It is all too easy for any dental clinician whilst bending over his or her patient and intently focused on treating a specific dental or gingival condition, to lose sight of its relation to the broader, holistic picture reflected in the patient’s overall well-being.
In fact, there is increasing evidence of a close connection between the health of the oral cavity and the general health of the patient. Dental professionals are uniquely placed for the early identification of a number of serious conditions affecting almost every part of the body.
The connection is effectively double-edged, with the relative ill health of the exposed oral tissue and mucosa serving either as a visible indicator of various existing systemic diseases, or else acting as a causal or predisposing factor for an apparently unrelated condition which may potentially have wide-reaching, damaging systemic consequences.
Among the more common conditions which manifest recognisable symptoms within the mouth are intestinal disease, chronic liver disease, anaemia and osteoporosis. A recent Japanese study has even suggested a causal link between tooth loss and memory loss, and the association of the severity of periodontal disease with that of rheumatoid arthritis is well documented and widely accepted among both medical and dental professionals.
The intestinal lesions and inflammation associated with crohn disease are often mirrored in the mouth, making eating painful, while the impact of liver disease on clotting agents may be the cause of otherwise unexplained excessive gingival bleeding. Jaundice, or yellowing of the thinner sublingual mucosa and of the soft palate, is also an indication of advanced liver disease.
Anaemic patients will exhibit mucosal pallor and glossitis may be a sign of folate or vitamin B12 deficiency. A particular concern with an ageing population is the early diagnosis of osteoporosis, where the first clinically observable symptoms may appear on dental radiographs – typically a widening of the lamina dura, a lessening of jawbone density and/or changes to the mandibular condyle.
Whilst all dental diagnoses need to take these symptoms into account, even more significant in terms of the number of patients likely to be affected is the growing problem of diabetes among the UK population, with type two being the most common in every age demographic. Diabetes UK states there are currently 2.6m diagnosed sufferers in the UK, with a further half a million undiagnosed and the figure set to reach 4m or more by 2025.
The link between diabetes and oral health is well established, and the condition is known to predispose periodontitis, gingivitis, candidiasis, lichen planus, burning mouth syndrome and xerostomia, as well as interfering with taste sensations. Diabetic children and teenagers are especially at risk of periodontal disease with the condition rapidly increasing in severity, and so early intervention is crucial. Another relatively high risk group is pregnant women, with gestational diabetes affecting five per cent of all pregnancies, making it imperative that gingival disease is treated to safeguard both the mother and the child.
To offer diabetic patients the appropriate care, dentists need access to their medical history, and new patients should be asked to provide this information on their first visit. Patients who present signs of heightened gingival tissue sensitivity, or bleeding, may be undiagnosed diabetics and should be referred to their medical practitioner.
As time passes and research continues, it is becoming more and more apparent that for many diseases the condition of the oral cavity not only affords a ‘window’ into the body’s general health, but also an indication of the patient’s susceptibility to conditions such as diabetes. Against this background, the importance of persuading patients, especially those with diabetes, to assume a consistent, deliberate, conscientious and pro-active stance towards their oral health regime should be a priority concern for all dental professionals.
Although diets and lifestyles vary hugely, an argument understood by all patients is the simple expression, ‘your teeth are for life.’ However, prescribing an oral health regime is less simple as every patient will have individual circumstances, and their ability to follow advice, even with good intentions, may be limited by physical or time constraints. For example, arthritis sufferers, other patients with compromised manual dexterity, or younger children may find flossing difficult or even impossible.
The benefits of fluoride toothpaste need no further mention, but there are still many patients whose use of a mouthwash is cursory or non-existent. Stressing the value a medicated mouthwash, such as Curasept ADS and rinsing for the recommended duration, is of particular value for diabetic patients.
As the number of diagnosed diabetic patients rises, the advisory and clinical roles of the dentist assume greater significance in overall healthcare across every social and age demographic. Being able to offer an individual oral health regimen solution to each patient is a key responsibility for every practitioner.