In addition to care of the teeth, dentists are often at the forefront of identifying disorders that affect the mouth, although usually physicians are the ones who would treat a diagnosed disorder. Changes in the color of the mouth’s tissues sometimes signal systemic disease.
Dental Disorders Chapters (A-Z)
Approach to the Dental Patient
A physician should always examine the mouth and be able to recognize major oral disorders, particularly possible cancers. However, consultation with a dentist is needed to evaluate patients with nonmalignant changes as well as tooth problems. Likewise, patients with xerostomia or unexplained swelling or pain in the mouth, face, or neck require a dental consultation. Children with abnormal facies (who also may have dental malformations requiring correction) should be evaluated by a dentist. In FUO or a systemic infection of unknown cause, a dental disorder should be considered. A dental consultation is necessary before head and neck radiation therapy and is advisable before chemotherapy.
Common Dental Disorders
Common dental disorders include caries and pulpitis. Periodontal disorders, including gingivitis and periodontitis, are discussed elsewhere (see Periodontal Disorders), as are dental emergencies, such as toothache (see Toothache and Infection), fractured or avulsed teeth (see Fractured and Avulsed Teeth), and postextraction complications (see Postextraction Problems).
Periodontitis (pyorrhea) is a chronic inflammatory disease of the gums resulting from an opportunistic infection of endogenous plaque biofilm. It usually manifests as a worsening of gingivitis and then, if untreated, with loosening and loss of teeth. Other symptoms are rare except in patients with HIV infection or in whom abscesses develop, in which case pain and swelling are common. Diagnosis is based on inspection, periodontal probing, and x-rays. Treatment involves dental cleaning that extends under the gums and a vigorous home hygiene program. Advanced cases may require antibiotics and surgery.
Symptoms of Dental and Oral Disorders
Bruxism is clenching or grinding of teeth. Bruxism can abrade and eventually wear down enamel and dentin in the crowns of teeth, damage metal or ceramic dental crowns, and cause teeth to become mobile. Tooth abrasion and erosion is often worse in patients who also have gastroesophageal reflux disease (GERD—see Gastroesophageal Reflux Disease (GERD)) and/or obstructive sleep apnea (see Obstructive Sleep Apnea). A bruxism triad has been described, consisting of arousal-induced tooth grinding, airway-associated sleep disorders, and sleep-related GERD.