OnlineReputation PatientTrust PracticeGrowth

Reputation Management That Turns Reviews Into Referrals

In dentistry, reputation is currency. Before visiting a dentist, nearly 77% of patients check online reviews1. Online reputation management can significantly transform reviews into referrals. 

Why Reputation Matters? 

In this online era, positive reviews reflect your reputation. The dentist who has more positive reviews is likely to experience fewer empty chairs.  
Thus, it is vital to put in efforts to improve the reviews. Similarly, it is also necessary to attend to the negative reviews. This will help potential clients see the complete story.  

Strategies to Turn Reviews into Referrals2 

  1. Ask for Reviews Proactively: After treatments, request patients to leave honest feedback on Google. Make it easier with direct links. 
  1. Respond Promptly and Professionally: Respond to all reviews whether positive or negative. However, while responding to negative reviews, don’t lose calm and display compassion.  
  1. Highlight Reviews in Marketing: Don’t forget to highlight top reviews on your website, social media, and newsletters. This will encourage referrals. 
  1. Incentivize Referrals Indirectly: Implement patient loyalty program to incentivize the patients who have given you positive reviews. Remember, directly paying can violate the guidelines. 
  1. Monitor Your Reputation Consistently 
    Promptly respond by turning on alerts about the reviews via Google Alerts. This will also help understand the concerns faced by the patients, giving you the opportunity to improve.  
  1. Turn Reviewers into Advocates 

Invite patients who leave positive reviews into your referral circle. Encourage them to participate in patient appreciation programs; while giving them the opportunity to share their experience. 

Don’t forget to thank them personally during follow-ups. This small touch will humanize your practice. In turn, increasing the chance of more referrals through word of mouth. 

Final Takeaway 

Reputation management will not just build a positive image but will serve as a powerful referral engine. By engaging with reviews, you can convert feedback into trust, loyalty, and growth. So, next time, if anyone leaves a review, engage with it as soon as possible.  

References 

  1. Sener C. Online reviews are becoming more important to patients in choosing their care: How to manage your online reputation in health care. Medical Economics. Published May 2, 2023. Available from: https://www.medicaleconomics.com/view/online-reviews-are-becoming-more-important-to-patients-in-choosing-their-care-how-to-manage-your-online-reputation-in-health-care 
  1. Van den Bulte C, Bayer E, Skiera B, Schmitt P. How customer referral programs turn social capital into economic capital. Journal of Marketing Research. 2018 Feb;55(1):132-46. 

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From Bite to Brightness: Integrating Occlusal Balance in Smile Makeovers

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ECC Prevention That Goes Beyond Fluoride

Do you also think that “Fluoride” is the gold standard in preventing the prevalence of Early Childhood Caries (ECC)? Well, the clinical reality is a bit different, and studies have proven that fluoride alone is no longer enough!  As ECC is multifactorial; so, prevention strategy must also be multifaceted and holistic. It must span around education, behaviour change, diet, sealants, probiotics, and even lifestyle factors like screen time.   Why We Can’t Stop at Fluoride  Fluoride remains a cornerstone in caries prevention, yet evidence consistently shows it cannot fully eliminate the risk of ECC.  Fluoride varnish reduces caries prevalence by 43% in primary teeth and 37% in permanent teeth1.  Fluoride toothpaste lowers caries incidence by 24–30%1.  Undoubtedly, these figures are enthralling, but they also point towards the prevalence of the critical gap. The reason fluoride cannot 100% prevent ECC lies in the multifactorial risk factors driving the disease.  Evidence-Based Prevention Beyond Fluoride  1. Oral Hygiene Education  Educate parents on the significance of brushing right from the eruption of first tooth3.   Make parents pro in selecting right toothbrush with soft bristle and in right brushing technique- gentle circular motions, proper flossing once adjacent teeth contact1,3.  Don’t forget to include screen-time counselling. Studies show that excessive screen time is directly linked to higher intake of cariogenic foods. Stats reveal that 22% of meals are consumed in front of screens; in turn, reducing brushing frequency. Thus, both accelerate ECC risk4.  2. Diet & Feeding Practices  Educate parents on dietary intervention like sugar intake must be <10% of daily caloric intake while highlighting the ways to identify the hidden sugars in packaged foods and beverages1,5.   Promote healthy snacking in the form of fruits and veggies to enhance salivary flow and natural remineralization.  Remember just like the fluoride factor; parent factor is equivalently important!  4. Sealants  Resin-based sealants are a great way to reduce caries risk on primary molars among children over 2–7 years and up to 76–85% reduction can be achieved1.  Along with sealants, you can add an extra layer of protection of glass ionomer cement (GIC) sealants especially in challenging moisture conditions because they release fluoride.  *Recommendation: This is ideal for children between the ages group of 3 to 6 and ones with enamel defects, deep fissures and early demineralization1.   5. Probiotics  Probiotics have emerged as a valuable adjunct in ECC prevention. They help by targeting and modulating the oral microbiome. Strains such as Lactobacillus rhamnosus and Bifidobacterium lactis have shown inhibitory effects on cariogenic bacteria, especially, Streptococcus mutans1.   Studies reveal that when used as an adjunct to fluoride toothpaste, the intervention reduced early enamel demineralization by 75% 1.  6. Silver diamine fluoride (SDF)6  Studies have found that 38% SDF, an ammonia solution containing fluoride and silver ions can slow dentine and enamel demineralisation.  It is a great option for uncooperative or medically fragile children due to its non-invasive nature.  7. Xylitol7  Xylitol, a naturally occurring and FDA approved nutritional additive.   Studies have reported that the consumption of xylitol (5–10 g/day) decreases caries incidence ranging between 30% and 80%.  8. CPP–ACP (Casein phosphopeptide–amorphous calcium phosphate)8  It stabilizes calcium and phosphate ions in plaque, helping to prevent enamel demineralization and promote remineralization during acidogenic challenges.   It also reduces the adhesion of Streptococcus mutans, supporting a less cariogenic biofilm.   Studies have found that fluoride varnishes enhanced with CPP–ACP provide additional caries protection. This is because CPP–ACP increases the release of fluoride ion from the varnish, further enhancing its remineralization potential.  9. Risk Assessment9  Use tools like CAMBRA to guide decisions.   Engage the caregiver, explain simply, and gather key details on health status, fluoride exposure, brushing habits, family caries history, dental visits, feeding practices, and diet.  Respectful, culturally sensitive interviews help tailor prevention to each child’s risk.  Final Takeaway  ECC prevention demands a layered defense system, in which fluoride acts as the foundation. So, next time when you need to deal with the tiny teeth, do use this holistic way and layer them as per the need of the child. ​​​​​​​ References   1. Aljohani AA, Alarifi AI, Almoain MF, Alrhaimi FF, Alhejji MT, Gazzaz NW, Ali LS, Alammari HD, Alwattban RR, Alharbi HM, Barnawi BM. Managing early childhood caries: a comparative review of preventive and restorative approaches. Cureus. 2024 Nov 28;16(11).  2. Puspitawati Y, Sulistiani S, Afdilla N. The role of parents in ECC prevention: A cross-sectional study. Journal of International Dental and Medical Research. 2023 Sep 1;16(3):1220-6.  3. Meyer F, Enax J. Early childhood caries: epidemiology, aetiology, and prevention. International journal of dentistry. 2018;2018(1):1415873.  4. Robin A, Padmanabhan V, Swaminathan K, Kc V, Haridoss S, Vignesh KC. Association Between Screen Time, Dietary Patterns, and Oral Health Among Children: A Cross-Sectional Study. Cureus. 2025 Mar 28;17(3).  5. Centers for Disease Control and Prevention. Get the facts: Added sugars. Centers for Disease Control and Prevention; 2024 Jan 5. Available from: https://www.cdc.gov/nutrition/php/data-research/added-sugars.html  6. Gao SS, Chen KJ, Duangthip D, Wong MC, Lo EC, Chu CH. Preventing early childhood caries with silver diamine fluoride: study protocol for a randomised clinical trial. Trials. 2020 Feb 4;21(1):140.  7. ALHumaid J, Bamashmous M. Meta-analysis on the effectiveness of xylitol in caries prevention. Journal of International Society of Preventive and Community Dentistry. 2022 Mar 1;12(2):133-8.  8. Attiguppe P, Malik N, Ballal S, Naik SV. CPP–ACP and fluoride: a synergism to combat caries. International journal of clinical pediatric dentistry. 2019 Mar;12(2):120.  9. Featherstone JD, Chaffee BW. The evidence for caries management by risk assessment (CAMBRA®). Advances in dental research. 2018 Feb;29(1):9-14. 

