• 1/8/2006
  • Annapolis, MD
  • Wendi Winters
  • The Capital Online (www.hometownannapolis.com)

Hopping into the chair in the dentist’s office might be a less-than-thrilling way to spend an afternoon, but for some it could be the difference between life and death.

That message struck uncomfortably close to home for Dr. Vernon Sheen the day he found a lump inside a patient’s mouth.The patient was his own 74-year-old father, Shuh-ji Sheen.

Mr. Sheen had dropped by Annapolis Center for Dental Health and Wellness for a quick checkup from his son while in town on vacation. Some vacation.

“The lump was bigger than a grape, and he didn’t even know it was there,” says Dr. Sheen in amazement. “It was something he’d gotten used to. It was a benign tumor in that soft spot right under the tongue. I sent him to an oral surgeon right away.”

He may have saved his dad’s life.

Turns out, dentists are looking for more than cavities these days when they say, “Open wide!”

“Nick Petrinko, my dental hygienist, and I are so careful to look inside people’s mouths, especially those of smokers or people who might drink to excess,” says Dr. Sheen.

He recalls another patient who, when asked to open up, exposed an inner check “so eroded it looked like a ‘Blooming Onion’ from the Outback Restaurant. It was a really bad case of mouth cancer. We sent him to an oncologist immediately. He’d either gotten used to it or thought it would just go away. He’d tolerated it for months.”

An oral cancer screening is something Dr. Scott Finlay, who has a practice in Arnold Station, does as a matter of routine.

“About one in 500 patients have lesions that need to be evaluated in a 10-day follow-up appointment or a biopsy,” he says. “Other medical conditions can also be apparent in the mouth.”

He ticked off a couple:

A patient’s diabetes might be out of control if the mouth shows excessive periodontal plaque, indicating an inability to ward off infection.

The medications some people take for high blood pressure may reduce their saliva flow, and adversely affect the way their mouth fights disease. Some might experience Xerotomia, a dry mouth condition that causes plaque to stick to teeth, causing rapid decay, periodontal or gum problems.

Dr. Sheen notes gum tissues swell in patients who take Dilantin to reduce seizures.

“It is difficult to reduce the swelling,” he says. “The teeth begin to shift. Everything goes back to normal when the medication is stopped. But, we teach people who take Dilantin to keep their teeth very clean and better maintain their mouths.”

“We have medical insurance and dental insurance, “Dr. Finlay says. “As if our mouths are not a part of our body.”

Signs of stress:

Shirley Siegert of Davidsonville has been one of Dr. Sheen’s patients for eight years. She met him when he was in a group practice and kept going to him after he set up his own office at 888 Bestgate four years ago.

During an exam, Mr. Petrinko noticed indentations and sores on Mrs. Siegert’s tongue. Although outwardly she is the poster child for grace under pressure, there were heavy stresses at home, at her job at Northrup Grumman and in dealing with ailing parents.

“I was pushing my tongue against the front teeth,” Mrs. Siegert says. “Doing that caused sores and my tongue constantly feels like it is burning.”

Dr. Sheen and his hygienist double-teamed to encourage her to reduce her stress load.

“I’ll will try,” she says with a deep sigh.

Jimmy Greenwell, 22, a recent graduate of Towson University, only wanted the gap between his front teeth fixed before beginning his first post-college job.

He was surprised at all the attention he got and the number of questions he had to answer at Dr. Finlay’s office. The close examination of his mouth also puzzled him.

“The dentist didn’t have to do that, all he had to do was fix my teeth,” says Mr. Greenwell, mildly protesting. “I got an exam like I’d never had before. Even my regular doctors never asked that many questions. The dentist and his staff were very professional.”

An appointment with the dentist almost feels like a physical these days.

The questionnaire:

Before you even ease into the reclining chair, an office assistant is likely to hand you a clipboard with a questionnaire attached. Expect to answer a minimum of 75 questions fully detailing your medical history.

It wants to know if your health has changed in any way, if you’ve ever had cancer and where, if you have any illnesses and if you’ve ever spent any time in a hospital. The questionnaire inquires what kinds of drugs, vitamins and natural supplements you are taking. It wants to know, in detail, about your smoking and drinking habits. It will ask if you are pregnant or planning a family, and what, if anything, you are allergic to.

Then, you’re likely to have your blood pressure and pulse checked and your temperature double-checked.

In the chair, before the cleaning starts, every tooth is scored in three separate locations. Consider it a report card for your choppers. Gums are probed. The tongue is lifted and looked at carefully, lights are shone inside the mouth – it feels like a mining expedition.

“Sometimes we’re the only medical professionals a patient might ever see,” says Dr. John Cutting of Dental Arts in Edgewater.

“Patients tend to see their dentist on a more regular basis than a physician,” agrees Dr. Finlay. “We take their medical history and cuff them to check for high blood pressure. A visual image of health might mask underlying problems. For example, a lot of elderly people are on medications. If you don’t understand their medical history or the medications they are taking, it could have an impact on how you are treating them. It’s important to have a completed updated medical history and list of medicines every time a patient comes in.”

Mouth-body connection:

All three dentists noted a connection between oral health and the body.

“People forget the mouth is part of the body,” says Dr. Sheen. “The mouth impacts the health of the rest of the body just as the body impacts the health of the mouth. What we see in a person’s mouth is a reflection of the rest of the body.”

For instance, lacking detailed knowledge of a patient’s medical history, a dentist probing inside the mouth of a person with a heart condition or a prosthetic joint could accidentally introduce bacteria into a patient’s system unless the patient has been pre-medicated with antibiotics.

“During treatment you can disrupt the barrier or seal that keeps germs out of the body, especially the bacteria under the gum line when gum tissues aren’t healthy,” says Dr. Sheen. “The barrier is re-established when tissue is healthy again.”

Look, smell, touch

Looking inside a patient’s mouth isn’t the only way dentists can detect problems.

“We take note of the smell of a patient’s breath,” says Dr. Cutting. “If there’s an unusually foul odor that smells like ammonia, if could be a sign of kidney failure or alcoholism. White, red or purple lesions could be one of several things from cancer to congestive heart failure. Spontaneous bleeding during an exam may signal liver malfunctions or cancer. Teeth that have been worn down by grinding, or signs of chewing on inner cheeks could be attributed to stress or a psychological disorder or tendency.”

Pierced tongues and lips also may lead to problems.

“The piercings can lead to infections and chipped teeth,” says Dr. Cutting. “They’re always playing with it and the metal rings and studs wear away the gum tissues, which leads to bone loss. Teeth can also become lose and fall out.”

All this attention is important considering in this day and age you’re likely to keep your teeth your whole life.

“People nowadays expect to keep their teeth throughout their life,” says Dr. Finlay. “In the past, they had their teeth pulled when there was a problem and their first set of dentures in their 30s.”

Floss, floss, floss

And while it’s nearly impossible to turn on a TV or open a magazine without seeing an ad for some teeth-whitening product, or a reality TV show touting a quick fix to an oral problem, not all dentists are converts in this recent trend.

“In recent years, the focus of dentistry has been on cosmetics and quick fixes – like the kind you see on those reality makeover shows,” Dr. Sheen says, shaking his head in disapproval. “Those radical transformations. The focus, instead, should be on the health of the mouth and the overall health of the body.”

For good oral hygiene and overall health, dentists recommend you get in the practice of regular visits.

“The most important thing is to get on a regular dental routine,” says Dr. Cutting. “Instead of coming in during an emergency, visit your dentist twice a year so the health of your mouth can be evaluated.”

“People also need to floss,” he adds. “Everyday.”