In taking care of the whole patient, physicians often loose sight of one of the most displayed body parts: the smile. This is the 1st in a series of articles regarding practical tidbits regarding the alimentary tract.
While taking care of patients, physicians often lose sight of one of the most displayed body parts: the smile. Just as our mouths are at the forefront of our alimentary tracts and often our minds, the mouth is at the forefront of our health. In addition to the obvious connection to our brain's reward center and the resulting obesity epidemic, there are other less-obvious connections our mouths have with the rest of our body.
The following five reasons are why physicians should work more closely with dental doctors in taking care of the whole patient. (In-kind service exchanges are a whole other thing.)
1. Referred pain. As a sophomore in college, I awoke one morning to a dull ear ache. It worsened over the day, and I finally broke down and bought ibuprofen to make it through the night. The next morning, I went to campus health, where I was given antibiotic ear drops by the PA. By now, the pain was pretty severe. I was unable to sleep and ended up driving two hours to my parents' house in the middle of the night. Thanks to the Internet, I had an inkling that dental problems could result in ear pain. I was able to secure a dentist appointment, who made the diagnosis and drained the pus from a leaking root canal. I wanted to hug the dentist.
It turns out that oral diseases (including temporomandibular joint syndrome (TMJ)) commonly presents as an ear ache or headache. Keep your differential broad to include diseases treated by dentists.
2. Bacterial pneumonia. The amount of microbes in the mouth can vary by orders of magnitude, but is on the order of millions of bacteria per millimeter squared. While the data do not imply causation, microaspiration of these microbes could result in subsequent bacterial pneumonia.
Makes me want some mouthwash just thinking about it.
3. Cardiovascular disease. Again, the data do not imply causation, but there is a definite association between periodontal disease and coronary atherosclerosis.
Just as a wreck can influence traffic miles away, it makes biological sense that periodontitis could prime white blood cells for inflammation and resulting atherosclerosis in far off locations. More data are needed before we can be certain about causation, but regardless, physicians and dentists can agree that both vascular and periodontal diseases are bad.
4) Kids. It turns out that pediatricians can treat (in a preventative sense) cavities by prescribing fluoride at well-child checks. (Don't go bragging to your dentist friends if you do this, though, since some of them may see it as lost business;)
5) Sleep apnea. Have you ever run into a hypertensive, chronically tired, obese patient with chronic pain that has a flagrantly-positive sleep study, but can't tolerate a positive-pressure ventilation mask? Who hasn't? So if they don't wear the mask, is all lost? No. A randomized, controlled trial showed that oral appliances for sleep apnea can work. While there are many over-the-counter devices available to help with sleep apnea, many dentists can make custom devices that fit the sensation-sensitive patient that otherwise couldn't tolerate the positive-pressure masks.
It is amazing to think that a dentist could treat sleep disorders, cardiovascular disease, chronic fatigue, and fibromyalgia. So keep a dentist in mind the next time you are struggling to take care of non-CPAP users with syndromes X, Y,and/or Z.