Anemia
Lack of hemoglobin can cause pallor of the oral tissues, but this is often difficult to distinguish. More telling is glossitis, which is a smooth, reddened, sometimes patchy tongue surface. Anemia can also lead to tenderness, burning, or pain of the oral mucosa. Oral candidiasis, a yeast infection involving small, curdy-appearing white papules and plaques, can develop due to decreased immune system function in chronic anemia.
Bulimia
Excessive dental erosion in young persons (most often females) could be an indication of bulimia. Exposure of the teeth to the high acid level of gastric contents with forced vomiting causes erosion of the lingual (tongue-side) surface. Bilateral enlarged parotid glands are also seen frequently in bulimic patients.
Diabetes
A variety of oral conditions arise from diabetes and should be considered as clues to the disease. The increased blood sugar levels of untreated or under-treated diabetes leads to tooth decay, gingivitis, and periodontal infection. In addition, nerve and vascular complications of the condition reduce saliva production and slow the normal healing process.
Research has shown that poor dental hygiene can also exacerbate diabetes, and treatment of dental conditions has been found to improve blood sugar control in diabetics. Therefore, good oral health should be part of diabetic education and chronic care monitoring for patients with this disease.
HIV Infection
Oral manifestations may be the first indication of HIV infection. Immunosuppression from HIV disease leads to oral candidiasis in 90% of those with HIV. Herpes simplex is another common oral infection frequently contracted by individuals with HIV. Other oral infections that may manifest in immunocompromised patients include hairy leukoplakia, Kaposi Sarcoma, and human papilloma virus (HPV) infection.
Leukemia
Leukemia can lead to oral bleeding, inflammation, and ulceration. The impaired immune function of leukemia can also lead to mouth infections such as candidiasis and herpes simplex.
Medication Side Effects
The use of certain medications can also have oral effects that are important to note on assessment. A few of the most common oral conditions caused by medications are listed below:
- Dry mouth (xerostomia) is the most frequent oral side effect of medications and can lead to increased risk of infection and decay. Use of diuretics and antidepressants are common causes of dry mouth.
- Inhaled steroids used by asthmatics can cause candidiasis in the oral cavity.
- Overgrowth of the gums (hyperplasia) can be a side effect of phenytoin, calcium channel blockers, and cyclosporine.
If any of these signs or symptoms are encountered during an oral screening, findings should be carefully documented and communicated to a medical or dental provider for further evaluation and treatment initiation.
This information is from The Correctional Nurse Educator class entitled Dental Concepts for the Correctional Nurse.
In our final Dental Blog Post VI, we will discuss Dental Patient Education.