The Mouth as Body's Mirror

by Food and Drug Administration (FDA)

The mouth: Lovers kiss with it, babies coo with it, fighters curl it in rage, winners lift it up in victory, and the doctor looks into it.

In fact, approximately 20 percent of visits to the doctor are because of mouth or throat complaints. But by peering into the mouth the doctor may discover more than a strep infection or a canker sore. It is a truism in medical circles that the mouth is the mirror of the body. "The mouth is affected by many bodily processes," says Jerome Goldstein, M.D., executive vice president of the American Academy of Otolaryngology — Head and Neck Surgery.

When the doctor asks you to stick out your tongue and say "aah," he or she may discover tell-tale clues that reflect underlying disorders elsewhere in the body. Stories are legendary of physicians who looked carefully at a patient's tongue and cleverly diagnosed disorders in other areas of the body.

Donald R. Haggerty, D.D.S., M.D., a medical officer with the Food and Drug Administration, recalls a patient who complained of a persistent bad taste in her mouth. Haggerty discovered multiple telangiectasis (little red spots formed by dilated blood vessels) in her mouth. Further evaluation revealed difficulty in swallowing and cold hands, leading to a diagnosis of a particular connective tissue disease — a serious chronic disease of the skin and internal organs.

Other disorders may also signal their presence by oral symptoms. Gums that have grown over the teeth may mean a patient has leukemia. A red or furry tongue may indicate scarlet fever; a tongue covered with brownish sores, typhoid fever; and a pale, smooth glossy tongue, pernicious anemia. A fine black line that appears on the gums is an important diagnostic sign of chronic lead poisoning, while spongy gums signal chronic mercury poisoning.

A doctor can also find diagnostic clues to Addison's disease (a disease of the adrenal glands that afflicted the late President John F. Kennedy), diabetes mellitus, vitamin B deficiency, scurvy, Sjogren's syndrome (an autoimmune disorder described in the February l989 FDA Consumer article "Eyes Too Dry to Cry: How Sjogren's Syndrome Makes the Body a 'Desert'"), inflammatory bowel disease, and multiple sclerosis by examining the oral cavity. Foul breath may indicate a lung abscess. Pain in the jaw may mean a patient is suffering from angina. And an extended tongue that bends to one side may indicate a stroke.

"The mouth is a valuable reflection of what's going on elsewhere in the body," says Goldstein.

Common Complaints

Although the condition of the mouth can provide a wealth of information about disorders elsewhere in the body, in most cases, complaints about the mouth or throat are usually more mundane. Following are some of the most common reasons people visit the doctor for mouth problems.

Fever Blisters or Cold Sores — Painful little blisters about the size of a dime that usually form on the lips, cold sores are caused by herpes simplex virus type-one or HSV-1. (Genital herpes is caused by a cousin, known as HSV-2.) Most people have been infected by the virus (40 percent of Americans acquire the virus by age 30), but it lies dormant in the body, flaring up from time to time with a cold or fever, exposure to excessive sunlight, or during periods of stress. People with cold sores should avoid kissing others and making skin contact with newborns or people with weakened immune systems — who are particularly vulnerable to infection.

There is no cure for cold sores; they must run their course. Keeping the affected area clean or using a protective cream may help relieve the pain. Over-the-counter products usually contain astringents that dry tissues, but these products do not necessarily speed healing. People who are susceptible to cold sores brought on by sun exposure should use a sunscreen on their lips. Persons experiencing recurring cold sores should consult their doctors. One drug for treating herpes, Zovirax (acyclovir), is available by prescription as either an ointment or capsule.

Canker Sores — Not to be confused with cold sores, these sores are ulcers that occur in the mucous membrane inside the mouth. They can range from the size of a pinhead to the size of a quarter and may appear alone or in clusters. Most canker sores heal within two weeks, although recurrent canker sores may afflict some people. One out of every two people will have at least one episode during their lifetimes.

The cause of canker sores remains a mystery, although stress may be a factor. For example, college students are most often afflicted before exam time. Certain foods, such as nuts, or sweet and acidic foods may cause canker sores. They may also result from deficiencies of folic acid, iron, or vitamin B12. Even genetics play a role: A predisposition to canker sores runs in families.

There is no treatment that speeds healing, but antiseptic mouthwashes may prevent their spread. "Washing the infected area with hydrogen peroxide may also relieve the symptoms," says Jean Rippere, a microbiologist with FDA.

Xerostomia (dry mouth) — There are many disorders that can cause a dry mouth, such as diabetes, anemia, Sjogren's syndrome, infection of the salivary glands, stress, even aging. Treatment falls into two categories: saliva substitutes and saliva stimulators. Demulcents such as glycerin solution soothe and coat the dry area. And a simple remedy such as sugarless lemon drops may temporarily stimulate some salivary flow. For some persons, a dry throat may simply be the result of not drinking enough water. The remedy, of course, is to drink more water.

Sore Throats — A sore throat is a common medical complaint that can be caused by allergies or irritations such as industrial pollutants, tobacco smoke, dry heat during the cold winter months, and cheering too loudly at a sports event.

Viruses and Infections

The most common causes of sore throats are viral illnesses (such as the "flu," the "common cold," or mononucleosis) or bacteria (such as Streptococcus). A viral sore throat can be a symptom of measles, chicken pox, or whooping cough. Antibiotics can be used to treat bacterial infections but have no effect against sore throats caused by viral illness. The body heals itself of a viral infection by building up antibodies that destroy the virus.

Such over-the-counter remedies as throat lozenges or anesthetic sprays may bring some relief. Increasing liquid intake (warm tea with honey is a favorite), gargling with warm salt water, and using a humidifier or mild pain relievers may also offer temporary relief.

Bacterial infections in the nose and sinuses can cause sore throats because mucus drains down into the throat, carrying the infection with it. One of the more serious kinds of bacterial infection is caused by Streptococcus bacteria. As many as 1 out of l0 Americans develops "strep throat" every year, and 40 million adults will see a doctor for it, according to the American Academy of Otolaryngology. Complications of streptococcal infections include tonsillitis, pneumonia, scarlet fever, and ear infections. A strep test approved by FDA a few years ago for use in a doctor's office detects an infection in about 15 minutes rather than the 24 hours usually required for a throat culture. Antibiotics can be administered if the test results are positive.

FDA is currently evaluating over-the-counter mouth remedies to make sure the ingredients are safe and effective. "If we discover that some ingredients do not live up to their billing or are unsafe, we will request that the manufacturer reformulate the product," said FDA's Rippere.

Role of Emotions

Not only does the mouth reflect what is happening elsewhere in the body, but changing the posture of the mouth can elicit bodily changes. Even a mere smile or frown can affect the nervous system. Researchers from the University of Michigan and the University of California Medical School at San Francisco have shown that lifting the corners of the lips in a smile or puckering the lips in a frown can affect the temperature of the blood flowing to the brain and change heart and breath rate.

In a series of experiments, participants were told to arrange their face and mouth in different poses. But the volunteers were not told what emotion they were mimicking or even that the study was testing the relationship between facial expressions and emotions. Volunteers reported feeling the emotion their expressions portrayed. For instance, when volunteers puckered their lips and mouthed the word "few" they reported feeling depressed or "down" even though they didn't know they were expressing a "down" mood. In other words, facial expressions are not only a sign of an emotion but actually contribute to the feeling itself.

Although people may pay little heed to their mouths except when something goes wrong, the importance of the mouth cannot be underestimated. Its condition provides clues to disease elsewhere in the body, and its posturings can affect a person's emotions so that just as the eyes are a window to the soul, so the mouth is a mirror of the body.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.