Did you know that your dentist doesn’t just look at your mouth during an examination, but your entire physique for signs of disease? The oral cavity is often considered the “mirror of the body”, and may be the first site to show clinical signs of systemic disease. Thus, the examination performed by the dentist not only helps identify oral problems, but also aids in the diagnosis of diseases such as anemia, diabetes, skin diseases, intestinal problems, immunodeficiencies, and more.

Anemia

Pale oral mucosa, atrophic glossitis and candidiasis can be oral signs in patients with anemia. Pallor of the oral mucosa may be more difficult to detect, but the dentist can diagnose atrophic glossitis by the presence of a red, smooth, shiny tongue caused by atrophy (shrinkage) of the papillae. Candidiasis can also present as white patches in the mouth. Burning, pain and ulcers may also occur.

Diabetes

Diabetes and the oral cavity are closely linked. In particular, periodontitis (inflammation and destruction of the tissues that hold teeth in place) can indicate a problem. Patients with poorly controlled diabetes are at greater risk of developing periodontitis than patients with well-controlled diabetes or those who don’t have diabetes. In addition, reduced salivary flow is one of the main disorders associated with diabetes, leading to xerostomia, or dry mouth. The latter increases the risk of fungal or bacterial infections in the mouth, as well as alterations in taste.

Skin diseases

Lichen planus is a common mucocutaneous disease that can affect the mouth exclusively or involve the skin, oral mucosa and tongue. On the skin, it can cause the formation of purplish papules that can become rough patches. In the mouth, lichen planus often appears as white “lacy” lesions called Wickham’s striae. These lesions are often asymptomatic, and are usually discovered during a dental examination.

Pemphigus vulgaris is a rare but serious autoimmune disorder that causes a loss of adhesion between the layers of the skin, resulting in blisters on the skin. These blisters form in areas of stress or pressure, and the oral mucosa is affected in 90% of cases. In fact, blisters in the mouth are one of the first signs to appear in affected patients. Left untreated, this condition is often fatal, but systemic treatment with corticosteroids and immunosuppressants can improve the prognosis.

Intestinal diseases

People with Crohn’s disease may suffer from lesions in the mouth in the form of small inflamed areas or granulomas. They may also develop swelling of the lips, gums and oral tissues, which can make eating difficult. Oral lesions can resemble those elsewhere in the digestive tract, such as inflammation, ulcers and fissures.

By looking at your teeth, your dentist can identify whether you suffer from acid reflux. In fact, acid regurgitating in the mouth causes erosion, which means irreversible dissolution of tooth enamel. Eating disorders, such as bulimia and anorexia, can also be identified by the dentist if the erosion is caused by periodic vomiting.

Immunodeficiencies

Sjögren’s syndrome is an autoimmune disease of unknown etiology, mainly affecting women and primarily involving the mouth and eyes. Common findings include dry eyes and reduced saliva in the mouth. The dentist may also identify atrophy of the tongue papillae, fissuring of the tongue and angular cheilitis (redness, cracks and crusts at the corners of the mouth) in these patients. Systemic Sjögren’s syndrome is linked to a number of complications, such as lung infection and, rarely, kidney failure, so early diagnosis and regular follow-ups with the doctor are essential.

Systemic lupus erythematosus (SLE) is another chronic autoimmune disease in which the body’s immune system attacks its own tissues, in particular the cell nuclei, leading to several systemic repercussions. In the mouth, SLE can be characterized by red, round or irregular, atrophic or ulcerated lesions, distributed asymmetrically. The dentist may also find ulcers and vesicles on the oral mucosa, or identify candidiasis and xerostomia. Early diagnosis and treatment of the disease can help prevent future systemic complications.

Viral infections

Viral infections are a major cause of death worldwide, and oral manifestations are often the first signs. HPV (Human Papillomavirus), among others, can cause several benign lesions in the oral cavity such as sores or warts on their lips, in their mouth or in their throat. These are either squamous papilloma, condyloma acuminata or verruca vulgaris, and can also be associated with the development of potentially malignant lesions. HPV-related lesions in the mouth can be surgically removed by the dentist and sent for biopsy analysis.

Shingles is a painful rash caused by the reactivation of the virus responsible for chickenpox. It’s a very common virus: around 1 in 3 people in North America will develop shingles at some point in their lives. One of the first signs of the disease is the appearance of blisters on the skin, face, or in the mouth. It’s important to treat shingles promptly to avoid long-term repercussions, using antivirals that your dentist may prescribe.

Other disorders such as Epstein-Barr virus (EBV) and Hodgkin’s lymphoma can also be detected by lesions in the mouth by your dentist.

A thorough examination of the oral cavity by your dentist may reveal signs of an underlying systemic condition, thus allowing early diagnosis and treatment. The mouth can show the first signs of various infectious and inflammatory diseases. That’s why an oral examination is essential at any age, whether you have teeth or not!