The Close Relationship of Medicine and Dentistry

Not long ago, my physician told me that I have gastro-esophageal reflux disease or GERD. That explains my persistent hoarseness, frequent sore throat, and occasional chest pain. Later, I saw my physician when he came in for a dental check up. I told him that one of my patients has extensive tooth decay due to GERD. My physician was surprised. He did not realize that the acidic stomach contents may enter the mouth unnoticed to cause decay.

Physicians and dentists have plenty to talk about. Physicians' organizations and insurance companies distribute brochures to patients, white papers to physicians, and informational packets to dentists enumerating the many ways dental health influences physical health. Blue Cross Blue Shield's Dental Blue insurance even offers the "Enhanced Dental Benefit" program for people with diabetes, and heart disease, and for pregnant women. Dentists and physicians understand that oral health is likely to impact on any medical condition, and many medical conditions and their treatments may affect oral health.

One of the most common ways that medical and dental issues interact is in the side effects of many medications. Over 400 prescription and over-the-counter medications cause xerostomia or dry mouth. People with xerostomia are much more likely to suffer rampant tooth decay. The lack of saliva opens the door to opportunistic infections, usually candidiasis which is also known as thrush or yeast infection. Dryness makes dentures slip and uncomfortable to wear.

Bisphosphonates are medications that slow the loss of bone substance. While there are other uses, this characteristic makes medications like Boneva, Zometa, Fosamax and Actonel very important for those with osteoporosis. Unfortunately, osteonecrosis (bone death) of the lower jaw can be a side effect of these medications. Patients with poor dental health are more likely to develop this problem. Many physicians refer their patients to a dentist for a complete evaluation before prescribing this kind of medication to prevent osteonecrosis. Other medical treatments and conditions that may cause osteonecrosis include diabetes, radiation treatment, and chemotherapy.

Another interesting side effect of some medications is dysguesia, a change in taste sensation. Many medications affect taste by entering the saliva from the blood, damaging the taste buds or causing xerostomia. When a medication causes dysguesia, the only way to stop the effect is to stop the medication. Some medical conditions may cause dysguesia by causing xerostomia or by changing how the brain perceives taste.

Diabetics have difficulty regulating blood sugar. Infections throw off the balance that diabetics achieve with diet and medication. Gum disease (periodontitis or gingivitis) is an infection that may affect a surface area the size of the palm of a man's hand. Many studies show this relationship.

Periodontitis may be a factor in the development of coronary artery disease or atherosclerosis. C-reactive protein is a marker for inflammation, atherosclerosis and periodontal disease. Worsening periodontal disease raises the level of C-reactive protein.

Research shows that there may be a link between periodontal disease and pregnancy. Dentists are reticent to treat pregnant women who suffer from periodontitis, so it is important for women who are planning a pregnancy to have a thorough dental examination before. Another issue for pregnant patients is that most dentists are familiar with a study published in April 2004, which demonstrates a link between dental radiography (taking dental x-rays) and low birth weight of the child.

Cleaning teeth and some other procedures allow oral bacteria to enter the blood stream. While this is not an issue for most patients, some patients require protection. Antibiotic prophylaxis is the practice of taking antibiotics before surgical or dental treatment. Patients with a history of artificial heart valves, infective endocarditis, and some congenital heart conditions require antibiotic coverage. Artificial joints (not pins, plates or screws), and some disease that affects the joints require antibiotic prophylaxis as well.

Some medications and health conditions cause oral irritation (stomatitis) and sores (apthous stomatitis). Medications that cause mouth irritation include Adriamycin, penicillamine, Plaquenil, Potaba, and many others. These are strong medications for serious conditions. Fortunately, most people will not use medications such as these. Some of the more common health conditions that may cause mouth sores include, herpes, tuberculosis, HIV, Crohn's disease, lupus erythematosis, and ulcerative colitis. Radiation therapy may induce oral ulcers.

Medicine and dentistry are closely related. Dentists always ask for the name and phone number of their patient's physicians. Increasingly, physicians refer their patients for dental care. If you have any concerns about how your dental health affects your physical health, please ask your physician and your dentist.