The link between overall health and oral health
September 13, 2004

The Australian Dental Association Victorian branch (ADAVB) is urging the Australian public to pay more attention to their oral health when visiting the dentist.

Dr Suzanne Hanlin, President of the ADAVB, says, “Australians should be raising all their oral health issues, not just those related to teeth, with their dentist. Oral Health is part of general health and disease often appears first in the mouth, meaning oral health and disease should be interlinked to general health and disease. Oral health conditions are often best detected and managed by a dentist, and the ADA will be encouraging Australians to discuss with their dentist symptoms such as unusual ulcers, sores or lumps that don’t heal, symptoms of a dry mouth and bleeding gums which might be indicative of other health conditions.”

Research suggests that over a quarter of Australians have not visited their dentist for three or more years. Conditions like oral cancer and diabetes have a serious impact on an individual’s well being. They also impact on the community in terms of social, emotional and financial burdens.

The ADAVB will be raising awareness of good oral health during August as part of Dental Awareness Month. However, in 2004, the focus will move from the teeth to include the whole mouth. In particular, the ADAVB will highlight a number of very important oral health issues, including Oral Cancer, Diabetes, Periodontal Disease linked to Cardiovascular Disease, Ulcers, Eating Disorders, Dry Mouth Syndrome and Snoring.

Oral Cancers:
Oral cancers include cancers that affect the lips, tongue, cheeks, palate and floor of the mouth. More deaths occur each year as a result of oral cancer than cervical cancer. (Oral Health of Australians, Australian Health Ministers’ Advisory Council, Steering Committee for National Planning for Oral Health, August 2001.)

Oral cancers account for 6.5% of cancers diagnosed in Australia and account for 2% of deaths. There is a link between oral cancer, alcohol consumption and tobacco use, as well as sun exposure in the case of lip cancers. If oral cancer is detected early, there is a 70% survival rate in the first 5 years, compared to a 30% survival rate if the cancer has spread. (1998 December/Dental Update from a paper titled Orofacial Disease: Update for Dental Clinical Team: 2. Ulcers, Erosions and Other causes if Sore Mouth Part I, University of London.)

Importantly, research has found that the sufferers often ignore oral cancers in their early stages. Regular oral tissue checkups conducted as part of a routine dental visit can lead to early detection and treatment, meaning better survival.

Diabetes:
With over one million Australians being affected by diabetes, the link between the state of the mouth and diabetes becomes significant. A dentist can play an important role in the detection of the early onset of diabetes by alerting a patient to certain subtle signs and symptoms such as non-responsive gum inflammation and persistent dry mouth. As well, people diagnosed with diabetes must alert their dentist because of their increased susceptibility to infection. “It is a cooperative relationship”, says Dr Hanlin.

“We advise people to seek medical investigations for symptoms that might indicate diabetes and the doctors advise their patients who have been diagnosed with diabetes to seek regular dental inspections.” People who suffer from symptoms of a burning mouth, dry mouth and altered taste should also raise these symptoms when visiting their dentist as they may indicate the onset of diabetes or poor control of diagnosed diabetes. Studies have shown that 40% to 80% of people with diabetes suffer from a dry mouth, which in turn has an association with increased dental cavities. (JADA, Vol. 132, October 2001).

Periodontal disease linked to cardiovascular disease:
Periodontal disease, commonly known as gum disease often presents as bleeding gums and low level inflammation, which can rapidly develop into severe inflammation and eventually tooth loss.

Epidemiology studies indicate a link between oral diseases such as Periodontal disease and systemic disease such as Cardiovascular disease. While more Australians are keeping their teeth, this can increase the risk of developing gum disease. With research suggesting a link between Periodontal disease and Cardiovascular disease, the dentist’s role in accurately diagnosing and treating Periodontal diseases becomes critically important. Often the treatment goes beyond improved brushing and flossing and may include specific treatment on the teeth to reduce the bacteria that cause the disease. Australians need to be vigilant with proper brushing and flossing which is shown to reduce the incidence of periodontal disease.

Ulcers:
Most people have experienced an ulcer, which is usually caused by some trauma such as biting or burns to the lips or inside the mouth. Other very common causes include denture rubbing or scratching from the broken corner of a tooth.

Most ulcers heal within a week. However, if a person experiences an ulcer that lasts longer than three weeks, they should visit their dentist for an oral health check-up and specifically, analysis of the ulcer.

More uncommon causes of ulcers include some medications such as anti-inflammatory, anti-diabetic and anti-malarial medicines. Additionally, ulcers can be a sign of nutritional deficiencies, and in rare cases, diseases such as Coeliac, Crohn’s disease and Ulcerative Colitis. It is also not uncommon for people to develop ulcers related to menstruation, stress or food allergies.

Very occasionally, an ulcer can represent early cancer, so persistent ulcers need examination and the dentist is trained to recognise the cause, offer treatment or refer the patient accordingly.

Eating disorders:
Conditions such as Anorexia Nervosa (accompanied by purging) and Bulimia can often impact on oral health. Severe tooth damage and dental hypersensitivity is not uncommon as vomiting brings stomach acids into the mouth, which in turn leads to dental erosion. Dental erosion and hypersensitivity are often permanent, which means lifelong management by the patient and the dentist is necessary.

Additionally, symptoms such as dryness of the mouth due to a restricted diet or recurrent vomiting can lead to increased dental cavities.

What is important is that sufferers establish a strong trust in their dentist’s ability to continue to assist with managing these conditions.

Dry Mouth Syndrome: Also known as Xerostomia, Dry Mouth Syndrome is not a disease, although it can be a symptom of certain diseases.

As its name implies, it refers to reduced saliva to the mouth, which leads to a ‘dry’ mouth. It can produce serious negative effects on a person’s quality of life, affecting dietary habits, nutritional status, speech, taste, difficulty with dental prostheses such as dentures and increased susceptibility to dental cavities. The increase in dental cavities can be devastating in many patients and therefore special care must be made to control this condition. Once again, the dentist is in the best position to recognise and coordinate treatment for Xerostomia

Snoring and mouth breathers:
Snoring affects 7 million Australians and, along with sleep related breathing disorders, it is one of the most common chronic health conditions. While often thought of as a predominantly male condition, 30% of Australian women also suffer from snoring, compared with 44% of men. Snoring is often accompanied by a much more serious condition known as Sleep Apnoea, where people stop breathing for abnormal periods during sleep. Dental patients must tell their dentist about their snoring habits.

There are three classifications of Sleep Apnoea – central, obstructive and mixed. Put simply, central sleep Apnoea refers to a situation where a person’s airway is open, but they do not breathe. Obstructive sleep Apnoea refers to the collapse of tissue around the airway during sleep, leading to snoring as a result of breathing through a blocked airway. Mixed is a combination of both.

The dentist is in the best position to discuss a range of treatment with patients. These including referral to a Sleep Physician, alerting patients to the positive effects of weight loss on snoring, changing sleeping positions, restricting alcohol a few hours before sleep, avoiding of any unnecessary use of sleeping tablets and taking care with over-the counter drugs which might impact on sleep apnoea. More specific treatments for more serious Sleep Apnoea in conjunction with the Sleep Physician include dental appliances, Continuous Positive Airway Pressure and surgery.

The ADAVB urges all Australians to give consideration to their oral health, and place importance on the raising any oral health issues with their dentist. The ADAVB and its members are committed to improving the oral and overall health of Australians and believe regular oral health examinations by the dentist play a vital role in this.