As new students in first year dental school, our very first clinical assignment was to examine each other’s mouth and to make a list of our findings. My list, like most, was rather short: tongue and cheeks, gums and teeth. Our eyes were not educated yet. For the most part, we all felt awkward examining a friend with mirror and explorer in hand. Today, after more than 3 decades in dentistry, I could write a book (and I may) about what I see in people’s mouths.
The mouth, or perhaps more appropriately, the masticatory system, is a complex apparatus. It is composed of the maxilla (upper jaw) and the mandible (lower jaw) joined by two Temporo-mandibular joints (TMJ) that, unlike any other joints in the body, are not independent of one another. A number of muscles move the mandible up, down and sideways to allow us to perform an amazing number of tasks such as chewing, swallowing, speaking, sucking, whistling, blowing, and kissing. In addition, there are numerous and various types of taste buds, strategically located inside the mouth, to make eating a pleasurable experience. Saliva plays an important role as it helps start the digestive process and moistens the food to facilitate swallowing. Then we add to this already complex system, 2 sets of teeth budding in the jaw bones and eventually erupting through the gums over a period of 2 decades: the first set of 20 for childhood and a second set of up to 32 for the rest of our lives. There is no other system in the whole body that is this complex and this versatile. Fortunately, unlike many other organs and systems, the mouth is easy to access for examination and treatment. This very unique combination of features is the reason why the mouth has become the focus of attention over the past few years: when examined carefully, the mouth can tell volumes about a person’s health, lifestyle, and stress and body awareness.
Teeth are the hardest structures in the body. One would imagine that because of their incredible strength, all teeth would last longer than any other body part and thus serve us well into our golden years. The sad reality is that very few of us make it into retirement with a full set of teeth. The reason is that, unlike the rest of the body, teeth have a very limited ability to heal themselves. When we cut ourselves, our skin will heal; when we break a bone, the bone will mend itself after a period of immobilisation; an infection anywhere else in the body will be eradicated by the immune system, sometimes with the help of antibiotics. A tooth that becomes infected with decay beyond the thickness of the enamel can not heal itself and will need to be drilled and filled. No matter how good the filling, this tooth will be weaker for the rest of its life. Chip a piece off a tooth and it will never grow back; crack a tooth and it is cracked for life. Loss of enamel due to grinding, excessive gum chewing or nail biting is a permanent loss. A severe fracture on a molar is a death sentence for that tooth; another tooth will not grow to replace it. Teeth are not a renewable resource.
Healthy gums are pink, tight and tough. They put up with food and beverage temperatures that would scald your skin. They resist the daily assaults of food abrasion, chemical erosion and unhealthy habits, better than teeth do. However, like teeth, gums are vulnerable to plaque. Plaque, the sticky film of food and bacteria that’s constantly forming on your teeth, is the main cause of tooth decay and periodontal (gum) disease. Plaque must be removed every day with brush and floss, ideally after every meal.
If the mouth came with an owner’s manual, the manual would stipulate that the mouth needs to be tended to like one would tend to an exotic garden, a precious treasure, and this from the moment the first tooth appears in the mouth. The owner’s manual would clearly specify that for best performance, gums and teeth need to be brushed after every meal, and teeth also flossed after each meal. It would stipulate that water is the beverage of choice to quench one’s thirst; any other beverages should be used in moderation. It would make it very clear that excessive consumption of sweets will cause permanent damage to the system. Finally it would prescribe a mandatory rest period between meals to allow the system to recover.
So what are those tales that gums and teeth tell me when I examine your mouth? I see wear patterns caused by night grinding, often related to stress, even in children; I see the typical pattern of decay of the toddler who gets put to bed with a bottle of milk or juice every nigh;. I see the narrowing of the upper jaw of the child who sucks her thumb; I see eroded enamel from excessive consumption of pop. Different enamel erosion patterns warn me of acid reflux or bulimia. A sudden increase in tooth decay and / or a sudden deterioration of the gum’s condition suggest the onset of Diabetes. A red and shiny tongue could be a sign of a vitamin B deficiency. Red and bleeding gums may be a sign of Leukemia or Lupus. But what I see most often are garden-variety tooth decay and gum disease caused by plaque. And what I like the most is when I see a healthy mouth with a set of perfectly clean teeth surrounded by pink and tight gums: it is usually attached to the healthy body of someone with a well developed sense of self-awareness.
Generally, I have found that people who take good care of their mouth also take good care of their body. After all, making healthy choices for the teeth likely has healthy repercussion for the rest of the body. Further more, keeping the teeth plaque free leads to healthy gums that do not bleed: this means that the plaque-forming bacteria do not enter the bloodstream or the airways to cause havoc in other body parts.
The mouth is the most accessible organ, yielding itself to self examination very nicely. Yet most mouth-owners have limited awareness of this subject. When was the last time you looked inside your mouth? Do you know how many teeth you have? How many spaces? Have you checked your tongue lately? Are your teeth shiny like valuable pearls? And are your gums pink and tight? When you start your self-examination, enlist the help of your tongue to evaluate every single tooth in your mouth. Pay special attention to the base of each tooth where it meets the gum: can you feel the clean definition between enamel and gum or the fuzziness of plaque? Do you feel like reaching for your tooth brush and floss now? Excellent!
I have had a fabulous career so far and I still enjoy my work very much. In the 70’s, when I was in dental school, there was a lot of talking about researchers working on a vaccine against tooth decay: I was worried I might not have a job after graduation. Today there is still no vaccine against tooth decay and I am just as busy fighting battles against plaque as I was 30 years ago, albeit with better instruments, technology and materials. What has changed is that I now see myself as a health provider responsible for the care of people’s mouth, the gateway to the rest of the body, and possibly to an improved general health.
Take a minute to have a look inside your mouth. If questions or concerns arise from that brief exploration, make sure to contact your dentist. Have a critical look at what you put in your mouth on a daily basis. Pick up some floss and commit to flossing every day, starting today. Tooth decay and gum disease are totally preventable: all you need is an increased sense of awareness leading to better plaque elimination. You might be pleasantly surprised to find yourself generally healthier for it.