St Petersburg University scientists: the changes of the oral mucosa can indicate the diseases of the digestive tract, lungs and heart

Patients usually go to a doctor suspecting the diseases of the digestive system, heart or lungs, feeling pain or discomfort. However, doctors claim that these are hardly the primary symptoms. We can often see the changes of the oral mucous: dryness, swelling, tongue plaque, or inflammation on cheeks.

Organs and tissues of the oral cavity are closely associated with the internal human organs and systems. Most part of the oral mucosa injuries therefore result from internal organs diseases. Most frequently they are discovered in cases of diseases of the digestive system, blood system and endocrine disorders.

Liudmila Ermolaeva, Professor of St Petersburg University, Head of the Department of Therapeutic Dentistry

Such symptoms are usually recognised by patients as the oral cavity diseases, so they go to dentists. ‘In such situations, dentists have the responsibility for precise diagnoses of primary symptoms of general diseases and carrying out medical examinations together with other specialists,’ Professor Ermolaeva emphasised.

The doctors said that 75 % of all the oral mucosa changes are the primary symptoms of pathological processes of the digestive tract organs. For example, the tongue plaque is often the result of gastroesophageal reflux disease, chronic gastritis, peptic ulcer disease with the stomach and duodenum injuries, enterocolitis and stomach tumours. The tongue colour in such cases is usually greyish — white but can be changed according to food colour or medicine. The yellow or yellow-brown colour can indicate a liver disease.

In case of peptic ulcer disease, the doctor can notice the hypertrophy of fungiform papillae — they are projected above the surface as bright-red dots. In case of gastritis and enteritis, on the contrary, the tongue is bald, papillae are atrophied. A specific symptom of colitis and enterocolitis is the frequent biting of a swollen tongue and cheeks. The lack of food taste or a perverted reaction can be the symptoms of peptic ulcer disease. The reduction in taste sensitivity is specific to stomach cancer.

Smokers, especially over the age of 40, often face chronic obstructive pulmonary disease. In this case, patients have fissures in the mouth’s corners, lips burning, inflammation of lips, palate and cheeks. The colour of the oral mucosa changes for blue-reddish, the consistency becomes thicker, in neglected cases there can be atrophied tissues. The sense of taste is decreased and perverted.

The doctors warn: in case of long-lasting smoking history, almost 100 % of people face Tappeiner leukoplakia. This is the precancerous process which leads to palate changes. There can be folds there and the oral mucosa becomes swollen. The salivary ducts are often inflamed, which results in cysts. This situation demands medical treatment and smoking cessation, otherwise it can become worse and lead to cancer.

The blue colour of lips, the bright-red or crimson colour of the tongue is specific to myocardial infarction. The symptoms of transmural myocardial infarction can be fissures, erosions, ulcers, bleeding on the tongue. Venous ulcers in the oral cavity can be specific to the patients with decompensated heart disease and heart failure.

In case of chronic kidney disease, there can be the plaque on the root of the tongue. In some cases, there can be the ‘geographical’ (spotted) tongue and the black "hairy" tongue — the tongue of the dark colour with long and hard papillae. The disorders in the thyroid gland functioning can lead to the swelling of the larynx mucosa. The human voice becomes dull.

The list of possible diseases associated to the problems with the oral mucosa is quite big. Among others, chronic kidney disease, bronchial asthma, diabetes mellitus, iron deficiency anaemia, leucosis can have an effect on the patient’s condition. Side effects of some medicines can also appear in the oral cavity.

Liudmila Ermolaeva, Professor of St Petersburg University

The experts emphasise that any of noticed symptoms is not the reason for making a diagnosis. ‘Any changes must be examined by a specialist. At the first stage, it can be a dentist. The dentist can make an oral cavity prophylaxis and give instructions on hygiene but after that they ought to send the patient to a specialist or to a primary care physician,’ Professor Ermolaeva emphasised.

The scientists from the Department of Therapeutic Dentistry of St Petersburg University Liudmila Ermolaeva, Denis Fedotov, Natalia Sheveleva, Evgenii Penkovoi and Associate Professor Ivan Pchelin, Acting Dean of the Faculty of Medicine of St Petersburg University, talked about these and others symptoms in the publication ‘The expressions of primary somatic diseases on the oral mucosa’.