Open wide for open book on health

Exam: A look into the mouth can reveal a lot about what's going on elsewhere in the body.

April 25, 1999|By LOS ANGELES TIMES

Think about this the next time someone in a white coat instructs you to "open wide." Your mouth is a window to your health.

Diagnosis through the mouth goes way beyond scanning for redness or white patches on the tonsils -- the telltale traces of strep throat.

An oral exam can reveal many more signposts to illness:

* A dentist peering at tooth enamel can see evidence of bulimia, the eating and vomiting disorder that exposes teeth to erosive stomach acids.

* A periodontist probing inflamed gums thinks about eradicating bone-gobbling plaque bacteria that are suspected contributors to heart attacks, stroke and possibly arthritis.

* Dry, thick, stringy saliva or breath with tones of alcohol or acetone can be indicators of uncontrolled diabetes.

* A doctor of Oriental medicine studies the color, condition and coating of the tongue for signs of constipation, fever, poor circulation and even infertility.

"The mouth has been typically referred to as the gateway, the doorway to the body," says Dr. Robert Schoor, director of postdoctoral periodontics at New York University College of Dentistry and president of the American Academy of Periodontology.

The mouth is much more than the conduit to the digestive tract. It's home to our sense of taste. And its connections to the brain allow us to communicate through our lips, tongue and palate. The mucous membrane lining of the mouth is full of blood vessels that provide a ready connection to other parts of the body. For example, drugs placed under the tongue, like nitroglycerin pills for chest pain, are rapidly absorbed through the membranes into the circulatory system.

Researchers are pursuing an emerging field that relates periodontal diseases -- infections of the gums and tissues surrounding the teeth -- to systemic disease. People with gum disease have higher rates of coronary artery disease than those with healthy mouths, and scientists are trying to understand what's behind that association.

Last year, researchers at the University of Minnesota reported that Streptococcus sanguis, a bacterium commonly found in dental plaque, caused human blood to clot in test tubes. Clotting is worrisome because it is the basis of heart attacks and strokes.

Dr. Joseph Brent Muhlestein, a cardiologist in Salt Lake City, studies the role of chlamydia bacteria in heart disease.

"What we have is some epidemiologic findings that show if you have periodontitis and then you're tracked for a long time, ... you're more likely to end up with a heart attack than if you don't have periodontitis," Muhlestein said. Researchers theorize that bacteria may trigger inflammation and set off a cascade of immune responses inside the arteries.

That suggests there might be some connection between the sticky plaque you brush off your teeth and the plaque that builds up inside arteries.

In 2001, the National Institutes of Health are sponsoring a global conference on the role periodontal medicine plays in stroke, coronary artery disease, low birth weight, osteoporosis and diabetes.

Periodontists and dentists are trained to think beyond tooth decay and bleeding gums. They look for swollen glands and examine the palate, gums and other tissues for cancers that may masquerade as wounds that won't heal.

Medical and dental professionals regularly screen for AIDS-related conditions in the mouth.

"There are changes to the tongue, like hairy leukoplakia -- a long linear lesion on the sides of the tongue -- which help diagnose an HIV infection," Schoor said. "More importantly, there are changes to the gum tissue which we call NUP, necrotizing ulcerative periodontitis, that's highly suggestive of an HIV infection. There are yeast infections [that] might indicate a reduced immune state."

Schoor cited several illnesses in which the periodontist may be "the first to diagnose." A very dry mouth might be the first symptom of Sjogren's syndrome, an autoimmune disease that attacks glands that produce tears and saliva. Without protective fluids, teeth and gums become vulnerable to infection and decay.

Autoimmune diseases such as scleroderma, in which tissues become overly thickened and stiff, might show up in problems with swallowing or in restricted movement in the jaw, Schoor said. Neurological disorders such as stroke might lead to problems speaking or swallowing.

And women's changing hormone levels are reflected in their gums. Maternal gum disease has been linked to increased risk of delivering a premature, low-weight baby.

A simple exam speaks volumes

Medical and dental professionals look for different things when they examine a patient's mouth:

* Throat, tonsils: A doctor uses a wooden tongue depressor to look for a red throat or white coating on the tonsils, which are indicators of strep throat.

* Inflamed gums: A periodontist looks to eliminate bacteria that invade the gums. Some research has suggested a link between mouth bacteria and blood clots that lead to heart attacks and strokes.

* Palate, gums, other tissues: Doctors and dentists look for growths that can indicate cancer, particularly due to smoking or tobacco chewing.

* Breath: When doctors detect the smell of acetone or an alcohol-like odor, it can be a sign of untreated, severe diabetes.

* Tongue: Doctors of Oriental medicine look at the color, condition and coating of the tongue to learn about other organs in the body. They believe, for example, that a yellowish coating, a red color or cracks in the tongue can indicate a fever or inflammation.

-- Los Angeles Times

Pub Date: 04/25/99

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