Don’t Underestimate the Value of Good Oral Health

A mouth is not just a mouth. It’s a window into a person’s overall health.

“It’s so important, and so neglected by the medical community,” said Suzanne Ahnquist, DMD, of Smilesbuilderz in Lancaster. “There is such an oral-systemic link.”

For one thing, the bacteria that occur naturally in the mouth and are harmless can be harmful for the rest of the body.

Basically, today, dentists deal with “everything above the neck,” not just the mouth, notes Ahnquist. More specifically, today’s dentists and the registered dental hygienists who work with them are taught to do an oral cancer exam.

“Mouth cancer is devastating,” Ahnquist said. “It can go fast and metastasize and can be disfiguring.”

Dentists and hygienists will also check for enlargements around the neck—the lymph nodes or the thyroid gland may be enlarged. The majority of the time the patient doesn’t know he or she has any pathological condition because initially it doesn’t hurt.

Dentists and hygienists look at the throat, “which should be ‘smooth and strong,’” said Ahnquist. “If they find an enlargement or open wound on one side, it can be suspicious. They should document the size of any abnormalities, such as lumps and lesions.”

Your dentist also should be checking the tongue, especially the lateral borders. Squamous cell carcinoma is most prevalent there but can appear in all areas of the mouth and lips. Mouth cancer lesions have an irregular border.

The dentist also checks inside the cheeks, asking the patient to extend the tongue and say “ah” so the dentist can look in the back of the throat for lesions.

If a lesion is found, the dentist can take photographs and email them to a periodontist or perform oral surgery to remove a sample for a biopsy for evaluation.

What are the causes of oral cancers? The No. 1 cause is tobacco use, but heredity plays a part. Other risk factors are alcohol consumption, poor diet, and the human papillomavirus.

“HPV is spreading because of oral sex, especially in teens, where it is the No. 1 cause of the virus,” Ahnquist said.

To get the most comprehensive view of a patient’s mouth, the hygienist should take a Panorex—X-rays that go around the head from one ear to another. A Panorex can pick up bone densities and radiolucencies that can be pathological lesions.

Some patients are concerned about radiation from X-rays, but, said Ahnquist, “the exposure is minimal, because X-rays now are digital. You get more radiation going outside to your car in the sunlight.

“X-rays” she continued, “help us see what can’t be seen otherwise. Decay is minor compared with finding cancer.”

Another important evaluation is the measurement of the airway when a patient says “ah.” Dentists should be educated in sleep apnea, Ahnquist suggested.

Recently, Ahnquist saw a child who was “dying to breathe.” As a result, he had behavior problems, allergies, and needed oxygen. He also didn’t sleep well, breathed through his mouth, and even had circles under his eyes.

“If you do a sleep study of a patient, commonly the problem is in the tonsils and adenoids. But the patient may also have underlying anatomical and physiological issues, and it is important to have an intervention,” Ahnquist said.

About 30 percent of the population has apnea but doesn’t know it, and apnea is related to many health problems.

For example, people with apnea tend to brux—clench and grind their teeth. The muscles of the face control the force of the teeth against each other and can lead to flattened, shortened, and fractured teeth. The muscles can also cause chronic headaches and migraines.

“If the bite is not balanced, people will have the tendency to clench,” said Ahnquist. “Stress can contribute, but unbalanced bites are one of the main causes of bruxism. They can lead to curvature in the neck and the spine.”

If you frequently wake up with headaches and/or have pain in the back of the neck, it can be a biting issue.

Another oral condition is temporomandibular disorder (TMD), which may result from a malaligned bite, trauma, facial muscle forces, degenerative discs or joints, or arthritis, among other factors.

Mouth sores, such as sun blisters, aphthous ulcers (or canker sores), and herpetic lesions, can erupt due to stress, diet, or trauma to skin.

Periodontal (or gum) disease is one condition dentists discover when they do an oral examination. The dentist should examine the patient for pain anywhere in the joints and neck and find out if the patient has headaches or sores in the mouth.

Many people don’t realize they have periodontal disease because it doesn’t hurt until it has done some bone damage. In periodontal disease, the gums become puffy and bleeding, and there are significant infections and bone loss.

Periodontal disease starts as plaque. Colonies of bacteria give off toxins that deteriorate the bone. Research shows the toxins can get into the bloodstream and cause heart disease and heart attacks.

Smoking is the No. 1 cause of periodontal disease. The toxins in smoke deteriorate the bone surrounding the teeth.

Toothbrushes can’t clean plaque. You need a hygienist to use scalers to get under the gum to remove the hard deposits that build up.

A cavitron is a dental tool that uses high-frequency sound waves to clean teeth from tartar and dirt. Water then flushes away the bacteria and plaque that build up on your teeth.

Drug use has multiple negative effects on the teeth: bone loss, decay, and periodontal disease.

Another dental condition dentists should look for is dry mouth, or xerostomia. Dry mouth has many causes, including certain medications and medical conditions.

“Though you may have a good health history, a dry mouth makes you more prone to getting cavities,” noted Ahnquist.

Saliva is necessary to moisten our mouths and keep them clean, as well as to digest food. Saliva also prevents infection by controlling bacteria and fungi in the mouth.

Clearly, it is wise not to forgo visiting your dentist for regular cleanings, which will help keep your teeth and gums healthy. But your dentist may also alert you to other health conditions that you may not have been aware of. BW