Oral disease: when the toothbrush is not the answer

As dentists, we understand the importance of good oral hygiene to prevent oral disease. Meticulous tooth-brushing, flossing and gargling with an antiseptic mouthwash are the bedrock of preventive dental care. I have often wondered why some patients, despite their impeccable oral hygiene, continued to have rotting teeth, bleeding gums and bone loss. This blog will discuss other, lesser-known causes of oral disease that may be affecting you.

Oral disease is a two-way street

The prevalent current viewpoint is that poor oral hygiene may cause or worsen other medical problems. The most common associations relate to oral bacteria causing infection and inflammation that may impact on the development of heart valve disease (endocarditis), diabetes and even premature births for pregnant women. These are all examples of oral disease causing medical problems.

What about medical problems affecting or being the principal cause of oral disease? Like our medical colleagues, patients presenting with mouth ulcers, a sore tongue or bad breath are often treated via an allopathic approach. “Allopathic medicine” can be defined as: “Relating to or being a system of medicine that aims to combat disease by using remedies (as drugs or surgery) which produce effects that are different from or incompatible with those of the disease being treated.” (Merriam-Webster Dictionary)

Are you distressed about the oral disease you are suffering? Is it causing you acute pain or embarrassment? In these circumstances, there may be a strong desire for a “quick fix” to mask the symptoms. But is this approach ideal?

I have often wondered why some patients, despite their impeccable oral hygiene, continued to have rotting teeth, bleeding gums and bone loss.

For instance, hypothyroidism can lead to more dental decay and an oestrogen imbalance can lead to osteoporosis and weaker jaw bones. An association has also been found between snoring/sleep apnea and tooth grinding (bruxism). Chronic bruxism, for some patients, may also accelerate jaw-joint dysfunction.

I remember a patient who shared with me her experience of a walk in a nature reserve in Boston in the US. A minor insect bite on her neck led to a whole body rash a few days later. A US doctor wanting to allay the patient’s alarm and discomfort prescribed steroid therapy. The patient was relieved when the rash and discomfort quickly disappeared.  Unfortunately, the patient later suffered chronic fatigue for a decade after she returned home, which doctors later surmised was due to a tick bite.

In hindsight, it is easy to be critical of this patient’s medical care, but no health practitioner could have foreseen exactly how an insect bite would have so severely affected her health. In a similar way, some common dental problems such as dental decay and gum disease may be “treated” but the patient’s problems keep reappearing every few years.

Throwing in the towel (and the toothbrush)

If you’re ready to throw in the towel, rest assured that the emerging science of “functional medicine” is starting to make inroads toward solving some chronic medical and dental problems. It goes beyond just “nutritional advice”, as one prominent medical doctor explains:

“As opposed to Western Medicine, functional medicine treats the patient and not the disease. In addition, it provides a framework for the practice of medicine that uses all the tools of healing, both conventional and alternative, to address the whole person rather than an isolated set of symptoms.” 

No longer should we abdicate our role as guardians of the mouth but develop stronger relationships with our medical colleagues to unearth the true causes of oral disease.

The results of adopting this approach in medical and dental spheres can reap profound benefits for the patient. One common observation we often observe is dental erosion caused by reflux disease. By taking the allopathic approach, the solution to reflux is an anti-reflux medication (eg Nexium). If taken long term, this can result in significant nutritional deficiencies. By taking a functional medical approach to reflux, we may identify:

1) A food intolerance: a dietary change may reduce or eliminate the reflux “disease”.
2) An inflamed and “leaky gut”: probiotics and nutrients may help heal the lining of the gastrointestinal tract.
3) Insufficient stomach acid: a supplement of hydrochloric acid (HCL) may be given. Stomach pH must be low enough to shut the entry of the stomach from the oesophagus (called the sphincter).

Bridging the dental divide

By extension, this brings us to the logical question: can functional medicine offer any benefits for patients whose chronic dental problem appear to have no solution? In my opinion, the answer is a resounding ‘YES’. No longer should we abdicate our role as guardians of the mouth but develop stronger relationships with our medical colleagues to unearth the true causes of oral disease.

By adopting this new approach to chronic disease, we as healthcare workers can concur with English writer and philosopher Aldous Huxley, who once said:

“There are things known and there are things unknown, and in between are the doors of perception.”