Oral cavity: A window to overall wellbeing

It all begins quietly — a little bleeding while brushing, persistent bad breath despite using multiple products or a mouth ulcer refusing to heal. All of these are often ignored but sometimes they could point to a much deeper and serious health concern.

From cardiology to gastroenterology and oncology, specialists acknowledge that the oral cavity can act as a window to systemic health. 

Speaking about the symptoms that reflect deeper problems, Dr Sindhu U Muktamath, Head of Department of Dental Sciences at a leading hospital in Bengaluru explains, “pyostomatitis vegetans, also called snail track ulcers in gastrointestinal issues, xerostomia in multiple health conditions including Sjögren’s syndrome, a chronic systemic autoimmune condition causing severe dry mouth and dry eyes, and diabetes are some of the common conditions identified primarily in the mouth.”

Certain genetic and immune-related disorders can also present early signs in the mouth, she added.

Conditions such as neutropenia, which affects the body’s ability to fight infections or Papillon-Lefevre syndrome, a rare genetic disorder characterised by severe gum disease and early loss of teeth may first become evident through oral symptoms. 

Cardiac issues

Is oral health linked to cardiac issues? Says Dr Sanjay Bhat, Senior Consultant, Interventional Cardiology, “Oral symptoms can be linked to heart problems, although they may look like simple dental issues. If a person has other risk factors like red, swollen, or bleeding gums, it can be a sign of gum infection; long-term gum disease is linked to heart conditions like coronary artery disease. Ongoing inflammation can affect blood vessels, and lead to loose teeth while constant bad breath may also point to serious gum disease connected with heart risk. Pain in the lower jaw can sometimes be a warning sign of a heart attack rather than a tooth problem; dry mouth may happen due to medicines for cardiac health, and in rare cases, bluish lips or tongue can mean low oxygen levels related to heart failure, so it is important to seek medical advice if these symptoms continue.”

Talking about gum health, especially a serious infection called periodontitis, where bacteria from the infected gums enters the bloodstream and causes long-term inflammation in the body, Dr Sanjay Bhat explains that it can damage blood vessels, increase plaque buildup in the arteries and increase the chances of blocked arteries, heart attack, or stroke. 

Dental screening can be considered a helpful part of preventive cardiology packages, he notes. 

Gut health

Gut health and oral health have a direct connection, points out Dr Adarsh CK, HOD & Senior Consultant - Medical Gastroenterology, Hepatology & Advanced Endoscopy, adding that “they share similar inflammatory pathways.” 

“Crohn’s disease, a type of Inflammatory Bowel Disease (IBD), presents first in the mouth through repeated ulcers. When we check the patient’s history, it would have mostly started from ulcers in the mouth. Vasculitis can also be sometimes identified by symptoms in the mouth,” he says.

Dentists can help identify the early symptoms; they could be good referral doctors, Dr Adarsh CK says. According to him, symptoms include:

• Recurrent ulcers with associated anaemia

• Abnormalities inside the cheek

• Gum inflammation

• Lip or tongue swelling

“In specific conditions, oral bacteria can contribute to leaky gut, and though it is unusual, a lot of data regarding the same is emerging,” he further adds.

On the oncology front

Dr Rasmi Palassery, Consultant, Department of Medical Oncology, observes, “The mouth or oral cavity, is a highly vascular area that is constantly susceptible to continuous micro-trauma from everyday activities like chewing and brushing. This makes the oral cavity a highly sensitive early warning system for systemic blood disorders. Statistically, up to 90 per cent of patients with blood cancer can experience some form of oral symptom during the course of their disease. This can present as paleness of the lips, tiny bleeding spots inside the mouth, gum swelling, or spontaneous bleeding from the gums.”

She notes that a review of medical literature shows that about one-third of newly diagnosed blood cancer patients first seek medical help because of a symptom they noticed inside their mouth. 

Oral health and blood cancer

According to Dr Rashmi Palassery, the following oral health issues may be seen in newly diagnosed blood cancer patients

•Anaemia: A classic sign of anaemia, when haemoglobin is low, is visibly pale lips. A red, painful, or completely smooth tongue, called atrophic glossitis especially when associated with nutritional deficiencies, like iron or vitamin B12 deficiency.

•Bleeding disorders: Blood oozing from the gums outside of brushing times, or notice tiny red blood spots inside the mouth, that is a much more concerning feature. It points more toward an underlying blood problem.

•White blood cell disorders: When a patient's white blood cells are low, they are much more susceptible to getting severe and recurrent oral ulcers. Similarly, certain cancers of the white blood cells, like leukaemia, can initially present as a noticeable swelling or inflammation of the gums, which is termed gingivitis.