The Checkup That Can Save Your Life
The dentist may be the most important doctor you see this year

BY DIANE PETERS

Lorne Jones could barely eat. The 63-year-old’s dentures were rubbing on the left side of his mouth, and the pain was getting steadily worse. Although the farmer from Utica, Ont., hated visiting the dentist—and hadn’t been in 15 years—he made a hasty trip to a nearby denturist he didn’t know and got his dentures relined. But the painful rubbing continued.
 
Finally, he made an appointment with a Port Perry dentist. Dr. Jack Cottrell did a quick exam and put down his latex gloves. “Lorne, I’m sending you to a specialist in Toronto. I don’t want to go any further.”

Three weeks later, he was sitting in Dr. Kevin Higgins’s office at Sunnybrook Health Sciences Centre. The head-and-neck surgeon took one look in Jones’s mouth. “It’s cancer,” he said. Six weeks after visiting his dentist, Jones went into surgery. Over the course of an 11-hour operation, Higgins split Jones’s jawbone in order to have access to the cancerous tissue on the tonsil, soft palate, tongue and the jawbone itself. The surgeon also cut from his lip down to his throat, under his chin from ear to ear, and from his left ear to his shoulder. “Without this surgery, Lorne would have been dead within a year,” Higgins told Jones’s wife, Doreen, and daughter, Sherrie.

Think your dentist only finds and fills cavities? Not at all. Dentists routinely spot signs of cancer, diabetes and heart disease, along with a variety of rare skin and autoimmune diseases. “We can spot disease processes at an early stage. We don’t just look for teeth and gum problems,” says Cottrell, who is also past president of the Canadian Dental Association. Visiting your dentist regularly can lead to early diagnosis and early treatment. Your dentist can do much more than save your teeth and gums; he or she can save your life.

And even if, on your next visit, your dentist doesn’t set in motion a serious diagnosis, you still need that regular professional cleaning. Keeping a healthy mouth plays a huge role in having a well body. Gum disease—which dentists help identify, prevent and treat—may heighten the risk for heart disease, diabetes, pneumonia and premature birth, according to recent clinical trials. With good old regular brushing and flossing, you may prevent all that. By seeing your dentist every six months, you can nip a lot of problems in the bud.

An Oral Contradiction

Canadians have brighter smiles than ever before, thanks to ubiquitous teeth-whitening systems. And we’re getting more dental care: Three quarters of Canadians see a dentist on a regular basis today compared to just half of us 25 years ago. As well, in 2003 only nine percent of the population had lost all their teeth to periodontal disease compared to 16 percent in 1990. But here’s the bad news: Seventy-five percent of Canadians have gum disease, and about 30 percent of those have advanced disease, according to Dr. Tammy Wright, president of the Canadian Academy of Periodontology. This can lead to serious health problems.

Part of the problem is that we’re not taking care of our teeth—surveys show that three quarters of Canadians don’t floss regularly. Not getting enough fluoride is also a factor. Only 40 percent of Canadians have access to fluoridated water. This problem is compounded for people who live in remote communities, and particularly in the Far North, where limited access to dentists just worsens the problem. But even people in cities aren’t always getting all the fluoride they need. What’s more, many brands of bottled water contain too little or none.

Another worrisome problem is that less than two thirds of Canadians have dental coverage, and a visit to the dentist can run over $100. “Although the majority of Canadians are able to visit the dentist, for some people, costs may be a barrier,” says Cottrell. (He estimates Canadian dentists quietly do about $200 million a year in pro bono work, mainly for patients who’ve fallen on hard times, and particularly children.) The reality is that people are still falling outside of the system.

