«Tell me who you walk with, and I will tell you who you are.» In dentistry, this old saying takes on a new meaning: «Tell me what oral manifestation you have, and I will tell you what disease you may suffer from.» While many people are unaware of this fact, it is scientifically accurate. If the eyes are the window to the soul, the mouth is the mirror of the body. The vast majority of systemic diseases leave some trace in the oral cavity. For this reason, accurate diagnosis in oral medicine becomes essential. Dentists are often among the first healthcare professionals to have close contact with patients, and their thorough evaluations can make a significant difference.
Below are some examples of systemic diseases that manifest in the oral cavity:
Leukemia
Oral manifestations in leukemia result from the direct action of immature leukocytes, local inflammatory responses, and the effects of treatments on oral tissues. The most common findings include mucosal bleeding, ulcerations, petechiae, infections, and gingival hyperplasia. Early dental intervention can significantly improve the oral health prognosis in these patients.
Herpes Simplex Virus Type 1 (HSV-1)
HSV-1 is highly contagious, widespread, and usually acquired during childhood. The infection persists for life. Most HSV-1 infections manifest as oral herpes (cold sores), although genital infections are also possible. Oral herpes is often asymptomatic, and many individuals are unaware they carry the virus. When symptomatic, it can cause painful blisters or ulcers around the lips and mouth. These sores are commonly known as «cold sores» or «fever blisters.» Patients often experience tingling, itching, or burning before lesions appear. Reactivations can occur periodically, with frequency varying by individual.
Oral Kaposi Sarcoma (KS)
Oral KS is the most common oral malignancy associated with HIV/AIDS. Although its presentation is uncommon, it is strongly linked to sexual transmission in sexually active individuals. Patients with oral KS tend to have a higher mortality rate than those with cutaneous lesions alone. Any KS variant may affect the oral cavity, but oral KS is notably more prevalent in HIV-positive individuals. According to Feller (2007), about 20% of HIV patients develop KS, with the mouth as the initial site in many cases, and approximately 70% of patients with AIDS-related KS present with oral lesions. Moreover, the worsening of oral KS can signal immune reconstitution inflammatory syndrome (IRIS), a potential complication caused by antiretroviral therapy and associated facial lymphedema.
Diabetes Mellitus
Diabetes Mellitus is a systemic condition affecting the entire body, including the oral cavity. Many type II diabetics are asymptomatic and unaware of their condition. Dentists play a crucial role in identifying early signs and may suggest a simple capillary glucose test. Healthcare professionals, including dentists and nurses, share this responsibility. Common oral manifestations in diabetic patients include:
- Aggressive periodontitis
- Coated tongue (saburral tongue)
- Xerostomia and sialosis
- Candidiasis
- Dental caries
- Oral lichen planus
- Dysgeusia
- Halitosis
- Burning mouth syndrome
- Geographic tongue
Addison’s Disease
Also known as adrenal insufficiency, Addison’s disease is a rare disorder caused by inadequate production of adrenal hormones. In Addison’s disease, the adrenal glands produce insufficient cortisol and often aldosterone.
Oral manifestations include:
- Hyperpigmented areas in the oral mucosa, lips, gingiva, palate, and tongue
- Delayed tooth eruption in children
- Candidiasis or other complications in patients treated with corticosteroids
These are just a few examples of how systemic illnesses can manifest in the oral cavity. Regular dental checkups play a vital role in early detection, prevention, and timely treatment of potentially serious conditions. Your mouth could be telling a story about your overall health—make sure you’re listening.
Alfredo Carrión - Dito 