Published: 2:00 AM – 01/25/12

While an old saying advises that “the eyes are the window to the soul,” modern dental research says the mouth provides an even better view of the body as a whole.

Some of the earliest signs of diabetes, cancer, immune disorders, hormone imbalances and drug issues show up in the gums, teeth and tongue long before a patient knows anything is wrong. and there’s growing evidence that oral health problems, particularly gum disease, raise the risk of some illnesses.

Some 20 million Americans – including 6 percent of children and 9 percent of adults – saw a dentist but not a doctor in 2008, according to a study in the December 2011 issue of American Journal of Public Health.

“It’s an opportunity to tell a patient, ‘You know, I’m concerned. I think you really need to see a primary-care provider,’ so you are moving in the direction of better health,” said the study’s lead researcher, Shiela Strauss, co-director of statistics and data management for new York University’s Colleges of Nursing and Dentistry.

A thorough mouth exam may also allow a dentist to see cancer, bulimia and certain drug addictions, such as methamphetamine use. In 32 years of practice, Dr. George Kivowitz, a restorative dentist with offices in Manhattan and Newtown, Pa., said he has spotted seven cases of cancer in 32 years of practice, as well as cases of bulimia, because of the telltale erosion of enamel on the back of the upper front teeth – as well as methamphetamine addiction.

“We call it ‘meth mouth,’” he said. “The outer surface of teeth just rots in a way that’s like nothing else.”

Dr. Thomas Littner of Cornerstone Dental in Middletown explains the concept called the “oral systemic connection.” the mouth is connected to the whole body, he says. “I review my patients’ medical history, medications … examine their teeth, gums, X-rays. … An oral cancer exam and neck palpation are important.”

A thorough exam “can display manifestations of systemic diseases,” says Dr. Bruce Weiner of the Smile Place in Middletown and Cornwall. some of those include measles, Rubella, diphtheria, AIDS, mononucleosis, blood diseases, vitamin deficiencies and metabolic disorders such as diabetes and other chronic diseases. “They may show up as lesions, sores, discoloration, coatings and yeast infections.”

Such findings are fueling a push for dentists to play a greater role in a patient’s health.

Littner explains that periodontal disease “involves pathogens (strong damage-causing bacteria) that form a coating around the teeth and inside the gum line, creating inflammation, infection and bone loss.”

It’s not something easily beaten, he adds. “Once you have periodontal disease, you’re never officially rid of it, you only manage it,” he says. he even suggests that patients see the dentist every three months because “every six months is just not enough to keep the levels of inflammation down.” For those fortunate enough to have dental insurance, Littner says that more frequent cleanings and exams may be covered if there is documented proof of necessity.

And, Weiner cautions, “Nothing is as good as prevention. Meticulous oral hygiene is best, coupled with professional measures and exams. a proper and balanced diet also helps maintain oral health.”

An estimated 6 million Americans have diabetes but don’t know it. and a 2009 study from new York University found that 93 percent of people who have periodontal disease are at risk for diabetes.

Inflammation from infected gums makes it difficult for people with diabetes to control their blood-sugar level, and high blood sugar accelerates tooth decay and gum disease, creating more inflammation.

And, says Weiner, “A large percentage of people with diabetes will develop periodontal disease. This is attributed to the fact that they are more susceptible to infections. Uncontrolled diabetics are particularly at risk.”

The good news? recent studies show that treating gum disease improves circulation, reduces inflammation and may even reduce the need for insulin in people with diabetes. “The less inflammation, the easier it is to control your sugar level, and when your sugar is under control, you may need less insulin,” says Littner.

While poor oral hygiene carries a risk for just about everyone, certain people are more susceptible than others. For pregnant women, periodontal disease “can create complications, namely early-term and low birth-weight babies,” says Littner.

There’s also growing evidence of the link between periodontal disease and cardiovascular problems. Inflammation in the gums raises C-reactive protein, thought to be a culprit in heart disease.

“They’ve found oral bacteria in the plaques that block arteries. It’s moved from a casual relationship to a risk factor,” says mark Wolff, chairman of the Department of Cariology and Comprehensive Care at NYU College of Dentistry.

That risk, says Weiner, happens because “the mouth has very high concentrations of bacteria. Insult, injury and even brushing introduce bacteria into the usually sterile bloodstream. This creates a systemic inflammatory response that has been shown to play a role in heart disease, and is also the theory behind bacterial pneumonia.”

Mouth bacteria traveling through the bloodstream can cause problems elsewhere, which is why people contemplating elective surgery are advised to have necessary dental work performed beforehand. the American Heart Association, American Medical Association and American Orthopedic Association all urge people who have had full-joint replacement to take an antibiotic before any dental visit — for the rest of their lives. It reduces the risk of post-surgical infections.

Dentists also need up-to-date information on their patients’ medications, supplements and over-the-counter drugs. Blood thinners can create excess bleeding, and osteoporosis drugs called bisphosphonates can severely weaken jaw bones. Calcium-channel blockers, drugs for high blood pressure and some anti-inflammatory drugs can cause gum ulcerations.

“Medications are a tough topic and challenge because they generally cause dry mouth,” says Littner. “If you bump your brush on the gum, cheek or lip, or your denture is real dry and rubs … it can cause a sore or ulcer. Dry mouth also increases the risk of dental decay.” he advises discussing side effects with your doctor to see if an alternative medication is available, and also suggests products to reduce dry mouth such as nonalcoholic fluoride rinses and xylitol — an ingredient in many sugarless gums — which is actually good for your teeth. Of course, there’s always water.

The Centers for Disease Control and Prevention recommends that dentists offer HIV testing because some of the first symptoms appear in the mouth. Weiner says, “HIV is sometimes diagnosed after finding Karposi’s sarcoma, which can turn up as a lesion in the mouth or skin. It’s confirmed by biopsy and a test for HIV if no history is indicated.”

A gleaming white smile is a sign of a healthy mouth, right? not necessarily. In fact, many dentists worry that people who whiten their teeth, and even people who have no cavities, can still be harboring tooth decay and serious gum disease. “Pearly whites are just that,” says Weiner. “It’s what’s underneath that counts.”

In fact, using whitening products more often than recommended can erode some of the enamel and cause teeth to appear translucent. “A lot of the whitening products are harsh,” says Littner. “If someone brushes with a hard toothbrush and brushes real hard and fast, it’s possible to get some enamel erosion. the abrasives in the pastes can also contribute to this problem.”

Freelance writer Carol Montana contributed to this story.

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