I have talked about how dentist can be the first line of defense against oral cancer. Many other illnesses can also manifest itself within the vicinity of oral cavity, head and neck regions. I am going to talk about the real case which I recently encountered.
This patient comes into my office with the major concerns of pain on lower left jaw area around root of the tooth. She is a 60 years of age with no previous history of significant illnesses. She has had gallbladder removal, and currently under treatment of hypertensive medication. She declines any other illnesses, allergies or surgeries. Her medical history does not seem to correlate to her current symptoms.
Next, I proceed to clinical examination. Immediately I notice multiple crusted blister on the skin around the left lips, and lower jaw area. Intraoral examination shows palpable nodules on the lower left mandible area around posterior teeth. This nodule is movable and is not fixated. This rules out the bone involvement. I suspect this is some lymphatic hyperplasia due to some kind of microbial infection. Then she relates to how her ears and eyes had some aches in the immediate past.
Her dental examination shows that the pathology is not dentally related. Radiograph shows normal tooth structure and bone.
Her physician has done MRI and blood test for white blood cells count and they are returned normal. I then asks what other blood test is done and patient is not sure.
Given her presentation of symptoms and history, I arrive at diagnosis of possible infection from herpes zoster virus. Commonly this is called Shingles. The virus spreads through the trigeminal nerve and rarely contagious to people who never had chickenpox immunization. I then write down my findings and immediately refer the patient back to her family medical doctor for confirmation of the disease. I also prescribe anti-viral medication to the patient.
After two days, the patient goes to her family medical doctor and confirm that it is indeed Shingles.
I am really glad that as her family dentist I can play an integral role in helping this patient.
Written by Daniel Tee, DDS, MS
Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.
