What Your Mouth Says About Your Health
November 11, 2021

What Your Mouth Says About Your Health

Show Notes

On this episode, Chuck Gaidica is joined by Dr. Lisa Knowles, Associate Dental Consultant and Dental Director at Blue Cross Blue Shield of Michigan. Together, they discuss what routine dental checkups can uncover about our overall health.

In this episode of A Healthier Michigan Podcast, we explore:

  • The link between dental hygiene and overall health.
  • What can be found during a dental exam.
  • Advancements in dentistry that’s improving how exams are performed.
  • What we can do to maintain optimal oral and general health.

Transcript

Chuck Gaidica:
This is A Healthier Michigan Podcast, episode 93. Coming up, we discuss what your mouth says about your overall health.

Chuck Gaidica:
Welcome to A Healthier Michigan Podcast, the podcast dedicated to navigating how we can all improve our health and wellbeing through small, healthy habits. We can start right now. I’m your host, Chuck Gaidica, and every other week we’ll sit down with a certified expert and discuss topics that cover nutrition, fitness, and like today a whole lot more.

Chuck Gaidica:
On this episode, we’re diving deeper into oral health and exploring what it can uncover about our overall health. With us today is the associate dental consultant and dental director for Blue Cross Blue Shield of Michigan, Dr. Lisa Knowles. How are you today?

Dr. Lisa Knowles:
I am great Chuck. Thanks for having me.

Chuck Gaidica:
We’re glad you’re here. You’ve got a rich background going back to graduating from Alma College, and then what was it? U of M?

Dr. Lisa Knowles:
Yes. Then I headed to Ann Arbor to the University of Michigan school of Dentistry. Yes.

Chuck Gaidica:
All right. You joined Blue Cross Blue Shield of Michigan as a director back in 2019. So this is really great because my family, we’re all big dental health advocates. I think sometimes we forget that our mouths play such an important role when it comes to how our bodies function. We read these articles from time to time, but everything from what you eat, to how you feel your body, now there seems to be a gut link. I mean, then there’s a brain link. It’s astounding, really when you think about all the connections to dental health, right?

Dr. Lisa Knowles:
Absolutely. We did a pretty good job of separating things out and figuring out all our body parts and specializing in things. But I think we’re at a really great moment to be able to just bring it all back together, and the research is showing that. So I am excited to talk to you about it today.

Chuck Gaidica:
Yeah. Well, we talk about hydrating and all kinds of things that holistically seem to affect other parts of our body. But talk about, I guess if I walk into the dentist for a general checkup and cleaning, what is going to be the link that hygienists and dentists are looking for in our overall health to begin with?

Dr. Lisa Knowles:
Well, there’s definitely that link between how we take care of our mouths and our overall health. So maybe I’ll start there a little bit. One example we can discuss is actually periodontal disease, and that’s getting so much attention in a lot of the research. Periodontal disease just to recap is that, when the bacteria in your mouth is so great it causes inflammation and bone loss around the teeth, we do a lot of measuring to figure out if there’s any bone loss around the teeth. So that is what’s getting linked with a lot of the other systemic diseases like heart disease, or specifically atherosclerosis cardiovascular disease, which is an inflammatory disease of the arteries in your heart that’s associated with the atheroma, that fatty material that can form in our arteries and cause things to close off and have the bad events of heart attacks or strokes.

Dr. Lisa Knowles:
So it’s really important when you’re going to the dentist and getting your teeth clean to think, “Oh, it’s so routine.” But truly you are preventing periodontal disease from forming in there and that whole inflammatory response. So lots of research going on right now to find out exactly how those two things are linked between periodontal disease and heart disease. So not only taking care of your own teeth, but then checking in. It’s hard for you to measure the bone levels around your teeth. That’s what we do with those little measuring sticks. Not everybody loves it, but helps see what’s going on and measuring. If there’s any bleeding in there too, which is also an indication that things aren’t healthy.

Dr. Lisa Knowles:
So that’s one thing that you’re definitely doing when you’re going into the dental office.

Chuck Gaidica:
But when you’re measuring and it is uncomfortable at times, right? And slight bleeding, it’s like you’re flossing, maybe something like that. But here’s what I’ve always thought, that is a great idea when I visit the dentist. Unlike many other kinds of doctors, you are establishing a baseline with every six month or yearly visit, right? So if I come in and all of a sudden you see something that’s out of whack, you could say, “Well, just six months ago, or over the course of time, this has been progressing in the wrong direction.” Am I right? You’re seeing things that can set at a baseline and then can show good health or worse health.

