1. What your dentist is seeing: Or in this case, smelling. You've got funky breath.
What it could mean: The most likely causes of less-than-minty-fresh breath are poor oral hygiene or gum disease, but halitosis can also signal a sinus infection, especially if your dentist still notices the odor when you exhale through your nose, says Mark Wolff, DDS, PhD, professor and chair of the Department of Cardiology and Comprehensive Care at New York University College of Dentistry. It can also be caused by acid reflux -- a study in the Journal of General Internal Medicine found a strong association between gastroesophageal reflux disease (GERD) symptoms and bad breath -- or sleep apnea, says Ruchi Sahota, DDS, a spokesperson for the American Dental Association, because people with sleep apnea are more likely to breath through their mouths at night, which can lead to dry mouth (another cause of bad breath).
Next steps: If your dentist decides that the problem isn't subpar brushing or gum disease, they'll likely refer you to your primary care physician to find the underlying cause.
2. What your dentist is seeing: Your gums bleed during the flossing, just like they do at home.
What it could mean: When you get back on the flossing bandwagon after falling off and notice some bleeding for the first few days, that's normal, Sahota says. What's not normal is gums continuing to bleed every time you floss. "It could be an indicator that you're pre-diabetic, diabetic and don't know it or, if you've already been diagnosed with diabetes, your blood sugar isn't under control," she says. Though it's not exactly clear why diabetes and gum disease are linked (or whether there's a causal effect to the relationship), the American Academy of Periodontology says that diabetics may be more likely to develop the disease because the condition makes them more susceptible to infection.
Next steps: If you know you have diabetes and your gums keep bleeding, talk to your primary care doc about how to manage the condition better. And if your dentist is the first one to suspect diabetes, he or she will recommend you get a blood sugar test.
3. What your dentist is seeing: White patches on your tongue or inner cheek.
What it could mean: You may have a less-than-stellar immune system. Oral thrush (an overgrowth of the candida fungus, or yeast, in the mouth) can lead to creamy white patches on your tongue or inner cheeks, and it can signal an immune system that's not up to snuff. (We all have some candida in our mouths, but it's kept in check in healthy immune systems). People are much more likely to develop thrush if they're undergoing chemotherapy or radiation treatment for cancer or have serious immunosuppression, such as HIV, but a dip in immunity due to a cold, a course of antibiotics or using corticosteroids for conditions like asthma can make someone more vulnerable too.
Next steps: An antifungal medication can help clear away the patches.
4. What your dentist is seeing: Worn-down teeth.
What it could mean: You're more stressed than you realize. Stress can manifest as teeth grinding, wearing down teeth. "In really bad cases, people will flatten them out," says Wolff. Your personality type may predispose you to grinding, too. A 2010 study in the Journal of Research in Personality found that people who rated higher on the neuroticism scale were also more likely to report that they grinded their teeth. Research in the International Journal of Oral Science in 2014 reported that sustained jaw clenching (another characteristic of bruxism, or teeth grinding) can lead to severe damage of the tissue in the joint that connects your jaw to the rest of your skull.
Next steps: Your dentist can fit you for a bite-protecting device like an acrylic mouth guard to wear at night to minimize the damage.
5. What your dentist is seeing: Squeaky-clean teeth but inflamed gums.
What it could mean: It's rare (Wolff has only picked up on it once during his 34 years in practice), but it's possible for certain types of acute myeloid leukemia to spread to the gums and cause bleeding, swelling and inflammation. "What would tip us off is if the gums are bright red and bleed upon touch, but the teeth themselves are immaculately clean with very little plaque," Wolff says. That combined with weakness and weight loss merits a trip to your primary care physician for evaluation.
Next steps: If you meet these criteria, schedule an appointment with your PCP to get it checked out.
6. What your dentist is seeing: Your dental X-rays look a little off.
What it could mean: The bones of the jaw aren't immune to the effects of osteoporosis, and on an X-ray, they may take on the appearance of ground glass, says Wolff. Osteoporosis also puts you at increased risk of tooth loss. Women with the condition had an average of 3.3 fewer teeth than women without it, noted a study in the Journal of Clinical Periodontology.
Next steps: Ask your doctor about getting a bone-density test. If it shows you have or are at risk for osteoporosis, you can discuss medications and other ways to slow the progression.
7. What your dentist is seeing: Your mouth is really, really dry.
What it could mean: Medications like antihistamines can dry out your mouth, but an extremely dry mouth (as in, you couldn't swallow a cracker without water) is a hallmark symptom of Sjögren's syndrome, an autoimmune condition in which moisture-producing glands in the body come under fire from white blood cells. It's most commonly diagnosed in people over 40, and 9 out of 10 Sjögren's patients are women. "It gets parched in there," says Wolff, who'll ask patients with dry mouth whether they're taking any medications that list dry mouth as a side effect and whether they're also experiencing dry eyes (another Sjögren's symptom). The lack of saliva can also lead to tooth decay.
Next steps: If he suspects Sjögren's, Wolff refers patients straight to a rheumatologist for testing.
8. What your dentist is seeing: Lesions at the very back of your mouth.
What it could mean: You could have oral cancer, which isn't exactly common, but it's also not rare. The American Cancer Society estimates that 45,780 new cases of oral cavity or pharynx cancer will be diagnosed in 2015, just over half the number of expected skin cancer cases. Cancers at the base of the tongue and tonsils (called oropharyngeal cancers) are most commonly caused by the human papillomavirus infection (HPV). Although the lesions can pop up anywhere in the mouth, they're most likely to develop under the tongue around the base and near your esophagus, says Judith Haber, PhD, principal investigator of the Teaching Oral-Systemic Health (TOSH) program at NYU College of Nursing. Oral cavity and oropharyngeal tumors are twice as likely to develop in men as in women, and the American Cancer Society reports a recent uptick in cases of oropharyngeal cancers linked to HPV.
Next steps: If your dentist notices these lesions, they may ask you about your sexual activity to assess whether you could have contracted HPV, as oral sex is one of the main reasons people get oral HPV, says Haber. They may then refer you to your doctor or an oncologist for testing.
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