The Tribune - Magazine section

Loose teeth? You may have cancer!
Peter Silverton

FROM bad breath to a numb tongue and tight lips, oral health can be a good indicator of the body’s general state of well-being. In the film, The Madness Of George III, the King is examined by his physicians, bit by bit, doctor by doctor. One pores over his faeces.

Another takes the urine, so to speak. If Iain Hutchison had been there, he’d probably have asked George to open wide. Then he’d have had a good look around inside the kingly mouth.

"You can find out a lot from a careful examination of the mouth," explains Hutchison. "I’m not just talking about tooth decay and gum disease, but about problems elsewhere in the body which present themselves through the mouth." A renowned specialist in facial reconstruction, Hutchison has been a consultant at St Bartholomew hospital in London since 1989 and now also runs the oral and facial surgical unit at the Royal London in Whitechapel — where John Merrick, the Elephant Man, was kept in an upstairs room, born 150 years too early to be helped by Hutchison’s skills and technique.

He’s perpetually but shame-facedly late for everything. Setting up a charity, the Facial Surgery Research Foundation - Saving Faces, has reputedly made things even worse. But if ever my face gets banged about in a car crash or I develop mouth cancer, hethe one I’d call. "If you don’t have a mouth that works properly, you can’t breathe or eat properly. You take something for granted till that something goes wrong." Disease in the gum and jawbone can threaten the heart. "Every time you clench your teeth or have surgery, it pumps the bacteria from your gums to the heart valves." There they cause inflammation. This can cause the valve to pull away from the heart or make it stenotic — stop sealing properly. "You get back-sucking of blood." And that is not recommended.

A quick checklist

Sweet breath may mean diabetes.

A fine tang breath may mean kidney problem

Not enough saliva may mean alcoholism or diabetes.

Loose teeth may mean blood disorders.

Mouth blisters may mean serious skin diseases.

A doctor could start an oral investigation of someone’s bodily state by sniffing their breath. ‘Because the mouth is part of the digestive tract and the airway system, a lot of diseases manifest themselves there." Halitosis can be sign of gastro-intestinal problems and hiatus hernia.

The most common endocrine problem, diabetes, can also be spotted via the breath. "The classic sweet smell of diabetes." Liver diseases smell funny that way, too. Kidney complaints produce their own odour, not unlike the "fine tang of faintly scented urine" which Joyce’s Leopold Bloom so savoured in grilled mutton kidneys.

Just looking at a patient’s face and lips can indicate problems. "Sclerodema causes tightening of the subcutaneous tissues. People look like they’ve had a face-lift on the mouth. It’s so tight you can’t open your mouth or swallow." A rare auto-immune disorder most often found in 40- to 60-year-old women, sclerodema can’t be cured, only treated to relieve the symptoms.

Then there’s saliva. Not enough saliva means you can’t eat properly — food can’t be dissolved and moved around the mouth. It also affects your ability to suppress harmful bacteria and can be a sign of both alcoholism and diabetes. Sjorgen’s syndrome, which most commonly occurs in post-menopausal women, produces a dry mouth - dry eyes, too. "Not enough tears or saliva is a common phenomenon in auto-immune diseases." Upset, the body’s own defence systems start attacking the glands that produce the body’s lubricators.

Now look at the tongue. A very smooth or sore tongue is often a sign of vitamin deficiency. The tongue can also indicate a brain tumour, MS or a transient ischaemic attack — a mini-stroke. "There can be wasting on one side of the tongue. It’ll look wrinkled or feel numb."

Crohn’s disease, a chronic inflammation of the gastro-intestinal tract, can be inferred from the condition of the mouth’s surface. ‘There’ll be lumpy mucosa - a cobblestone effect.’

Loose teeth and persistent gum-bleeding can be a sign of various blood disorders, notably leukaemia, and platelet and blood-clotting deficiencies.

What about those little mouth ulcers that so many of us get so regularly, often once a month? "Aphthous ulcers, as doctors call them, are incredibly common but we don’t know the cause. They can, however, also be a sign of deficiencies of iron, vitamin B12 or folic acid." An overgrowth of thrush can be a sign of diabetes. HIV, too.

Mouth blisters can be a sign of serious skin diseases such as pemphigus. There can be massive skin and fluid loss, as with severe burns. "Life-threatening if they burst. They need to be dealt with promptly." By now, like me, you probably feel like the prisoner-narrator in Kipling’s Cells: "I’ve a mouth like an old potato, and I’m more than a little sick."

— The Guardian