Dr. Lisa Knowles:
Right. We’re so fortunate in dentistry and the statistics actually show it that a lot more people will come to us regularly than a physician or a primary care physician. So we do have that advantage of having the baseline measurements. We get to see everybody’s medical history and inquired about their new medications or less medications, or what’s happening from that side. Then we get to of course, look into the mouth and see indicators there to things that might be going on or things that are different.

Dr. Lisa Knowles:
So we’re very fortunate to be able to establish a baseline and then track for years and years. That’s why it is so important to see your dentist every year.

Chuck Gaidica:
I’m sure you’re not a big fan of the rest of us kicking the can down the road when it comes to visiting the dentist, because I’ve seen in my own family’s life, the idea that even an infection, something that was part of a root canal, it all sounds like, “Oh my gosh, here comes a problem.” The can gets kicked down the road. That infection actually led to somebody I know and love having a bone loss. It actually created another issue. Right?

Dr. Lisa Knowles:
Absolutely. I mean, it’s like the body too. We can only kick the can, like you said, down the road, so long it’s just going to come back and get us in a worse way, usually in more expensive way in dentistry. So a small little issue can be a lot of times corrected or fixed pretty easily and pretty inexpensively. But if just left, you either potentially could lose a whole tooth or you lead to infection. You start losing bone, infection can go to the brain, the heart, all that. So it’s dangerous to just leave it be. I mean, sometimes you just want to ignore it and you hope that you ignore it, ignore it. It’s going to go away. It’s going to get better. But teeth usually just don’t get better after a day or two of something or swelling. It’s an immediate issue, and you don’t want to neglect that or ignore that because that can lead to some pretty significant health problems.

Chuck Gaidica:
Yeah. That’s great advice that I’ve never thought of it that way, that teeth don’t usually get better. It’s not like the sliver that you pride out and you just use peroxide for a couple days and it’s gone, right? That could be a whole different thing for teeth. What else are you looking for when I come in for my exam? What other things are you keeping an eye out for inside the mouth around the tongue, throat, whatever?

Dr. Lisa Knowles:
Gosh. I can kind of walk you through the whole thing if that’s alright.

Dr. Lisa Knowles:
So part of it starts kind of when you walk in the door anymore and probably a dental assistant might be the one seating you and taking your blood pressure. Not everybody still does that, but it’s highly recommended, because we are screening for hypertension. Truly one of the reasons we do is because a lot of times we are using anesthetic, which has epinephrine in it and increase the heart rate and blood pressure and all that. So there’s the medical side of why we want to do that front in the dental office.

Dr. Lisa Knowles:
But a lot of times, again, it’s catching that baseline and knowing what normal is for a patient. So if we do end up doing oral surgery extraction using anesthetic and we need to monitor and keep track of that blood pressure, we want to know what normal is. So we’re taking that. But in the meantime, we’re also catching a lot of hypertension, high blood pressure. That gives us the chance to refer to a physician and work collaboratively with our physician colleagues and make sure that our patients do have a primary care physician. I can tell you so many times my patients say, “Well, I haven’t seen my doctor in five years, 10 years. I haven’t had any problems.” Because they don’t know they they don’t have any problems, but just like periodontal disease and heart disease are similar in that you don’t know you have it, until you probably get it diagnosed and get things checked.

Chuck Gaidica:
Yeah. Yeah. We heard so much about under lying conditions, coming through the pandemic. How do you know if you don’t know? I mean seriously, right? You’re saying that. Yeah.

Dr. Lisa Knowles:
Truly.

Chuck Gaidica:
Oh man.

Dr. Lisa Knowles:
Yep. It’s too late when you have a heart attack or a stroke, that’s not the indicator you want. You want to catch it earlier. Same with periodontal disease when we’re in there, so when we’re doing an exam, we’re also doing an oral cancer screening at first. Checking just to again, screening for that. The tongue is a great spot for squamous cell carcinoma to begin. So we’re checking that and just we’re not diagnosing it, but we’re certainly screening for those things and we can refer out and get biopsies or whatever it might be needed.

Dr. Lisa Knowles:
So another thing obviously we’re looking at bone levels around the teeth like I mentioned, looking at those gum tissues, looking for the bleeding. Certainly we’re looking at the teeth and all angles in every way and checking for anything cracked, broken, decayed. Those are the easy ones.