Silent Threats

Dentists can recognize signs of cancer, including lymphoma, leukemia and particularly oral cancer, as in Lorne Jones’s case. This extremely dangerous and disfiguring cancer is diagnosed in 3,000 Canadians every year, and 1,000 people die of it. To screen for it, a dentist thoroughly checks the tongue, palate, gums, inside of the cheeks, lips, face and neck, for any bumps or unusual sores. “Screening for oral cancer is always in the front of our minds as dentists, especially when the patient has a history of tobacco use,” says Dr. Christopher Robinson, an oral surgeon from Edmonton and past president of the Canadian Association of Oral and Maxillofacial Surgeons. If, like Lorne Jones, a person mentions pain or discomfort in their jaw or teeth, that gets a dentist’s attention, too.

Pain in the mouth doesn’t always arise from a cancer. Oral pain can also be a sign of a dental infection. These infections can have serious repercussions. A bad tooth can trigger an infection in the surrounding tissues. These can crop up quickly and spread like fire through the mouth and even the rest of the body. “If a dental infection is not addressed promptly, it can spread into the deeper tissues of the neck and lead to obstruction of the airway. It can also lead to such things as kidney damage, brain abscesses or heart-valve infections,” says Robinson.

He and his colleagues see infections on a daily basis, especially among patients who haven’t been getting regular dental care. Last year he saw a man who had tried to pull his own tooth with a pair of pliers. The botched self-surgery turned into a full facial and bodywide infection that nearly closed off his airway and almost cost him his life. He spent three weeks in intensive care, and the infection worsened problems he already had with his heart valves. Runaway dental infections have also been known to eat through the skin in jaws, faces and necks, burrow into brains and, yes, even kill people.

While mild gum infections, called gingivitis, may lead to red and swollen gums, they’re not especially dangerous by themselves. But they can worsen into periodontitis, painless but chronic gum infections that, if left untreated, degrade bony sockets and ligaments that hold teeth in place. The immune system fights gum infections to keep oral bacteria from spreading to other parts of the body. It usually succeeds, but not always. Gum-disease bacteria can enter the bloodstream and move to the heart, creating life-threatening infections in previously damaged heart valves. What’s more, scientists believe the resulting inflammation releases infection-fighting compounds that can inadvertently damage other tissues.

The arteries may be the most common target. People with periodontitis are twice as likely to die from a heart attack and three times as likely to die from a stroke, according to a study that examined 18 years of medical histories for 1,147 people. Steven Offenbacher, director of the Centre for Oral and Systemic Diseases at the University of North Carolina School of Dentistry and co-author of the study, is helping conduct another to see if treating periodontitis in cardiac patients will cut the risk of heart attacks.

Pregnant women with serious periodontal disease have about four times the risk of delivering preterm babies and they face an increased risk of pre-eclampsia, in which blood pressure climbs sky-high after the 20th week, threatening the lives of both mother and fetus. In an early clinical trial, researchers found that treating seriously infected gums reduces preterm births fivefold, but the results need to be confirmed in larger trials.

Diagnostic Dentists

Diagnosing cancer and infections is just the beginning. Dentists can also spot signs of gastrointestinal problems such as Crohn’s disease, skin diseases, autoimmune diseases and more. “There are signs in the mouth that can alert us that a patient may have diabetes, and they may not even be aware of it,” says Wright. She comes across undiagnosed diabetes at least once a month. “A lot of the changes that are happening in the body are just easier to see in the mouth.” That’s because the mouth is so full of blood vessels and nerve endings that many changes in the body’s health causes colour changes, small sores and a change in saliva that a dentist can identify, sometimes with even just a look.

If more people realized the consequences of not taking care of their teeth and gums, they’d probably call a dentist tomorrow. “People lose sight of the fact that their head is attached to the rest of their body,” says Dr. Kenneth Krebs, president of the American Academy of Periodontology. Healthy teeth and gums let us talk, smile, laugh and kiss without embarrassment. That’s reason enough to take care of our oral health. But as medical science reaffirms that head and body are indeed connected, there are more reasons than ever to brush twice a day, floss daily, get dental checkups every six months and see a dentist promptly when you have a problem.

Even if your smile looks fabulous.