How the mouth holds clues to your current and future health potential
By Dr. Michael Wald, Blood Detective
914-242-8844 (EXT. 1)
Throughout our lives our nutritional needs vary greatly. Newborns require very different nutrition than adults, males require different nutrition than females and the sick require different nutrition than athletes. Even a given individual’s nutritional needs are subtly or sharply different from day-to-day depending upon stress levels, sleep habits, medications, exercise and other factors. Genetics is always influencing our core nutritional needs. How does one figure out how to manage optimal nutritional needs throughout our lives? Sophisticated laboratory tests and medical technologies are available that, when considered together with medical and health history questionnaires and consultation, can very accurately estimate one’s nutritional needs. In the interest of teaching my patients how to take care of them selves to a certain degree, I have written this article providing specific physical signs of current or potential illness that are related to diet and overall nutrition as well as lifestyle in general. If you pay attention to these “signs of health status” you should go a long way towards maintaining health for longer and avoiding premature chronic disease.
Your mouth tells all
The structures and lining of the mouth, or oral cavity, offer valuable, and easily accessible, information on your nutritional status. Lesions in the mouth, often overlooked by even well-trained health professionals, may indicate a nutrient deficiency or may be manifestations of gastrointestinal or other disease. Because of the very rapid cell turnover of the oral mucosa, or cells that line the mouth, these lesions often may precede other manifestations of nutrient deficiency or systemic disease by weeks, months or even years. Some typical lesions are mucosal ulceration, cheilosis, gingivitis, and glossitis. Between 5% and 10% of the people in the United States are deficient in one or more nutrients, so signs of nutritional deficiency are common, but often go unrecognized producing other symptoms.
Anatomy of the mouth
Before one can start to recognize signs of nutritional problems in the mouth a little anatomy of the mouth is necessary. But don’t be discouraged! Once you learn a small amount of mouth anatomy you will start recognizing signs of nutritional deficiency and disease very quickly. The top of the healthy tongue is covered with smooth, pink mucous membrane and lymphoid follicles. On the bottom surface, the various specialized cells called papillae (which contain the organs of taste) produce a rough, grayish red appearance. The thick epithelial tufts of the filiform papillae give the tongue its characteristic grayish white coating, whereas the globular, pale red fungiform papillae give it a speckled pink appearance. Furrows are not a characteristic of the healthy tongue. The buccal mucosa (the sides of the inside of the mouth) has a grayish red color and may be crossed by fine grayish ridges where it touches the closed teeth. The healthy gums have a light reddish appearance and cover the roots of the teeth completely. The assessment of oral health, obviously, must assess the health and status of the teeth. Patients should be asked about their dental history and encouraged to have
regular dental checkups. Here are some key nutritional considerations for examination of the teeth. However, do not expect your dentist to pick up any or all of the oral signs of nutritional deficiency; so it is up to you to take a careful look and bring what you suspect is a problem in the mouth to your dentist or nutritional health care provider.
Also, having fewer than 20 teeth as an adult is associated with significantly reduced capacity to eat nutritious foods, such as salads, raw fruit and vegetables, nuts, and whole grain products. The same applies even to denture wearers. Other causes of poor nutritional status showing up as decay in the mouth include:
- Bulimia may manifest as erosive tooth wear.
- Osteoporosis may manifest initially as changes in jaw structure and/or loose teeth.
- Presence of mercury amalgams may be associated with systemic disease, especially neurologic conditions.
Membranes can be a “pain”!
Below I have summarized many common typical oral lesions associated with a particular nutrient deficiency, are summarized below.
In general, ulceration should be considered a nonspecific expression of a disease state. A search for the cause will usually result in a specific therapy. Aphthous stomatitis is a common example of a mucosal ulceration and I see many patients with this particular finding. I visited with a 15-year old girl with ongoing intestinal problems undiabnosed by other doctors. I noticed this finding and then tested appropriately and discovered the presence of gluten intolerance. Removal of gluten caused an immediate reduction of this 15 year old intestinal bloating, cramps, weight gain and gas.
Similarly, cheilosis is a common expression for acquired nutrient deficiency. Gingivitis is associated with the classic signs of scurvy, but other nutrients have now been shown to play a role in gingival health; this subject is discussed in Chapter 201. Glossitis is associated with numerous vitamin deficiency states, each with a charac- teristic appearance.
Examples of nutritional deficiencies seen in the mouth
- Vitamin deficiencies of various kinds can cause these and other oral lesions:
- Biotin - Geographic tongue, atrophy of lingual papillae
- Folic acid - Gingivitis, glossitis with atrophy or hypertrophy of filiform papillae, cheilosis
- Niacin - Intraoral burning, canker sores, halitosis, glossitis, tongue swollen with red tip and sides, swollen red fungiform papillae, filiform papillae becoming inflamed and losing their epithelial tufts (giving the characteristic slick red appearance)
- Pyridoxine - Intraoral burning, glossitis, mucosal ulcerations and erosions, cheilosis
- Vitamin B12 - Intraoral burning, mucosal ulcerations and erosions, painful glossitis with a beefy red or fiery appearance eventually resulting in an atrophic (smooth and shiny) tongue
- Riboflavin - Soreness and intraoral burning, cheilosis, angular stomatitis, glossitis with a magenta tongue
- Vitamin C - Sore and bleeding gums, deep blue-red color to gums, loose teeth, follicular hyperkeratosis
- Vitamin D - Intraoral burning Vitamin E Glossitis
- Calcium - Periodontal disease, tooth decay
- Iron - Cheilosis, atrophic glossitis, gingivitis, candidiasis, intraoral burning or pain, mucosal ulcerations and erosions, pallor
- Zinc Marked halitosis, cheilosis, stomatitis, discrete red, scaly plaques
Specific oral manifestation of disease
- Cheilosis - Crohn’s disease, acrodermatitis enteropathica, alcoholism, celiac disease, malabsorption syndrome
- Gingivitis - Crohn’s disease, anorexia nervosa, celiac disease, scurvy
- Erythroplakia - Dysplasia or carcinoma
- Glossitis - Crohn’s disease, diabetes, alcoholism, celiac disease, malabsorption syndrome, pernicious anemia, iron-deficiency anemia, amyloidosis, carcinoid syndrome, cigarette smoking, anemia
- Intraoral burning - Menopause, diabetes mellitus, esophageal reflux, Sjögren syndrome
- Leukoplakia - Chronic irritation, dysplasia, early invasive squamous cell carcinoma
- Ulcerations, Crohn’s disease, ulcerative colitis, celiac erosions disease, corticosteroid use, acrodermatitis enteropathica, anorexia nervosa, pernicious anemia, iron-deficient anemia, mercury poisoning, nicotine withdrawal
If you should discover any suspected oral lesions please report them to your qualified health care provider. Visual clues of disease can prove to be life-savers. They have for many of my patients. Please go to: www.blooddetective.com for specific nutritional supplements of interest.