by Laura Tedesco
The health of your mouth may shine a light on what’s happening in the rest of your body. (Kulka/Corbis)
You expect your dentist to flag cavities, but did you know your drill-wielding doc might also be able to spot trouble that extends well beyond your pearly whites?
“It’s becoming clear that we need to consider integrating oral and general health care,” says Steve Offenbacher, D.D.S., director of the Center for Oral and Systemic Diseases at the University of North Carolina at Chapel Hill. “The oral cavity is the mirror to the rest of the body, so we can pick up on systemic problems by simple dental examinations.” In other words, the state of your smile may shine a light on the rest of your body — sometimes even before other symptoms show up.
Case in point: Offenbacher once told a middle-aged patient he suspected she was pregnant, based simply on the redness of her gums. “The next week, she came back and said, ‘I went to the doctor, and yes, I am pregnant!’’ he recalls. In that case, Offenbacher was the bearer of good news, but not all of the secrets your mouth may reveal are so positive. Your teeth may also provide clues about these five health-threatening conditions:
Your dentist isn’t just worried about how white your teeth are. In a 2014 study, nearly two-thirds of dentists said they’d refer a patient with periodontitis (inflammation around the gums) for a diabetes evaluation. Why that’s a good thing: “Diabetes is not only a common problem, but it’s also highly under-diagnosed,” says Offenbacher. Read: Lots of people have diabetes and don’t know it, which means adding your dentist to your team of health detectives is a smart idea.
So what’s the dental-diabetes link? High blood sugar may be as damaging to your oral health as the sweet stuff in a can of soda. That’s because the condition can cause dry mouth, which increases plaque build-up, making people with uncontrolled diabetes more prone to dental problems.
“[Periodontal disease in diabetics] is usually severe for their age or for local factors, meaning they have pretty clean mouths, but they still have a periodontal problem,” says Offenbacher.
Two common oral signs of diabetes: multiple abscesses on the gums and bad breath. “It’s kind of a sour fruit smell,” Offenbacher says. “It’s ketones — metabolic products associated with poor glycemic control — in their bloodstream that you can smell.”
Your teeth may reveal what’s going on with your ticker. A 2007 study review found that people with periodontal disease are significantly more likely to develop heart disease than folks with good oral health. Among people who have both diseases, “if the periodontal disease is treated, the heart disease is greatly improved,” says Marjorie Jeffcoat, D.M.D., a professor and dean emeritus of dental medicine at the University of Pennsylvania.
The common thread? Inflammation. “When you look in a patient’s mouth and you see chronic inflammation, you know that it’s creating systemic stress,” says Offenbacher.
Although there are no dental red flags specific to heart disease, “more severe periodontal disease is strongly associated with heart disease risk,” Offenbacher says. Signs include loose, shifting, or missing teeth, and increased probing depths, where the pockets around the teeth have deepened.
Can tooth loss indicate memory loss? In recent British research, a lack of teeth was associated with mental decline, while a 2012 study found that older adults with poor dental hygiene were 76 percent more likely to develop dementia. This is a relatively new area of research, which means the link between the two isn’t entirely clear, says Jeffcoat. However, a small 2013 study detected Porphyromonas gingivalis — a bacteria associated with gum disease — in the brains of people with dementia, suggesting that it may play a role in the inflammation associated with cognitive decline.
Osteoporosis won’t cause your teeth to decay — but your dentist may be able to spot bone loss in the surrounding structures, like the jaw, with digital X-rays, says Jeffcoat. Normal, healthy bone should be dense both at the edges and in the interior, and when that’s not the case, “the patient is more likely to have osteoporosis,” she explains.
In fact, in a 2013 study in the Journal of Research in Medical Sciences, the thickness of postmenopausal women’s jawbones — as measured with a panoramic X-ray — was correlated with the bone density of their spine. This means that dentists could potentially diagnose osteoporosis, which often goes undetected until a fracture occurs, in its early stages, the scientists say.
Acid reflux disease
You may feel heartburn most intensely in your chest, but its effects may be most obvious in your mouth. If you have acid reflux disease, the constant uprising of stomach acid could wear away at the enamel on your teeth, says Jeffcoat. “You’ll usually see it in the lower front teeth,” she says. “You’ll see erosion of the teeth — they get thinner. You can’t miss it.” Another sign you may be suffering from acid reflux disease: You have a persistent sour taste in your mouth, she says.
In a 2008 study review, researchers found that about a third of adults with dental erosion also had gastrointestinal esophageal reflux disease, or GERD. Keep in mind, this erosion can happen even in the absence of chest pain — that is, you may have reflux without knowing it, until your dentist points out the damage to your choppers.