Open Wide

Dentists can learn a lot about your health by looking in your mouth.

Illustration by Gordon Studer

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Dentists can learn a great deal about your health by inspecting your mouth.

For 10 years, Henrico attorney Sherri Thaxton suffered an increasing number of maladies that seemed to come from nowhere—migraines, a runny nose, mouth pain, suspicious breast lumps, chronic fatigue, and “earaches and dizziness to the point that one time I was falling all over the federal courthouse steps,” she recalls. Extensive testing failed to provide clarity.

A chipped tooth led to a life-changing dental visit last November. Her dentist, Dr. Allen Davia, had a new X-ray machine known as a cone beam CT, which creates extensive 3D images. The images revealed an infection near a molar, where another dentist had performed a root canal a decade before. An abscess had pierced her sinus cavity. “I was shocked. A few hours later I was at the endodontist and the next day, they undid the root canal, drained the dental abscess, and gave me antibiotics,” Thaxton says. Her health has been dramatically better ever since.

“We tell people that your mouth is a window into the health of your body,” says Davia. “Up to 700 species of bacteria can live in your mouth, and 11 of these types have been directly linked to oral and systemic diseases.” For example, 90 percent of Alzheimer’s cases are associated with spirochetes, a bacteria that originates in the mouth. And, he adds, “If you have advanced gum disease, you might be two to three times as likely to have a stroke.” 

Dr. Lee Jones, section chief at Carilion Dental Care, says, “The idea that there is a connection between oral health and systemic health is nothing new—it has been around for 100 years or so.” The idea gained traction in 2000, when the surgeon general issued a report on oral health in America. “One of their findings was recognizing an association between oral conditions like periodontal disease and the systemic problems like cardiovascular disease and stroke, diabetes, and even some adverse pregnancy outcomes. Now, that was a leap … that got people’s attention.”

According to the Centers for Disease Control, half of Americans aged 30 or older have periodontitis, the more advanced form of periodontal disease. Signs of the disease include red, swollen, or bleeding gums, foul odor or bad taste in the mouth, gum recession, and deep pockets between the teeth and gums. “We know that chronic inflammation is hard on the body and that periodontal disease is a common source of systemic inflammation,” says Davia. “The bacteria in our mouths can infect the gums that surround the teeth, which causes inflammation around the tooth, leading to periodontal disease. This allows the bacteria to get under the gums and it now has a pathway to the human body.”

As a result, Jones is often called to assess a patient’s oral health before valve or joint replacement surgery. “They need a dental clearance. If there’s a chronic inflammatory or infectious condition, those bacteria are just dripping into the bloodstream all the time. But it’s not causing a problem until you give some artificial surface—like a joint or an artificial heart valve—for those bacteria to adhere to. Then your body’s immune system can’t clear it as well or as quickly, so these people are prone to infection at those sites,” he says.

A person’s dental anatomy can also play a role in their health. Davia received a referral for a patient who suffered sleep apnea. Larry Boyd had already tried CPAP masks and nose pillows to no avail. A sleep study revealed that he woke up 52 times an hour. “I was weak, I could hardly do anything, I couldn’t stay awake at all,” says Boyd. He avoided driving long distances out of fear of falling asleep. Davia fitted him with a mandibular advancement device, which looks like a mouth guard, to push the lower jaw forward to open the airway. Boyd says, “It’s been working for me. It seemed like the first night I had one of the best night’s sleep I’d had in a while.” He has more strength to work around the house and is more comfortable driving. “My whole family tells me they can tell a lot of difference in me,” he says.

Dentists look for such holistic links between dental and overall health. “The dentists of today are doing much more extensive health histories when their patients come in,” says Davia. Most perform oral cancer screenings—especially critical with the rise of human papillomavirus (HPV), which can be transmitted orally and cause cancers of the back of the throat, including the base of the tongue. Saliva studies to test for pathogens are also on the horizon.

While links have been established between oral health and systemic disease, researchers are still working to confirm causation in some cases. In the meantime, experts urge patients to brush and floss thoroughly, and see their dentist at least twice a year. “My patients are always amazed when I tell them 1 cubic millimeter of dental plaque contains about 100 million bacteria,” says Davia. “That’s why you want to floss.” 

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