The Importance of Teeth in Routine Gastro-intestinal Examinations

Abstract

IN the last few years it has been my practice to inspect the mouth of patients referred for gastro-intestinal examination. Having seen the large fillings, and finding many crowns that have been placed for a number of years, I have suggested the raying of the teeth. In the cases of approximately 85 per cent of those patients, who, following the suggestion, have had dental films made, there have been found alveolar infections. Now it is recognized by the medical profession at large that infections of the teeth or tonsils may be the cause of arthritis, and many do not think of a focal infection unless they are confronted with this same arthritic condition. Others believe that focal infections are the cause of much of the muscular rheumatism, and many of the neuralgias and cardiac conditions. Granting that these conditions may be secondary to the alveolar infections, why may not gastric and intestinal conditions also be secondary to the same condition? In the case of a patient having pyorrhea, every time food is masticated some of the pus is squeezed out of the gums into the food and passes directly into the intestinal tract. This, then, is a chronic source of infection and it is possible that the stomach may not be able always to care for it, especially if there is an intercurrent condition that lowers the normal resistance of the patient. In the case of the apical abscess the toxins or the bacteria may be transferred through the blood stream to an area of lowered resistance in the intestinal tract. Here, again, the normal condition of the body may take care of the condition till such time as there is a general lowered resistance and then the gastric symptoms begin to appear. Ofttimes when the attention of the referring physician has been called to possible sequelæ arising from the condition of the teeth, he has referred the patient to a dentist, who, by inspection of the proximal surfaces, has pronounced the teeth to be in good condition. This cannot mean that there is no alveolar infection, for it is impossible for the dentist or physician to tell what is below the gumline without X-ray films. Many times when one is inspecting the mouth the patient will volunteer the information that he has recently visited the dentist and the teeth have been pronounced to be in perfect condition. (Questioned as to whether or not the dentist used the X-ray in the examination, the patient will reply, “No.”) In my experience some of these patients have been found to be carrying around a half-dozen or more abscesses, and some have been seen with one root completely detached by caries. Many patients coming for examination report indefinite symptoms of trouble in the abdomen, and others with definite ulcer symptoms are found on examination to be negative for gastro-intestinal pathology as far as can be demonstrated with the X-ray. Most of these patients will be found to have foci of infection in the alveolus.