By Henrylito D. Tacio
* Names have been changed to protect privacy
Jonathan Chew* has been smoking since he was a teenager. The 24-year-old office clerk from Kuala Lumpur quit smoking only recently when his gums did not stop bleeding after brushing his teeth. Then, after a month of tolerating the problem, he noticed a tooth in upper left portion started to loosen each day.
Chew talked with one of his friends, who recommended that he should see a dentist. The tooth bothers me every time I eat, he told the dentist, who extracted the affected tooth. Five days later, however, Chew returned to the clinic and complained of a pain in the socket which should have healed already.
The dentist attempted to debride the non-healing socket. That will solve your problem, the dentist assured him. But it didn’t happen. In fact, the socket still failed to show signs of healing even three weeks after the tooth extraction.
Chew returned to the clinic again and it was at this point that the patient was referred to Dr Siti Mazlipah Ismail, an oral and maxillofacial surgeon with the University of Malaya. Can you get rid of the pain I am suffering now? Chew asked the dentist.
After examiningg Chew, Dr Siti observed that there was something wrong with him. So, Dr Siti asked him if they could get some tissues for biopsy. Chew wondered; after all, the problem he was suffering from was only his non-healing socket. “We had to explain to him the need to investigate on other parts of his skeletal and lungs as he didn’t realize that his tooth problems could also have an implication on other parts of his body,” Dr Siti says.
After a much thorough examination in the laboratory, Dr Siti told the patient that he was suffering from Langerhans cell histiocytosis, a rare spectrum of disorders characterized by proliferation and accumulation of a white blood cell in the various tissues and organs of the body. A chest radiograph revealed significant lesions in the lungs of the patient, which caused some parts of the lungs to collapse.
Chew did not show any signs of the disease despite the collapsed lung. Had it not been for the non-healing socket, he would never be diagnosed of having the disease. Immediately, Dr Siti referred the patient to a chest physician, who took the necessary steps of saving Chew. “He was very lucky,” Dr Siti says now. “If not treated immediately, Langerhans cell histiocytosis is fatal, especially if the lungs are affected.”
Chew’s case is not isolated. Across Asia, people don’t equate oral health with their overall health. They fail to recognize that some mouth infections can be treacherous. They have eaten through the skin in people’s necks, choked off airways, migrated to the heart, burrowed into brains and, yes, even killed people.
Have we scared you enough yet? Here’s the point: Everyone is vulnerable, because bacteria that routinely lurk in the mouth cause tooth decay and gum disease. The problem: Most people don’t know they have these infections. They often cause no pain and few symptoms, but can lead to far worse. Gum disease may also heighten the risk for heart disease, diabetes, pneumonia and premature birth, according to recent clinical trials. But the good news is that with good old regular brushing and flossing, you may prevent all that. And by seeing your dentist often, you can nip most problems in the bud.
Unfortunately, in almost all parts of Asia, people are courting death because they have neglected their oral health. “I find it odd that that dental treatment is not always a part of an employer’s medical benefit plan,” observes Dr Siti. “Oftentimes, it is equated with aesthetic needs rather than functional. As a result, the amount located for dental treatment per year would only suffice for scaling or single filling of teeth.”
Compared with other medical problems, oral health issues in the region are often regarded as trivial. “People don’t go to dentists for checkup because they do not consider oral diseases as debilitating or life-threatening,” points out Dr Zosima Reyes, chairperson of the Department of Dentistry and Oral Medicine at the St. Luke’s Medical Center in Manila.
Most Asian experts cite low education on dental health as one of the primary reasons. “I believe the government should give attention and importance on oral health in educating our people,” says Dr Malcolm Ming-Kuang Guo, a professor of pediatric dentistry at the National Taiwan University Hospital.
Dental experts are urging Asians to rethink their commitment to oral health. After all, regular dental checkups can pay off in some other ways. For example, dentists can spot signs of diabetes, heart disease and cancer, along with a variety of rare skin and autoimmune diseases. Your dentist can do much more than save your teeth and gums. Your dentist can also save your life.
“Early detection of symptoms and early treatment may prevent the progress of the disease and its complication, and hopefully, save the life of the person,” explains Dr Perla Cruz-Triviño, chair of the dental medicine department of Manila Doctors Hospital. “You never know what your dentist may tell you on your next visit,” adds Dr Eugene Tang Kok Weng, immediate past president of Singapore Dental Association and general dental practitioner with Drs Tang and Associates.
An Oral Epidemic
Like their Western counterparts, Asians have brighter smiles than ever before, thanks to ubiquitous teeth-whitening systems. But behind those gleaming smiles, all is not well. Oral health has improved some in recent decades: Children in Japan, Hong Kong and Singapore have among the lowest rates of dental decay in the world. In Taiwan, the incidence of mild gum disease (gingivitis) among those in the age bracket of 20-34 has decreased by 38 percent in 30 years.
But here’s the bad news: In Malaysia, ninety per cent of school children between the ages of 6 and 18 suffered from dental caries more than 40 percent of older people suffer from total tooth loss. In Taiwan, approximately 58 percent of the adults still have gum disease (periodontitis).
Not getting enough fluoride may be part of the problem. When fluoridation was introduced in Hong Kong, Singapore and parts of Malaysia, only around half of the children have dental caries compared with those in nearby countries. In comparison, 98 percent of the population in the Philippines, where the water supply is not fluoridated, have dental caries and 50 percent suffer gum disease.
