The Tell-Tale Mouth

Want to know if you're healthy? Ask your dentist.

By Brenda Hudson

“The mouth is the barometer of the body,” says Patrick Lloyd, dean of the School of Dentistry. Based on the appearance of the tongue and the cheek linings, he says, “We’re often able to gauge what’s going on in the body.”

Because tissues in the mouth tend to be replaced quickly, changes due to infection or illness are manifested more quickly in the mouth than in other parts of the body, he explains. As a result, researchers are investigating connections between the mouth and the body, yielding exciting discoveries.

Bacteria associated with periodontal disease now are linked to conditions such as preterm births, diabetes, and lung and heart disease. In addition, biomarkers found in saliva and oral cells provide clues to HIV infection and cancer. Much of this research crosses disciplines, which the University’s Academic Health Center—with its six health sciences colleges and schools— excels at supporting.

The School of Dentistry leads interprofessional research connecting the mouth and body. Bryan Michalowicz, director of the Clinical Research Center, works with obstetricians to determine whether periodontal disease causes a higher incidence of preterm births. His colleague Mark Herzberg, professor of oral sciences, researches the link between oral health and systemic illnesses, such as HIV and heart disease. Earlier in his career, Herzberg studied oral bacteria’s role in heart infections, showing that certain bacteria trigger clots that lodge on heart values. This work led to further research suggesting that oral bacteria may contribute to heart disease.

Herzberg also examines the mouth’s role in HIV infection. Until recently, it was thought that HIV passes through the mouth without causing an infection, passing into the intestines where it takes hold. Herzberg’s work suggests that skin cells lining the mucous membranes in the mouth and throat have a role in moving the virus into the immune system. “There may be specialized mechanisms at play,” says Herzberg.

In addition, early symptoms of cancer can be detected in the mouth. Nelson Rhodus, professor of oral medicine at the School of Dentistry, collaborates with Frank Ondrey, an otolaryngologist in the Medical School, to examine premalignant oral tumors. Through more effective and earlier diagnosis, Rhodus and Ondrey hope to improve the survival rate for oral cancer patients.

Their target is the first sign of oral cancer—a small white lesion known as leukoplakia. When the lesion first appears in the mouth, says Rhodus, it may not be cancerous so a biopsy might be negative. The lesion may become cancerous, however, and, if not consistently monitored and treated early, can become fatal.

The two researchers are conducting a clinical trial investigating drug treatments to kill leukoplakia cells. They also are taking saliva, tissue, and blood samples to better understand the biomolecular development of oral cancer. Their goal, explains Rhodus, is to develop tests that will be able to predict or diagnose cancer. Rhodus also is investigating biomarkers in saliva to diagnose or predict the likelihood of oral, head, and neck cancers. He adds: “It’s possible, however, other cancers may be linked to oral biomarkers.”

Even before asking a patient to “open wide,” dentists are uniquely placed to monitor a person’s health. “Patients tend to see their dentists more frequently than they do their physicians,” says Lloyd. “By taking a patient’s oral history twice a year, we have a chance to inquire about their overall health”—which puts dentists on the front lines of preventive health care for their patients.

 The mouth is a font of information: from physical characteristics, to biomarkers, to oral histories. Using the knowledge they gain there, dentists are beginning to reveal just how interconnected the body is.