How we wish to be cited:
Ekholm M-L. Signs for seers - mouth mirrors man [health]. Rondel 2005; 25.
URL: http://www.rondellen.net
Signs for seers -
mouth mirrors man
The oral cavity reflects the health state of the patient (1,2). A proper
examination of the mouth adds quality to the evaluation of medical history
and health state of the patient. |
|
Autobiography
of the author
I was born and raised in Gothenburg, where I
also received my medical education. I made up my mind to be an ENT
specialist, when I as a young child had to battle several own ear
infections.
My career began at the very same hospital, where I was once a young
patient. Life changed quite a bit for me when, in the midst of a research
career, I met a man and moved from the big city to the small town of Nässjö.
Instead of working at a
university hospital, I found myself at a small outpatient clinic.
Over the years, I´ve become a mother of four children, and instead
of research, I´ve found an interest in politics. Today the politics take
up almost half my time. My political assignments include the municipality,
county council, the region and the social insurance office.
Every
other week I host a radio programme at the local station. I mix medical
information with music. Life is good and it is exciting to live.
Marie-Louise |
Oral
cavity and teeth in physical examination
The
status of the teeth and the oral cavity is a useful indicator of a person´s
general health, since no other mucous membrane is as readily accessible to
inspection.
Deficiencies
of vitamin B12 and/or folate have their typical hallmarks in the mouth, mucosal
atrophy, gingival hyperplasy, fissures. The oral cavity shows signs of
cardiovascular disease due to insufficient perfusion of the mucous membrane.
Furthermore, diseases with a decreased salivary secretion, such as diabetes and
rheumatoid arthritis, are manifested in the oral cavity at an early stage.
Alcohol and substance abuse, use of tobacco, anxiety, muscle tension, stress and
even depression can be seen in the oral cavity and on the teeth.
A
thorough examination of the oral cavity could be of great assistance in
diagnosing disease, determining its severity and getting an indication as to how
the patient is doing.
Mouth
and medicine
A
large number of medications cause a decreased salivary secretion. Bacteria found
in pockets surrounding the teeth can spread to the heart valves even in young
people. Signs of anaemia can be seen. People with neck injuries are at greater
risk of tension in the maxillary joint, causing headache and tinnitus. Salivary
secretion is of great importance to the digestion and function of the bowel, as
well as the development of disease in the digestive tract.
Lumbago
at top level
Maxillary
joint dysfunction has become a widespread problem in the population today. All
forms of headache, facial pains and tinnitus are common diagnoses to an ENT
specialist. Many patients are treated for suspected sinusitis because the pain
is located to the face and ear and the pain itself causes a blocked nose. In
such cases, there are no signs of disease in the ear or sinus, but the tongue
shows atrophy of the tip and marks of being pressed against the teeth. In
addition, bite marks on the inside of the cheeks and general dryness can be seen.
Oral
examination in practice and in house
The oral status documented in the medical charts from the
GP is often the result of a brief look using a poorly working flashlight.
Patients who have been admitted to a medical ward often lack an oral status
based on an inspection of the teeth and gums. If at all examined, it is often
noted as "unremarkable", but it is doubtful that it was in fact
unremarkable. Important signs are not utilized when making a diagnosis, if the
oral cavity has not been thoroughly examined.
Discussion
Why
is it that the oral cavity is not used when diagnosing a patient? Dental and
oral status provides interesting details to a patients health. The gap between
dental care and health care is too wide. Dentists often know a lot about
diseases but physicians know almost nothing of dental issues.
Medical
school only covers a few hours of dental care and in most cases further
education is completely absent. It is a matter of different occupational groups
and systems of financing.
Free
dental care is given to people with chronic disease and those undergoing
treatments causing impaired dental health. This rarely benefits patients with
medical diseases. There are many clauses in the medical insurance system that
could explain this, but deficent knowledge regarding the oral cavity and dental
care is a part of the explanation as well (cf 3,4).
Conclusion
It
is a bit strange that the teeth and oral cavity, which are highly important to
health and quality of life, are neglected in today´s health care. It is
obviously necessary to increase the exchange of knowlegde between health care
and dental care. Dental care should recieve more attention at medical school.
The teeth and oral cavity should be part of a basic exam in diagnosing medical
disease. Without a thoruogh exam to determine the status of the oral cavity it
is impossible to form a correct opinion of a person´s health status.
Marie-Louise
Ekholm
ENT specialist
Höglandssjukhuset
Nässjö
marie-louise.ekholm@lj.se
References
-
Mörnstad H,
Norberg B. Medical Trouble-Shooting. An introduction to doctoring. 162
pages, 4000 copies. Meda, Göteborg 1991
-
Mörnstad H,
Norberg B. Cavity of ignorance. J Int Med 1991; 229: 387-9
-
Norberg B.
Kapitalisten – ”gräver sin egen grav om priset är rätt” [hälsa].
Rondellen 2005; 25. URL: http://www.rondellen.net/health25_swe.htm
-
Norberg
B. Universal Emergency Service – a breakthrough for public health care [health].
Rondel 2005; 23. URL: http://www.rondellen.net/health23_eng.htm
Published December 31, 2005