Dr. Lisa Knowles:
And then I just want to make you aware of something else that dentists are taking a peek at more, and that is sleep apnea. Dentists, again, we’re not diagnosing sleep apnea, but we are screening more because we realize, gosh, these patients are right here in front of us. We can check out those big tonsils in kids. Parents tell us their kids snore. They’re maybe struggling in school. They’re sleepy, they’re falling asleep or they are as the parents can hardly stay awake when they’re driving. So we initiate a screening tool, you might be familiar with or heard it before, something like called STOP-Bang. So we’re looking for, if someone reports something like that, we’re checking out their snoring history to see if they’re tired during the day. The O stands for observed stop breathing at night. The P in the stop bang is the pressure, as in blood pressure. If it’s elevated, elevated blood pressure could be an indication of some type of sleep apnea. Then we’re looking at BMI as far as their mass ratio there.

Dr. Lisa Knowles:
Again, sometimes we’re not exactly doing this. We’re just eyeballing it or we’re wanting a physician to be calculating these things or getting them out there. Age is a factor in sleep apnea. Neck size, we’re right there palpating people’s necks and looking at their head and neck area. Then gender, men have more prevalence, but women do get diagnosed with sleep apnea. So that’s something that kind of just an additionally has come on in the last several years stronger. It’s been there by some, but even more so.

Dr. Lisa Knowles:
So that’s something from a systemic thing that we look at and we’re doing an exam and when someone walks in the door and just … Most people just think they’re getting their teeth cleaned. I just want my teeth cleaned. I want my teeth checked. But it’s truly so much more. We’re talking about the mouth is such an indicator or can be of overall health too.

Chuck Gaidica:
But we hear these words these days more than ever holistic, we’re hearing integrative health and you are doing that. You’re suggesting of what most data should be doing, right? You’re really integrating various kinds of health and wellness for us, which I think is fantastic.

Dr. Lisa Knowles:
Right. We have the opportunity. We’re there. We have the knowledge. We have the background, we have the training. I mean obviously sometimes you need some continued education training from the dentist. We’re not going to learn everything in dental school, but these are pretty easy things to screen for and can be very life saving. So you do it once as a dentist, you find oral cancer once or you find sleep apnea once and you’re hooked, it’s just like, “Wow, I helped save that person’s life.” I hope that our whole profession sees that advantage. We have an opportunity again, because patients want to see us and not necessarily always think about going to their physicians.

Chuck Gaidica:
So when you’re discussing these best of practices, I can tell you, I love my dentist and I don’t really have as many of these check marks that you’re suggesting, is this a growing trend within dentistry? Is it suggestions that you are putting forth from Blue Cross? Tell me how you see that weaving itself through the world, because I’m trying to think, I don’t know that I’ve ever had my blood pressure checked for instance, at my dentist office. Should I ask for it?

Dr. Lisa Knowles:
Certainly. I think you can. I think it’s definitely trending that way.

Chuck Gaidica:
Okay.

Dr. Lisa Knowles:
As dentists, we’re always trying to be valuable to our patients and serve them as in many ways as we possibly can. These are some things that are put out there in all sorts of continuing education courses through the American Dental Association, through the Michigan Dental Association.

Dr. Lisa Knowles:
Again, we’re not diagnosing some of these things, but we are just taking advantage of our opportunity to help patients even more holistically as you say, or systemically. So it is up to each dentist to decide how they want to practice. So if your dentist isn’t doing it, that doesn’t mean that they shouldn’t be a licensed dentist by any means.

Chuck Gaidica:
Yeah. Right, right.

Dr. Lisa Knowles:
They just might have a different pathway to how they practice.

Chuck Gaidica:
Yeah. I’m trying to think of other questions. I get a complete, I know they’re looking at of oral cancer and around the tongue and they massage around the neck and the lymph nodes. I’m used to that level of care, which I’ve always thought to be fantastic because I don’t really think to look or to touch my neck, unless there were a problem that arises. So much good can come out of that from the mouth down and up. Right? I mean, you’re talking about brain health, heart health. These are really big deals.