Children Not Spared
Oftentimes, children suffer the most since they cannot really tell what the problem is. Last November 2005, William Chen* came to the pediatric clinic of Dr Guo along with her three-year-old daughter, Sandra*. A day earlier, the two visited the clinic because the little girl had a mild toothache on her upper left molar. The attending dentist at that time didn’t give any treatment since clinical examinations and X-ray showed no obvious and significant findings.
They returned to the clinic since the left side of Sandra’s face was swelling. Dr Guo was very alarmed, so he decided to check the little girl. After a thorough examination, his verdict was pulpitis (a painful inflammation of the tooth pulp, the innermost part of the tooth that contains the nerves and blood supply) with cellulitis (an acute spreading bacterial infection).
Dr Guo opened the pulp chamber and a very putrid odor came out. After that, the girl felt better. The dentist inserted a cotton pellet and prescribed an antibiotic. At home, later that night, the swelling got worse and spread to Sandra’s left eye area.
The parents rushed the little girl to the oral surgery ward of the university hospital and intravenous antibiotic was given but still the swelling didn’t subside but got worse. The next day, the swelling spread across the facial mid-line to the right face. Seeing this, the doctors immediately carried out an emergent surgery, incision and drainage in the operation room under general anesthesia.
Two days later, Sandra was discharged from the hospital. “This case terrified me, since it happened despite dental and antibiotic treatments,” bares Dr Guo. “If she wasn’t properly treated, brain abscess may occur which may kill the little girl.”
A Silent Threat
Gum infections, too, harm more than just mouths. 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 were 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 in the United States. Dr Steven Offenbacher, director of the Center for Oral and Systemic Diseases at the University of North Carolina School of Dentistry, who co-authored the study, is helping conduct another to see if treating periodontitis in heart 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 preeclampsia, in which blood pressure climbs sky-high after the 20th week, threatening the lives of both mother and fetus. In an early clinical trial, American researchers found that treating seriously infected gums reduces pre-term births fivefold, but the work needs to be confirmed in larger trials.
The gums of 56-year-old Indira Ramesh* were painful, red, and swollen. For the past three weeks, she had been getting less sleep because of the sore gums. Not only that, her tooth on the lower right posterior jaw had been loosening. Her eldest son, Biman*, urged her to see a dentist, she declined.
But when the Indian immigrant Ramesh could no longer endure the excruciating pain, she immediately went to see her Singaporean dentist. Upon a thorough examination, the dentist decided to refer her case to oral and maxillofacial surgeon Dr Kok-Sen Ho.
While reading the report of Ramesh’s dentist, Dr Ho asked the patient some important details about her medical and social history. He found out that before she came to Singapore, the patient had been chewing betel nuts for more than half of her life. She quit her habit just a year ago.
After examining her oral tissues, Dr Ho gave an initial diagnosis of tissue burns as Ramesh had been applying salt and tamarind to ease the pain. He removed the loosen tooth. But Dr Ho knew there was more it, so he excised some tissues from the affected area for routine biopsy.
When the biopsy report came back, Dr Ho’s findings were confirmed. Ramesh was suffering from oral cancer. Immediately, Dr Ho referred her to a public hospital with all the necessary records. At the hospital, the cancer team of doctors performed a resection of her lower jaw followed by a reconstruction using bone from her leg.
“Dentists in the hospital settings would be more likely to screen for oral cancer as compared to general practitioners,” says Dr Siti. The dentist thoroughly checks the tongue, palate, inside of the cheeks, and lips for any bumps or unusual sores. If the dentist doesn’t do it, “the patient can always ask his dentist regarding his fear of the possibility of having cancer,” Dr Cruz- Triviño admonishes.
“Like any other types of cancer, oral cancer is not detected until it is in advanced stage,” says Dr Tang of Singapore. “If detected early, it has a high chance of being successfully treated. Hence, it is very important for you to visit your dentist regularly.”
Cancerous cells can develop on the lips and anywhere in the mouth – on the gums, cheeks, tongue, or the upper part of the throat. Most oral cancers emerge from flat, scaly cells that line the inside of the mouth. Oftentimes, the cancer does not spread beyond the head and neck.
Besides spotting oral cancer, dentists can recognize signs of leukemia and lymphoma (cancer of white blood cells). But diagnosing cancer is just the beginning. Dr Siti of Malaysia had once referred a pale and tired-looking patient to a physician who later diagnosed him of having heart failure.
Dentists can also spot signs of gastrointestinal problems like Crohn’s disease, skin diseases, autoimmune diseases and more. “I have been in practice for 25 years now, and from time to time, I pick up cases of anemia, diabetes, herpes, and rarely oral cancer,” informs Dr Tang of Singapore.
If more people realized the consequences of not taking care of their teeth and gums, they’d probably call a dentist tomorrow. Still, only about one-fifth of the patients of Taiwan’s Dr Guo come for regular checkup. “We advice our patients to return for follow-up every 3 or 6 months after treatment,” he says. In the case of Singapore’s Dr Ho, some of his patients come back only when they have problems. “So I see them maybe once in a year or two years,” he claims.
Healthy teeth and gums allow us to 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’s more reason than ever to brush twice a day, floss daily, get dental checkups every six months, or see a dentist promptly if you have a problem.
Jonathan Chew learned that lesson the hard way. As he recovered from his illness, Chew remained at home for recovery. He was wondering if he had not visited his dentist immediately. “I thought my dental problem was just miniscule,” he says now. “After this incident, I have now known better. Never again!” — ###