The Five Things Dentists Wished PCPs Weren't Missing

Dentists are urging primary care doctors to pay closer attention to signs of illness that may show up in the mouth. From overlooked gum disease to suspicious lesions, oral health can provide a critical window into broader medical concerns. 

A recent statement by the U.S. Preventive Services Task Force found that dental screenings by primary care doctors may not work well enough to catch patients most at risk of oral health issues. 

But dentists say a quick look during regular office visits could help catch health problems. 

"Health care providers other than dentists don't look in the mouth a lot, and if they do, they're looking past the teeth and mouth into the throat," said Romesh Nalliah, DDS, MHCM, an associate dean for patient services at the University of Michigan School of Dentistry in Ann Arbor.

"It can be a big ask of primary care physicians, because we already ask a lot of them. But some of these things are very simple – just a quick scan of the mouth – and could be done by other medical office staff."

Here are five key conditions with oral signs that dentists wish primary care doctors would catch during checkups, which could unlock early detection and treatment:

• Diabetes: Within the realm of oral health, type 2 diabetes can leave distinct imprints that dental professionals are trained to watch for. For example, gum disease – marked by inflamed, bleeding gums – can be a sign of the illness. People with diabetes may have a dry mouth, stemming from reduced production of saliva, leading to discomfort, a hard time swallowing, and a higher risk of dental infections. An estimated 34% to 51% of people with diabetes have dry mouth. 

Another sign that can show up in the mouth is a fungal infection, such as oral thrush, which can mean your immune system isn't working well and is often linked to uncontrolled diabetes. 

"We know gum disease appears more frequently and more severely in patients with diabetes, and that treating the gum disease can help improve diabetes-related outcomes," saidMarie Jackson, DMD, FAGD, a dentist in Montclair, NJ. "Good oral health habits are just generally beneficial from an overall health perspective."

• Inflammatory bowel disease (IBD): Illnesses like Crohn's disease and ulcerative colitis have long been recognized for their effect on the gut. However, a lesser-known aspect of these disorders is their potential to  show up in the mouth, presenting a unique set of challenges for both patients and health care providers. Some people with IBD have painful ulcers in the mouth called aphthous stomatitis – more commonly known as canker sores. These oral symptoms not only add to discomfort for those with IBD, but also can show that a disease is present. 

"Crohn's disease in particular can cause mouth ulcers that look like sores," Jackson said. "Anytime someone comes in for a checkup, we look for red patches, which can be an indicator."

These ulcers often are shallow and round, and typically are on the soft tissues lining the mouth, such as the inner cheeks, lips, and tongue. IBD and oral ulcers come with inflammation. The body's immune response can result in an overproduction of pro-inflammatory cytokines, triggering a cascade of events that help cause these painful ulcers. 

• Heart disease: The mouth may be an unexpected place to find signs of diseases of the heart and blood vessels. Heart issues often come with oral symptoms, notably a higher chance of gum disease. The connection lies in the inflammatory nature of both conditions; chronic heart disease may add to an inflammatory response that, in turn, worsens gum inflammation and leads to more severe issues with the teeth and gums. Symptoms such as bleeding gums, persistent bad breath, and gum swelling can serve as early warning signs. 

Also, people with gum disease are at a higher risk of issues with their heart and blood vessels. Bacteria in the mouth can enter other areas of the body, including the heart. 

"Gum disease provides an open portal to get into the bloodstream," Jackson said. 

• Osteoporosis: Osteoporosis, a bone disease that leads to fractures and disability, often goes unnoticed until the condition leads to injury. But research shows it can affect the teeth in noticeable ways, including tooth loss and gum disease.

For patients with implants, dentures, and bridges, weak bones may lead to looser-fitting replacements.

Unfortunately, certain medications for osteoporosis, bisphosphonate drugs, also  can cause dental issues – something all doctors should be aware of when prescribing any medications, Nalliah said. 

"When a medical office puts someone on a new medication, they should send them to a dentist," Nalliah said. "Many of them can cause dry mouth, which can cause decay."

• Oral cancer: Symptoms of oral cancer that may be visible during a doctor visit include a sore on the lip or in the mouth, white or reddish patches on the inside of the mouth, loose teeth, or a lump inside the mouth.

"Anytime I have a patient with a white patch they have not had before, if they have not bitten their tongue, we have them come in again in 2 or 3 weeks, and if it's still there, we have it biopsied," Jackson said. "Oral cancer definitely is on the rise with HPV," or human papillomavirus, she said. 

Oropharynx cancers linked to HPV infection increased yearly by 1.3% in women and by 2.8% in men from 2015 to 2019.

According to the CDC, compared with other cancers, oral and pharyngeal cancer has one of the poorest 5-year survival rates: only 52% of people diagnosed with oral cancer survive 5 years. Only 35% of oral cancer is detected at the earliest stage.

"Most patients are diagnosed at an advanced stage of the disease," Nalliah said. "Many of those vulnerable people don't have dental insurance."

Effects of Oral Hygiene on Overall Health

While some health issues may show up in the mouth, the problems go both ways: Poor oral hygiene can lead to negative health outcomes. Some studies show there may even be a connection between poor oral health and worse brain health.

"What I wish physicians would talk to our patients about is the importance of regular dental visits," said Ruchi Sahota, DDS, a general family dentist in Fremont, CA, and a consumer adviser for the American Dental Association. "Teeth don't necessarily hurt until something big is going on. Going to the dentist regularly, brushing at least twice a day, flossing at least once a day, all of these things can contribute to greater overall health."

Sources

Romesh Nalliah, DDS, MHCM, associate dean for patient services, University of Michigan School of Dentistry, Ann Arbor.

Marie Jackson, DMD, FAGD, dentist, Montclair, NJ.

Ruchi Sahota, DDS, general family dentist, Fremont, CA; consumer adviser, American Dental Association.

World Journal of Diabetes: "Oral manifestations in patients with diabetes mellitus."

World Journal of Gastroenterology: "Oral manifestation in inflammatory bowel disease: A review."

Frontiers in Cardiovascular Medicine: "Periodontal disease is associated with the risk of cardiovascular disease independent of sex: A meta-analysis."

Journal of Frailty, Sarcopenia and Falls: "Diagnosis of osteoporosis in dental patients."

American Cancer Society: "Key Statistics for Oral Cavity and Oropharyngeal Cancers."

CDC: "Improving Diagnoses of Oral Cancer."

University of Florida Health: "Poor dental hygiene can lead to serious health problems."

MedRxiv: "Poor Oral Health Is Associated with Worse Brain Imaging Profiles."

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Cite this: The Five Things Dentists Wished PCPs Weren't Missing - Medscape - Nov 29, 2023.