bad breath, or mouth sores. The patient's mouth and teeth look acceptable, and he or she can chew and speak without problems. Attaining a healthy mouth is simple, Dr. Radke says - practice good oral hygiene and smart lifestyle habits.

"That means daily brushing and flossing," he says, "although even today you have to convince people to do that. Diet is a major factor, but too many people make choices that aren't healthy. It's amazing the volume of soda and sugary snacks people consume. And then there's smoking and excessive alcohol use. So much is preventable and manageable."

Simply having a healthy mouth does not necessarily guarantee overall good health. But an unhealthy mouth can indicate problems elsewhere in the body. "If you do have a healthy mouth and still get infections or sores, it could indicate an underlying medical condition," Dr. Radke says.

Healthy Mouth Can Prevent Infection
"A healthy mouth is a great defense against bacteria, viruses, and fungi that can cause disease," he says. "If the mucosa - the pink stuff - is intact, it forms a good barrier that wards off infection."

During a dental exam, dentists look for decay and gum disease, and check for signs of cancer of the mouth or throat. They look under the tongue and in areas of the mouth that are difficult to see in a self-examination in front of a bathroom mirror, he says.

Approximately 500 different types of bacteria live in the mouth, and many of them have protective properties that help prevent overgrowth of harmful microorganisms, Dr. Radke says. "There is a delicate balance between good and bad organisms in the mouth and throat, and maintaining this balance is what a healthy mouth is all about," he explains. "The saliva also contains antibodies and enzymes that protect against many bacteria and viruses."

"Oral bacteria can sometimes enter the bloodstream, especially after invasive dental procedures such as cleaning, extractions, and gum surgery," he notes. Patients with certain cardiac conditions, prosthetic joints, or immune compromises are often advised to take antibiotics before such procedures, he says.

Some researchers believe that in the future, saliva testing might replace blood testing as a means of diagnosing and monitoring diseases such as diabetes, Parkinson's disease, cirrhosis of the liver, and many infectious diseases. Right now, saliva testing is routinely used to measure illegal drugs, environmental toxins, hormones, and antibodies indicating hepatitis or HIV infection.

"Meantime," says Dr. Radke, "awareness of the association between oral infections and diseases like stroke, diabetes, and even preterm labor keeps increasing. It's quite a dynamic topic in the dental and medical literature. Cause and effect has not been proven yet, but the connection between oral infection and systemic disease is evolving rapidly. I think it's important to understand the relationship between oral health and overall health."

Barbara Abel
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.