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A Good Dentist Sees More Than Teeth: The Mouth Holds Clues to Many Ills

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By Michael Birnbaum
Washington Post Staff Writer
Tuesday, June 23, 2009

Your mouth can tell you a lot about your overall health.

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Troubled teeth and gums aren't always just a dental problem. Sometimes they indicate deeper issues, and dentists are increasingly picking up the clues.

"We look around the mouth and we look for color changes. We're looking for certain smells. Spots around the gums," said Washington dentist Joseph Kravitz.

The relation of oral health to the rest of the body has gotten increased attention in recent years, spurred by such experts as Richard H. Carmona, who as U.S. surgeon general urged policymakers in 2003 to "increase the understanding of how the signs and symptoms of oral infections can indicate general health status and act as a marker for other diseases." The publicity reminded a lot of dentists that their jobs weren't just about root canals and fillings, and it educated the public, Kravitz said.

Following are some non-oral-health issues and the possible clues Kravitz says dentists may be able to identify:

-- Heart disease. Gums that have turned a "bright beefy red" or purple. Kravitz checks his patients' blood pressure when he notices those symptoms.

-- Type 2 diabetes. Gums that bleed at the slightest touch although there is no plaque evident. Kravitz said patients with diabetes also typically have sores elsewhere on their bodies that they may not have connected to the disease.

-- Kidney disease. A sweet ammonia smell on a person's breath, detectable even from behind a dentist's surgical mask.

-- Acid reflux. Teeth that look worn and pitted, as if they'd been "dipped in battery acid." Only some teeth will be affected, depending on where the acids settle during a person's typical sleeping position.

-- Oral cancer. Gum tissues with white spots that last two weeks or more. (Kravitz said spots that clear up more quickly can indicate many other things, including something as simple as having bitten into too-hot pizza.)

-- Leukemia. Fiery-red swollen gums that just won't heal, distinguishable from diabetes symptoms with a blood test.

-- Osteoporosis. Certain black spots on tooth X-rays that indicate air pockets and dead bone.

-- Stress. Gums that have pulled away from teeth, or teeth that themselves are fractured. All sorts of fungal, bacterial and viral infections can enter the body through cracked teeth, Kravitz said.

-- Sleep apnea. An enlarged tongue and inflamed gums in the part of the mouth through which air passes.

-- Pregnancy. Deeply swollen gums can indicate hormonal changes.

-- Bulimia. Upper front teeth that are paper thin, with the enamel almost completely worn away, and teeth that hurt. Distinguishable from acid reflux because different teeth are affected.

Kravitz said that patients should make sure that dentists aren't "just looking in their mouths for five to 10 seconds" and that a thorough inspection should take at least five minutes.

He said that when he notices symptoms in his patients' mouths, he'll often have them come back in two weeks. About half the time, the symptoms are gone with no lasting effect. The other half of the time, he'll refer the patient to a physician.

"Every dentist in this country has this training," Kravitz said. "So it's good for consumers to make sure their dentists are paying attention."


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