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Your oral health

Did you know that your dentist could spot signs of coeliac disease and diabetes during a simple dental examination? Look after your oral health with Dental Care Ireland.

We often view oral health as separate from general health but the two have much in common. Some risk factors for chronic conditions like heart disease and cancer are the same for oral disease. Yet few people connect what’s going on in their mouth with what’s happening with the rest of their body. The links are largely ignored despite mouth problems impacting school attendance, nutrition and an individual’s overall quality of life and wellbeing.

Dentists can identify possible signs of a number of serious conditions due to the fact that health issues can lead to oral problems and vice versa in some cases. Mouth lesions could be a sign of a HIV infection and pale and bleeding gums could signal the presence of blood disorders. The presence of aphthous ulcers in the mouth could also mean a patient has coeliac or Crohn’s disease.According to the World Health Organisation (WHO), risk factors for oral diseases include, tobacco use, alcohol abuse, unhealthy diet, poor oral hygiene and social factors. A lot of these risk factors are present for cardiovascular diseases, cancer, chronic respiratory diseases and diabetes.

Common Risk Factors

The “Oral Health in Ireland: A Handbook for Professionals”, produced by the Irish Dental Health Foundation, outlines that several risk factors for major chronic diseases are shared with oral disease. They include diet, smoking, alcohol consumption, hygiene, injuries, control and stress and socio-economic status. The handbook states that diet is a risk factor for dental decay, coronary heart disease, diabetes, stroke, cancers and obesity.

Stress and control, according to the Handbook, are risk factors for cardiovascular diseases and periodontal disease. “It has been theorised that chronic stress speeds up the process of atherosclerosis in the coronary arteries and that the stress hormone cortisol plays a role in increased periodontal destruction. Cortisol also acts to suppress the immune system, allowing bacteria to flourish in the mouth,” the Handbook outlines. We’re all familiar with the phrase ‘too much sugar will rot your teeth’ but poor nutrition can also lead to many other health problems, as outlined above. The World Health Organisation (WHO) stated more than 10 years ago that a clear relationship exists between oral health and general health. In 2005 a bulletin from the Organisation remarked that: “oral health affects people physically and psychologically and influences how they grow, enjoy life, look, speak, chew, taste food and socialise, as well as their feelings of social wellbeing”.

“Oral diseases are the most common of the chronic diseases and are important public health problems because of their prevalence, their impact on individuals and society, and the expense of their treatment,” the Organisation declared.

Kieran Davitt of Dental Care Ireland says that he has picked up on a number of undiagnosed health conditions during dental examinations. “I would have diagnosed ulcerations before and they would have lead on to oral cancer. “I have also come across a lot of people with oral ulcerations and sometimes it’s very severe and can be a sign of vitamin and iron deficiencies. It can be a sign of coeliac disease and it can be Crohn’s disease.”

Diabetes

Decay and periodontal or gum disease are the two major conditions that impact the teeth. Severe periodontal disease is linked to diabetes, as diabetes can lower the body’s resistance to infection placing patients more at risk of having oral health problems. According to the HSE toothache, stress and anxiety can affect blood sugar levels. Patients with diabetes are advised to inform their dentist of their condition. Individuals with uncontrolled diabetes are more likely to develop oral health problems such as dry mouth, which increases the risk of tooth decay, gum disease, oral infections and poor healing.

Diabetes affects almost six per cent of the Irish population, with around 190,000 patients in Ireland. The HSE has projected that this figure will increase by 60 per cent in the next 10 to 15 years, which is a huge cause for concern as diabetes care already consumes 10 per cent of the Irish healthcare budget. A paper in the Journal of the Irish Dental Association entitled: “Does the dentist have a role in identifying patients with undiagnosed diabetes mellitus?” recommends that a screening policy be developed for implementation in practices to detect undiagnosed diabetes.

“Dentists are ideally suited to screen for signs and symptoms of undiagnosed diabetes through medical history taking and oral examination, and should refer any patients about whom they have concerns to their general medical practitioner for further testing,” the paper notes. It adds that dentists have an important part to play in identifying patients with undiagnosed diabetes and says dentists may have a crucial role in helping to manage the condition by treating periodontal disease. Mr Davitt believes there is a role for dentists in identifying diabetes and is in favour of screening in practices. “I think it would be a good idea if there were more concerted, coordinated policies in place. For example dietary policies on anti-smoking or alcohol, and I think to include dentists in that would be a great idea.”

Cancer

World Head and Neck Cancer Day recently took place, highlighting the prevalence of such cancers in Ireland.

Mouth Cancer Awareness Day takes place in Ireland on September 16 this year. Audit figures for the number of oral cancers in Ireland annually, compiled by the Royal College of Surgeons (RCSI) and the National Cancer Registry, show there were 165 oral cancers recorded in 2009. This figure rose to 183 in 2010 and in 2011 183 oral cancers were documented. In 2012 the figure dropped to 159.

James Paul O’Neill, Professor of Otolaryngology, Head and Neck Surgery at the RCSI, says that dentists should review all areas of the oral cavity, including the lips, alveolar margins, hard palate, buccal mucosa, floor of mouth, anterolateral tongue, retromolar trigone for any areas of concern. Dentists “have a definite primary care role” when it comes to mouth cancer, he believes. He advises that any issues should be referred to an Ear Nose and Throat (ENT) Head and Neck Surgeon. The signs and symptoms of oral cancer specific to the oral cavity include persistent pain, ulceration, bleeding gums, loose dentures, loose teeth and painful swallowing. Individuals that smoke, consume alcohol and who have poor diets high in processed foods and red meat are at greater risk of developing oral cancer.

Thanks to awareness campaigns like Mouth Cancer Awareness Day, Mr Davitt says that more people are now conscious of mouth cancer, particularly smokers. In under a minute a dentist can undertake a soft tissue screening to check for lesions – a simple inspection that could save a person’s life.

Haemophilia

Haemophilia sufferers must take extra care when visiting their dentist due to the reduced ability of their blood to clot. According to the National Haemophilia Council, proper dental care is essential for haemophilia patients.  Regular dental visits are advised to reduce the risk of developing infections and other problems. If extractions are required the Council recommends coordination between a patient’s dentist and haemophilia centre to ensure any bleeding is contained and dealt with appropriately.

Bleeding gums signal early gum disease and are a common problem among the general population but individuals with haemophilia must take extra caution if bleeding gums occur and regular check-ups are recommended. The Council advises that everyone with haemophilia attend his or her dentist at least once a year for a check up. Dr Barry White, Consultant Haemotologist and National Haemophilia Director at the National Centre for Hereditary Coagulation Disorders at St James’s Hospital says that the centre has a comprehensive oral heath programme for haemophilia sufferers. “Oral health is very important for haemophilia care,” he advises.