48 NOVEMBER 2017 | RDHMAG.COM
THE ‘DENTAL DETECTIVE’ AND SYSTEMIC DISCOVERIES
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they might tell you that they never have heartburn. But, unfortunately,
this tricky condition can be hard to detect. Things are not always as
they seem. You might just be a detective yet.
Aside from the obvious, and by “obvious” I mean bruxism, ab-fractions, wear facets, or enamel wear, there may be other signs
that your patient is suffering from stress, anxiety, or depres-sion-related disorders.
Frequent canker sores, noticeable xerostomia, and ongoing, unresolved gingival inflammation can all be signs. The body’s response
to intense stress can present itself in many different ways, often affecting hormonal, vascular, and muscular functions. These changes
might present as compromised digestion, reduced salivary flow, and
In some cases, the stress is so severe that “trench mouth,” or acute
necrotizing ulcerative gingivitis (ANUG), perhaps even acute necrotizing ulcerative periodontitis (ANUP), may present itself. The
patient may complain of painful gums that bleed with little provocation, and we may notice the characteristic “punched-out” papillae
that we learned about in our primary dental education. There may
be a fetid odor, or a gray pseudomembrane around the gingival
margin, and complaints of fever or malaise by the patient.
Granted, this disease may have many other causes, including
a compromised immune system from conditions such as HIV,
cancer, or the like, one of the primary causes might be ongoing
or high-pressure stress. It’s important to talk to your patient
about their stress level and recommend help as needed. Some-
times, you’re the only person they can vent to, and they might
be surprised that you caught on. It might open the door that
they need to regain control of their life.
You brought your patient back, and he tells you he’s been very tired
lately. Your conversation carries on and you ask the usual questions
about his work and home life; meanwhile maybe you’re still thinking
about his mention of fatigue from earlier on. The dental detective
inside is questioning everything and yearning to discover a cause.
You have the patient open up for the initial examination and oral
cancer exam. Then, bam! Right there, you notice it! Pale mucosal
tissue that makes you wonder if your patient has become a zombie,
and glossitis of the tongue that you could play air hockey on. These
little nuggets could very well be anemia. Educate the patient—but
maybe keep the zombie part to yourself.
There are many other systemic conditions that we can look for as
dental detectives, though not nearly as telling, and much more
difficult to piece together.
Maybe your patient mentions loss of energy, memory loss, or
exhibits signs of forgetfulness during conversation. Did you notice
a change in the pitch of her voice while she spoke to you, and