Systemic diseases that can be discovered through an Oral Examination
Ask The Gentle Dentist – January 2012

I want to wish all of the readers a Blessed 2012 as we enter into the new season and year.  I have been writing these articles for the past nine years and have appreciated all of the positive feed back over the years on how these articles have informed so many people and the fact that they look forward to reading them each month.  When I hear these comments I know my efforts to provide informative and relevant topics that relate to the oral condition are worth it.  I do depend on questions from the reading audience to keep this monthly article relevant.  Please submit your questions to me even if you want to just call the office and ask the question so I can post it on the next month’s article would be fine.  Our address is:

Ask The Gentle Dentist
15055 22 Mile #2
Shelby Twp, MI 48315

The phone number at the office is: (586)247-3500 or email at DrAntolak@thegentledentist.com.

The reason why I post our office address is that a new patient I recently saw has been reading the articles and thought I was a national dental writer.  He didn’t realize that I was local so to answer his question—Yes our office is local.

Oral/Systemic connection (continued from last month)

Diabetes- The palate and tissues of the mouth appears reddish with possible white film.  This can be from hyperglycemia (uncontrolled diabetes).  Excessive blood sugars from diabetes can increase the bacteria levels on the soft tissue and plaques of yeast can be present from a poor balance of good/bacteria in the mouth.

Dry Mouth

• Multiple drugs can lead to dry mouth.  Dry mouth has a number of consequences, including altered taste, increased risk of fungal infections, increased risk for decay and even traumatic ulcers due to lack of normal lubrication that saliva provides.  Patients with severely impaired salivary flow are challenged with eating, swallowing and speech.  This can result in poor eating and nutrition. Healthy saliva naturally controls the balance of the micro-organisms in the mouth and buffers the soft tissues from the ill effects of this disease. We have a number of options to lubricate the mouth.  These include:
1. The use of a lozenge with a drug called pilocarpine which helps to induce saliva flow.  I have this compounded at a local pharmacy.
2. MI Paste. This is a gel that is applied with the finger and rubbed into the teeth.  It contains Calcium/phosphorous and fluoride in a milk base.  This is good for preventing decay and adds lubrication to the mouth.
3. Biotene products:  These are an entire line of lubricating toothpastes and mouth rinses sold over the counter.

Inhaled steroids

Inhaled steroids are used for those who have asthma or other breathing disorders.  The steroid dries out the mouth and gives the gums and soft tissue a reddish appearance which causes them to bleed very easily and thrush (yeast) infections are prevalent in these patients.  Rinsing out with water after its use is helpful in preventing these problems.

Autoimmune disease

Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body.  This means the body starts attacking itself and its own cells.

1. Sjogen’s Syndrome is an autoimmune disease which causes the body to destroy its own saliva glands.  This makes it very difficult to maintain a healthy mouth.
2. Lichen Planus is a disorder that creates erosive or ulcers on the cheek and other mucus membranes.

Gingival Enlargements

Medications and hormone abnormalities including pregnancy can cause the gums to swell.  Those patients on dilantin for epilepsy or calcium channel blockers for blood pressure control are at risk for this problem.

Oral cancer

The most common areas for oral cancer is under the tongue or in the pharynx  and presents as a red or whitish lesion. Oral cancer is under diagnosed and usually treated at a very late stage when the five year survival rate is low.  Early detection at every examination is the best course.  With the careful examination of the mouth under proper lighting conditions, magnification and even special instrumentation it is possible to diagnose cancer in its earliest stages when it is most treatable.  Smokers and snuff dippers have localized areas of trauma where the heat and nicotine affect the tissues of the lip and hard palate (roof of the mouth).  Kicking the habit is always encouraged to help our patients be substance free.

Viral infections such as HIV, HPV and herpes

These sexually transmitted diseases and others can appear in the mouth because the mouth contains mucous membranes which are very thin.  The signs that appear in the mouth are similar to those who have other diseases that compromise the immune system.

Herpes simplex (cold sores show up on the edge of the lip but can be found on the tongue gums and hard palate.  These are very common and usually follow a burning and tingling sensation in the lip.  Sunlight, stress and fevers can activate the virus which is stored in the nerve of the lip.  When the virus reproduces it travels down the nerve (where it is stored when inactive) from near the brain to the lip.  Those affected can sense this with a burning or tingling sensation on the lip.  When the virus finally breaks out as a sore this is EXTREMELY contagious.  Washing the hands regularly and being protective of the affected area should be exercised.  Small children and those who have not been infected with the virus should not be kissed.  It is also very important to avoid rubbing the eyes as this could lead to vision problems.  To treat these there are a number of home remedies including lysine, placing witch hazel, turmeric or even honey on the site.  Rinsing with baking soda/water can make it more difficult for these viruses to repopulate.  I often prescribe anti-viral pills and ointment to take a more direct approach.

Other potential problems:

Blood Pressure: When we see a patient for the first time we do a blood pressure screening and amazingly enough we have uncovered many patients who have undiagnosed high blood pressure and have referred them to a physician to get this under control.

General systemic infection:  When feeling then neck any lump or bump in the neck could be a swollen lymph node.  Swollen lymph nodes could be a sigh of an infection in the body.

Thyroid gland enlargement:  The thyroid gland located on the front of the neck is used to regulate the metabolism of an individual.  If there is enlargement of the gland then there could be too high of a metabolism.  This increased metabolism can result in unintended weight loss, restlessness and a lack of sleep. A blood test by the physician is needed to confirm these symptoms.

There are other potential diseases that present themselves in the oral cavity at the early stages but because of limitations in this article I didn’t discuss them.  It is noteworthy to say that when we know what looks normal then we can define what looks abnormal.  We refer patients to their physician all of the time to see if what we see in the mouth is a related with an undiagnosed systemic medical issue.

This is the first issue of 2012 and I want to thank the readers and Jody McVeigh the editor for allowing me to inform the public of issues that relate with their oral health.  May you have a prosperous and Healthy New Year.

Blessings, Robert Antolak DDS