Dr. Lisa Knowles:
Yeah. You mentioned the gut. That starts in the mouth, right? Everything we put in, goes in the mouth, goes on the gut, the whole digestive track. One thing that we can see too systemically is erosion on the teeth. So if someone does have digestive issues, they have acid reflux. Sometimes they will show a pitting on their back teeth, in the molars and they’ll have some wear, flattening, especially if they grind and have something like that, and that’s even exacerbated even more and faster, more rapid wear of their teeth. So you can always protect it with a mouth guard or a night guard or some type of a occlusal guard in there. But if that’s persisting and it’s very aggressive, then we start thinking systemically, “Well, this person isn’t just grinding their teeth. They’re just flattening their teeth right away.” Could be some system issue going on. We might again, refer to a physician to check out some digestive issues going on. Of course, quiz our patients more about their diets and any acid reflux and that type of thing.

Chuck Gaidica:
Well, I don’t have acid reflux, but I do have sleep apnea or at least my wife told me I should go get check for it. Right? So I did and I’ve got it. But I can understand how, I know that those are even connected. So here you are with all these points of light, if you will, of things that you can see through experience, through asking the right questions that, oh my gosh, you could find an issue for somebody I would think, and they’d have to love you because you would come across something that could help them sleep better, which leads to better health overall. Right?

Dr. Lisa Knowles:
Absolutely. Truly, I feel like an investigative person, a lot of times asking lots of questions, putting all the puzzles together. It’s like we’re solving a mystery in the mouth. Fortunately, we get a lot of hints in the mouth. But you got to think like that. You got to think broadly. I guess that’s what as the dental director from Blue Cross Blue Shield of Michigan, that’s what I’m encouraging in my profession and dentist to do is think broadly, and really think about connecting all the information we have at our fingertips, from the medical histories, to what we see in the mouse, to what we’ve learned to what we’re growing and learning continue education-wise.

Dr. Lisa Knowles:
So we have a lot to work with and just incorporating that philosophy into the way we practice. I think dentistry’s already going that way anyways, we’re taking it that way and encouraging that at Blue Cross Blue Shield of Michigan too.

Chuck Gaidica:
So when you hear things like the word metaverse and ocular, whatever, people putting on headsets, what high tech stuff are you seeing advance within dentistry that either will help you from a diagnostic standpoint or could even help me while I’m in the chair as a patient or someday, could I just be watching TV on a pair of glasses while you’re treating whatever it is I came in to see you for? What do you see is actually happening that you think could be real in the next five years or it’s here already?

Dr. Lisa Knowles:
As far as technology that I’m seeing, a lot more or advancement in radiology, be able to see the tooth in three dimensions, which is super important when you’re placing implants or doing root canal therapy. So we used to only have two dimensions, which was pretty good better than before. But now we have three dimensional radiology to help us in certain situations. So we can look truly how thick the jaw bone is to be able to place a certain implant and avoid a nerve and all that type of this. So I think that’s really helping to take us to the next level of replacement of teeth with implants and things like that. It’s going to be so much more mainstream. At some point you’re not going to see a lot of edentulous people anymore because people are just going to get implants placed in there, or implant retained dentures where maybe there’s two or four implants holding those dentures in place, and that’s occurring more and more and more.

Dr. Lisa Knowles:
So there’s definitely that type of technology. Also scanning of the teeth is pretty newer or becoming more mainstream versus taking impressions. Again, preference to dentists, the impressions still work. The scanners are nice that you don’t have to put impression material in patient’s mouth, but then you do have to pay for those costs and the scans and all that. And you’re limited in that aspect if need be and of course costs. So we’re all paying for this technology, which is awesome, but these advancements are making it better for patients to tolerate treatment and have more accuracy. So of course, as dentists, we love that too and patients benefit.

Chuck Gaidica:
But just thinking in my lifetime, we’ve gone from, I’m waiting for my film to come in from the x-ray. Right? It’s got to come in from down the hall. So the dentist can look at it, to the 2D and now to the 3D where somebody can rotate my teeth and my entire mouth of teeth in three dimensions. That’s pretty wild. And the speed at which this occurs in real time is astounding sometimes, when see this thing just kind of fill in and a screen right in front of you. The dentist goes to work right away saying, “Well, see this, this is what I’m talking about.”

Dr. Lisa Knowles:
It is such a time saving too. Yeah. I did the developer stages of radiology as well and the wait times and all that. So instantaneous, digital x-rays are great and less radiation to patients too. So there’s different fears of the dentist and why that, well, I don’t want radiation or I don’t want, it to hurt, or I just don’t want somebody touching me. I want someone that’s close to me and there’s lots of concerns there. I think we just keep getting better and better in dentistry. Those fears become less and less. The patients have just good experiences. I hope we continue to decrease that overall fear, but we’re right in people’s faces and that’s something I think we’ll always be dealing with to some extent and learning.

