Understanding dental health is key for correctional nurses, as we are often the first to assess oral health during the intake screening, sick call, and emergencies. The mouth can provide clues to many medical conditions and drug side effects. Here are some of the most common conditions that may be detected during an oral exam.

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 burning, pain, or tenderness 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 females could be an indication of bulimia. Exposure of the teeth to the high acid content of gastric contents with forced vomiting causes erosion of the lingual (tongue-side) surface. Bilaterally enlarged parotid glands are also seen frequently in bulimia.

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.

An interesting finding is that poor dental hygiene can also exacerbate diabetes. Treatment of dental conditions has been found to improve blood sugar control in diabetics. Therefore, good oral health should be a 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 include hairy leukoplakia, Kaposi Sarcoma, and 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

Medication use can also have oral effects worth noting on assessment. Here are a few of the most common oral conditions caused by medications.

• Dry mouth (xerostomia) is the most frequent oral side effect of medications and can lead to increased risk of infection and decay. Diuretics and antidepressants are common culprits of dry mouth.
• Inhaled steroids used by asthmatics can cause candidiasis.
• Hyperplasia, overgrowth of the gums, can be a side effect of phenytoin, calcium channel blockers, and cyclosporine.

If any of these medical conditions are encountered during an oral screening, carefully document your findings, initiate appropriate treatment, and communicate this information to medical or dental providers for a diagnostic workup.

Practice, Practice, Practice!

It takes time and practice to be able to spot various oral conditions. This American Family Physician article provides pictures of many conditions to get you started.

In addition, let your dental staff know you are interested in developing your oral assessment skills. Ask to be alerted when a particular condition is discovered so you can also see the condition and note what it looks like for future reference.

Also, take advantage of online learning such as this module by Medscape.

Through mindful practice, you can develop the skills you need to competently detect oral conditions that require further medical evaluation.

Have you discovered a medical condition during one of your oral exams? Share your experiences in the comments section of this post.