Home Issues2023 OSH Issue What do Sherlock Holmes and Dentists Have in Common? 

What do Sherlock Holmes and Dentists Have in Common? 

by DeWitt Wilkerson

Holmes' job description is similar to the modern-day dentist!

Sherlock Holmes is a fictional private detective created by British author Sir Arthur Conan Doyle. Referring to himself as a consulting detective” in the stories, Holmes is known for his proficiency with observation, forensic science and logical reasoning that borders on the fantastic, which he employs when investigating cases.  

Sherlock’s job description sounds very much like that of an astute, modern-day dentist. A consulting detective, who uses keen observation, forensics, and logic to investigate cases that involve problems of pain, inflammation, swelling, structural defects, smile concerns, medicine, engineering, art and whole-body health. Knowing all that borders on the fantastic — and there is even more being understood every day!  

It has been said that the mouth is the window to the whole body.” The mouth reveals many clues to our overall health. Let’s discuss some of the things dentists can determine regarding whole-body health concerns during routine dental visits.  

Gum Inflammation Can Negatively Affect Whole Body Health

As a dentist, you are already familiar with inflammation in the mouth. It produces red, swollen gums, which may bleed easily due to chronic irritation and a weakened immune system. The growth of certain key bacteria in the mouth produces irritating acids, which can cause gum disease and bone loss around teeth. Bleeding gums and infected teeth can move bacteria from the mouth into the bloodstream, causing body-wide inflammation and infection.  

For example, oral bacteria have been found in the lining of blood vessels, in the plaque buildup that narrows the arteries. One oral bacterium, Fusobacterium nucleatum(Fn), has been associated with pregnancy complications, because it may be passed from the mother’s bloodstream to the unborn child.  

We now understand that inflammation is the greatest risk for the development of many chronic ailments. Maintaining a healthy bacterial balance and reducing mouth acidity is a top priority, and an important point of discussion regular dental and hygienist visits. Professional dental care has been demonstrated to help protect the heart and other organs, as well as teeth!  

Diet and Diabetes Can Affect Gum Inflammation

When the body is imbalanced because of inflammation, such as through a poor diet or diabetes, the gums often will swell and may bleed easily. A fascinating research project was conducted at the University of Manitoba Dental School. Dental students who had healthy gums with no signs of gum swelling or bleeding were identified. They agreed to eat one gallon of Ben and Jerry’s ice cream every day for a week! At the end of the week, filled with a diet rich in calories, sugars and fats, every student had swollen gums that bled easily.  

Again, unresolved gum swelling and bleeding provides a point of discussion for the dentist or hygienist regarding suspicion of high sugar levels in the diet, as well as the potential of chronic high blood sugar levels seen in pre-diabetic and diabetic conditions.  

Today, more of the older generation are keeping their teeth for a lifetime. When an 80-year-old has healthy gums and teeth, we know for certain that they have excellent home dental care and eat a diet low in sugar and refined carbohydrates, like candy and most snack foods.  

Breathing Problems and Stomach Acid Can Cause Significant Wear on Teeth

As dentists, we generally observe two different kinds of wear on teeth 

1.) Wear on the edges of teeth (abrasion) — from rubbing, grinding or clenching. This type of wear will cause anterior teeth to become rough on the edges and shorter over time. This type of wear is often a sign of a breathing and airway problem. When breathing is compromised through chronic allergies, nasal obstruction, swollen tonsils and adenoids, the body will compensate to assure adequate airflow into the lungs.  

Both during the day and when sleeping, stress hormones may be released in the bloodstream to increase the heart rate and increase oxygen delivery to every cell in the body. There also may be an increased stress in the jaw muscles. Clenching and grinding back and forth (bruxism) may help open the airway in the back of the throat. If the teeth are in the way, they will be damaged. This is common in people suffering from obstructive sleep apnea. Other causes of clenching and grinding teeth include:  * poor bite, which can stimulate abnormal muscle activity * neurologic problems, like Parkinson’s Bruxism, * medications, such as certain antipsychotics, antidepressants, and amphetamines.        

2.) Smooth wear on the top and sides of teeth (biocorrosion, erosion) — from acidity due to stomach acids. When acids come up into the mouth from the stomach, they can dissolve both the top and side surfaces of the tooth structure. These stomach acids also can cause postnasal drip, chronic sore throat, chronic coughing, heartburn, asthma like symptoms, indigestion, Barrett’s Esophagus, and possibly esophageal cancer.  

There are several medical reasons for this to occur, including:  

*hiatal hernia — causes a poor seal at the top of the stomach   

*obstructive sleep apnea — causes a negative pressure due to frequent breathing efforts  without success, producing a negative pressure in the abdomen, in which stomach acids are pulled up, like through a straw   

*acidic western diet — low pH colas, carbonated drinks, sports drinks, canned foods and processed foods all stimulate the activity of a stomach digestive enzyme, pepsin, to irritate the walls of the esophagus, airway, nasal sinuses and mouth.   

The Answer: Both are brilliant diagnostic superstars!

In this article, I have described just a few of the clues revealed in the mouth for the investigative dentist doing his/her consulting detective work during every routine dental visit.

By understanding the importance of the mouth as the window into whole-body health and wellness, dentists are poised to be an invaluable, integral player in their patient’s complete healthcare. 

So, you see, Sherlock Holmes and dentists increasingly do have a lot in common — they are both brilliant diagnostic superstars!   

DeWitt Wilkerson

Dr. DeWitt “Witt” Wilkerson joined Dr. Peter Dawson’s private practice in 1982 where he is a partner. This has provided invaluable clinical experience in a renowned clinical culture. Dr. Wilkerson lectures on the subjects of restorative dentistry, dental occlusion, temporomandibular disorders, airway/dental sleep medicine, and integrative dental medicine. He serves as a Senior Faculty/Lecturer and Director of Dental Medicine with the Dawson Academy. Dr. Wilkerson is a Past-President of the American Academy of Oral Systemic Health (AAOSH), Past-President of the American Equilibration Society (AES), Director of Dental Medicine at the Dawson Academy, Adjunct Professor of Graduate Studies, the University of Florida College of Dentistry, and former Associate Faculty and Special Lecturer, the L.D. Pankey Institute. He also authored the book, “The Shift, The Dramatic Movement Toward Health Centered Dentistry”

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