Dr. Lisa Knowles:
I think that’s something that advancing in dentistry too, is learning the psychology behind that and just behavior management and being truly better practitioners. Again, something we emphasize at Blue Cross Blue Shield of Michigan as well, it’s a joint effort. We want the providers and dentists to be at their best and knowledgeable and members and patients are in there taking advantage of being able to know more about their overall health from their dental appointments.

Chuck Gaidica:
Well, as we start to wrap things up here, we’ve covered a ton of territory, which I find so interesting because I have to admit to you, I’m way different than my wife here. I have no trepidation about a dental visit, even though I’ve gone through the whole thing of, I cracked a tooth with a chicken bone and went and got an implant, went through the whole thing, tooth extraction. I just don’t have trouble. I don’t have trouble going to the dentist. But for a lot of us, that’s not the case. You’ve talked about that and how to address it and how your profession is getting better doing that.

Chuck Gaidica:
But give us some takeaways here. What should we be thinking about as we walk in the dental office again so that we can really have a good health and wellness approach to our entire bodies?

Dr. Lisa Knowles:
Yeah. I would say that you are worth it, and this is an investment in your health. I know people think, “Oh, well, I don’t know if I can afford cleaning an exam twice a year and those x-ray.” Which year around 150 to $200 ish for a cleaning an exam and x-rays it’s going to be more. But I challenge people to think about what they’re already spending on too sometimes of gosh, all sorts of things-

Chuck Gaidica:
Well sure.

Dr. Lisa Knowles:
… highlights and shoes and nails and phones. How much we’re all spending in that aspect. Truly if budget is tight, one of the best ways to save on your budget is to prevent bigger, more costlier trips. So I say, invest in your health. See a dentist at least once a year. If the budget’s tight and you can’t do twice a year, depending on your situation, at least you’re going to catch some of the big things.

Dr. Lisa Knowles:
I would pretty much recommend twice a year for most people. But again, that’s something that if you had to make a budget decision on that’s something you could do. But it just lets you know what you don’t know. In dentistry, like heart disease you may not know there is a problem until it hurts, until something is not working correctly. So by that time, it’s not too late, but it’s going to probably cost more. You’ve already been in pain and suffering, which could have been prevented.

Dr. Lisa Knowles:
So just know that your body needs routine maintenance. If you cannot afford to have that routine maintenance, there are federally funded programs to help you get that treatment. The healthy kids dental program in Michigan is covered in all counties in the state. So all kids should be able to have care. Just know that by doing this, you’re teaching your kids and you’re taking that time for yourself to not only get your teeth cleaned and checked, but you’re also preventing bigger problems like periodontal disease that could lead to heart disease, potential Alzheimer’s and all these things that could just … We’re just finding out more and more systemic relationships too.

Dr. Lisa Knowles:
So don’t delay, I guess that’s my last message. Don’t delay. Don’t put it off, invest in yourself and in your kids and teach. For parents, be that role model, teaching them that they need to have their teeth checked and it’s important. Truly your mouth is pretty important for everything we do, speaking, eating, socializing. So I can’t understand sometimes why it’s lower on the priority list, but obviously everybody has different priority lists, but I’m the bias dentist that says super important for your mouth.

Chuck Gaidica:
No, that’s great stuff. I appreciate you wrapping it up in a bow for us because you know this and I know it from personal experience, any one of those, even small problems that we’ve discussed today, if you wait too long, that’s giving you a bad day overall. I mean, to think that you let by procrastinating to let go, that can turn into all kinds of bad stress at work at home and it’s just not worth it. So you deserve it.

Dr. Lisa Knowles:
Yes.

Chuck Gaidica:
That’s great. Well, Dr. Knowles, it’s so good to have you on today and so much good stuff. I appreciate it.

Dr. Lisa Knowles:
Well, thank you Chuck for having me. It’s been a pleasure.

Chuck Gaidica:
Take good care.

Dr. Lisa Knowles:
You too.

Chuck Gaidica:
Thanks for listening to A Healthier Michigan Podcast. It’s brought to you by Blue Cross Blue Shield of Michigan. If you like our show and you want to know more, you can check us out online at ahealthiermichigan.org/podcast, or you can leave us a reviewer rating on Apple Podcast or Stitcher. To get new episodes, old episodes on your smartphone or tablet, be sure to subscribe to us on Apple Podcast or Spotify or your favorite podcast app.

Chuck Gaidica:
I’m Chuck Gaidica. Be well.