Laura J. Martin, MD
During your routine dental check-up, your dentist can uncover important clues about your overall health.
If your tooth enamel is worn down, for example, that's a sign that you may be suffering from stress and grinding your teeth at night. Swollen and receding gums can be an early sign of diabetes, and sores in your mouth that don't heal can sometimes indicate oral cancer.
A dentist or periodontist may be the first to notice these symptoms and can tell you which additional tests or treatments you may need. In some cases, they'll work closely with your primary care doctor to help manage your follow-up care.
"Dentists and periodontists are concerned about more than saving your teeth - they're looking at how oral health fits into your overall well-being," says Steven Offenbacher, DDS, PhD, chair of the department of periodontology and director of the Center for Oral and Systemic Diseases at the School of Dentistry at the University of North Carolina at Chapel Hill.
Here are some of the most common conditions dentists look out for that can affect your oral health.
People with type 1 and type 2 diabetes are more likely to develop gum disease.
That's because they may have a decreased ability to fight bacterial infections, including those that occur in the mouth. In addition, serious gum disease can make it more difficult for people with diabetes to control their blood sugar.
"When I see a patient with symptoms like frequent gum abscesses, swelling, a lot of bone loss in a short amount of time, and gum disease that doesn't respond to normal treatment, those can be signs that they have diabetes," says Sally Cram, DDS, a periodontist in Washington, D.C., and spokeswoman for the American Dental Association. "Over the years, I've had at least a dozen patients who I identified as diabetic and they didn't know it."
If your dentist suspects that you have undiagnosed diabetes, he or she will advise you to go to an endocrinologist or to your primary care doctor for testing.
Once you've been diagnosed as having prediabetes or diabetes, your dentist may send status reports to your doctor -- letting him know, for instance, if they suspect your blood sugar is not well controlled because your gum disease has been difficult to treat.
Also, your dentist or periodontist may recommend that you schedule dental exams more frequently -- for example, every three months -- if you have a history of diabetes and gum disease.
The first sign of oral cancer is often a small red or white spot or sore in the mouth. It can appear on your lips, gums, tongue, cheek lining, or in other parts of your mouth.
"Often, the patient does not notice it because it starts as a small spot toward the back of the mouth or under the tongue and they don't have any symptoms," Cram says.
Your dentist, dental hygienist, or periodontist will typically screen for oral cancer as part of a routine dental exam. By scheduling regular check-ups, you can increase the chances that any potentially cancerous or precancerous lesions will be caught early and successfully treated. Also, be sure to tell your dentist if you've noticed symptoms like a sore in your mouth that doesn't heal, a lump, or pain or numbness anywhere in your mouth or on your lips.
Your teeth may be worn down or chipped if you've been unconsciously grinding or clenching them. This grinding -- also known as bruxism -- can eventually cause bone loss that your dentist may detect on your X-rays.
Bruxism is usually caused by stress but can also occur because the top and bottom teeth aren't aligned properly. You may or may not be aware that you've been grinding your teeth, but your dentist can spot the signs.
To prevent damage to your teeth and keep them apart so your jaw muscles can relax, your dentist can fit you with a custom mouth guard to wear while you sleep.
Studies suggest that pregnant women with serious gum disease -- called periodontitis -- are more likely to deliver a premature baby of low birth weight.
Offenbacher explains that the bacteria in the mouth of a woman with gum disease can trigger an increase in a chemical compound called prostaglandin and other harmful inflammatory molecules. These chemicals can induce early labor and impair fetal growth. Offenbacher has conducted several studies on the link between periodontitis and an increased risk of delivering a premature baby.
More research is needed to determine the best way to manage gum problems to lower the risk of preterm delivery. Researchers have yet to determine, for example, the best treatment to use and whether the treatment should ideally begin before women with gum disease get pregnant.
Experts agree, however, that women who are pregnant or thinking about becoming pregnant should get a dental exam and, if necessary, treatment for gum disease as early as they can.
"If you want a healthy and predictable pregnancy, it makes sense to take care of your periodontal health as early as possible," says Donald S. Clem, DDS, a periodontist in Fullerton, Calif., and president of the American Academy of Periodontology.
Since gum disease may increase the risk of heart attacks and strokes, you should tell your dentist if you have cardiovascular disease or have a family history of these conditions.
Researchers are investigating the links between gum disease and cardiovascular disease. One potential link is that inflammation in the mouth increases inflammation in other parts of the body, including the arteries. This inflammation may play a role in heart attacks or strokes.
By treating gum disease and reducing the inflammation in your mouth, you may be able to lower your risk of stroke or heart attack, Offenbacher says.
"I tell my patients: If you have a family history of heart disease or stroke, you should keep your gums as healthy as possible so you don't add to your other risk factors," Cram says. "Spending 5 minutes a day to remove plaque and bacteria by brushing and flossing is worth it if it will help prevent serious heart problems or stroke."
SOURCES:Steven Offenbacher, DDS, PhD, chair, department of periodontology; director, Center for Oral and Systemic Diseases, School of Dentistry, University of North Carolina at Chapel Hill.Mayo Clinic: "Oral health: A window to your overall health."American Dental Association: "Diabetes."Cleveland Clinic: "Oral Health Problems and Diabetes."American Academy of Periodontology: "Gum Disease and Diabetes."American Diabetes Association: "Diabetes and Oral Health Problems."Mayo Clinic: "Diabetes and dental care: Guide to a healthy mouth."Sally Cram, DDS, periodontist; spokeswoman, American Dental Association.American Dental Association: "Oral Cancer."Cleveland Clinic: "Oral Cancer."American Cancer Society: "Oral Cavity and Oropharyngeal Cancer."Mayo Clinic: "What is the best way to screen for oral cancer?"Mayo Clinic: "Bruxism/teeth grinding."American Dental Association: "Bruxism (Teeth Grinding)."American Academy of Periodontology: "Gum Disease and Pregnancy Problems."CDC: "Public Health Implications of Chronic Periodontal Infection in Adults."Vergnes, J. American Journal of Obstetrics and Gynecology, February 2007.Offenbacher, S. Journal of Periodontology, October 1996.Offenbacher, S. Obstetrics and Gynecology, September 2010.American Dental Association: "Pregnancy."Donald S. Clem, DDS, periodontist; president, American Academy of Periodontology.American Academy of Periodontology: "Gum Disease Links to Heart Disease and Stroke."Mayo Clinic: "Can poor oral health cause heart disease?"Cleveland Clinic: "Oral Health and Cardiovascular Diseases."American Academy of Periodontology: "Healthy Gums and a Healthy Heart: The Perio-Cardio Connection."American Academy of Periodontology: "Mouth-Body Connection."
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