Clues from your mouth

I was doing my rounds one morning, on a patient being treated with a  6 weeks course of antibiotics for a bone infection.  After talking with him a bit, I then started to examine him by first asking him to open his mouth for me to inspect it. He asked “why do you always ask to look into my mouth?”

I told him I was checking to see if he was developing a yeast infection, ulcers, or any other problem that could arise from him being on a prolonged course of antibiotics.

He said, “Oh! I thought you were looking at my teeth to try to figure out my age!”

I couldn’t do anything but laugh. Then I quickly told him that was not the case.

He said he grew up around horses and was taught that you examined a horse’s teeth, to get an idea of it’s age. I found that rather interesting as I’d never heard such a thing before. But my veterinarian sister confirmed that the patient was indeed correct.

I went on to explain to the patient some of the clues I might get from looking into his mouth every day:

-Is he developing a yeast infection (also known as thrush)?
Overgrowth of yeast normally present in the mouth can happen on a prolonged course of antibiotics. The antibiotics kill not only the bad bacteria causing infection, but also a lot of the good bacteria in, and on our bodies.

The antibiotics don’t kill the yeast.  The concentration of yeast present therefore increases and a yeast infection can develop, causing soreness/pain in the mouth. Sometimes this can spread to the throat and down the feeding tube (esophagus) causing a person to stop eating altogether due to extreme pain with swallowing.

I always look in the mouth because I want to find and treat a yeast infection, before it gets too severe.

-Does he have any mouth ulcers?
Sometimes, the stress of an infection and it’s treatment course, can lead to a flare of “fever blisters” caused by the herpes virus.

However rather than a simple blister on the edge of the lips, the herpes flare can sometimes cause blisters and ulcerations inside the mouth, instead of on the lips. If this is not detected early, multiple ulcers can form all over the mouth and tongue. This is extremely painful, again causing a person to be unable to eat.

-Does his mouth appear more red/inflamed?
This can be a sign of a yeast infection. Not everyone gets the curdy white plaques in the mouth with a yeast infection.

However, some medications/antibiotics can cause a raw sensation of the mouth, from the surfaces getting inflamed. The patient would feel as if they can no longer have a hot beverage because of the soreness. But they would not necessarily see anything abnormal in the mouth.

If I am looking in the mouth every day, I can see when it is starting to look inflamed and either give something to ease the discomfort, or change a medication.

-Are his teeth in good shape?
This generally does not have much to do with side effects/complications of antibiotic treatment. However during the initial assessment of a patient, knowing what the teeth and gums are like can give a clue as to the type of infection the patient may have.

Very poor dentition can increase the chance for bacteria getting in the blood from inflamed gums. If this leakage of bacteria into the blood happens often enough, someone can eventually get bacteria sticking onto a heart valve, or onto an artificial hip or knee joint, causing serious infections.

So, the next time a doctor asks to look into your mouth, know that they are not trying to find a reason to doubt the age stated on your medical record. They simply want to pre-empt problems that can make you miserable.

There is a saying related to checking a horse’s mouth to determine it’s age: “Don’t look a gift horse in the mouth!” I never in my life heard that saying until my veterinarian sister shared it with me.  She said it means, if someone gives you a horse as a gift, don’t go looking in it’s mouth to check it’s age.  Be grateful! 

Am I the only one who has never heard of checking a horse’s age by looking at it’s teeth??!! Comment below if you were as clueless as I was 🙂