Video as a Patient Education & Engagement Tool

When was the last time a patient remembered every instruction, you gave them in the clinic? Most forget at least half of those and miss instructions can lead to avoidable complications.   What if there were a way to make your guidance stick?   Here comes the power of visual learning. Not many realize, but it can be a game changer in dentistry1.    Why Videos Are a Game-Changer for Dentists  Videos are effective because   Grabs Attention Instantly: In comparison to text or images, videos are more engaging, keeping patients interested.  Boosts Patient Understanding: Visual representation allows complex treatments to become easy to grasp.  Build Trust and Credibility: Sharing real patient testimonials and procedures helps to create trust and confidence.  Increases Engagement and Retention: Patients remember what they watch far better than what they read.  Improves Online Visibility: Videos enhance SEO, social media reach, and website traffic, the most crucial requirement to reach maximum patients in and around your locality.    Tips to Make Engaging Videos  Keep it short and snappy. 30–60 seconds is ideal and best for social media platforms.  Use visuals over text  Add the subtitles. This will help people to watch anywhere and anytime.  Don’t forget to include call-to-action  Leverage real-life scenarios, not just theory  Quick Wins: Video Examples That Really Work  Daily oral hygiene hacks for kids  What to expect during a root canal  How to care for your braces  Tips for managing post-extraction care  Even a short clip of 30–60 seconds can make a significant difference in patient understanding and compliance. Interestingly, studies have also shown that 65% of individuals are visual learners2.    Practical Uses: Beyond Education  Do you know videos can boost your practice too? Here’s how and the right way to use them  Why Use Videos Where to Use Videos Easily shareable, allowing patients to spread the word to friends and family  Online platforms such as social media, website, YouTube, WhatsApp  Builds trust and positions you as a patient-focused dentist   Play videos to engage patients while they wait in the waiting room.  Improves digital visibility and credibility  Use procedural videos in the consultation rooms to show treatment options, procedures, and outcomes  Reduces patient fear and anxiety3  Before treatment and during patient follow-ups. This will let them know the success rate and aftercare required  Final Thought  Video creation is not just a trend but a bridge between information and engagement, fear and trust and more importantly between your practice and patient community. So, when are you going to shoot you first clip?   Because in dentistry, trust is everything, and video builds it faster than words ever could!  Reference  Jawed S, Amin HU, Malik AS, Faye I. Classification of visual and non-visual learners using electroencephalographic alpha and gamma activities. Frontiers in behavioral neuroscience. 2019 May 7;13:86.  McNab M, Skapetis T. Why video health education messages should be considered for all dental waiting rooms. PLoS One. 2019 Jul 16;14(7):e0219506.  Gazal G, Tola AW, Fareed WM, Alnazzawi AA, Zafar MS. A randomized control trial comparing the visual and verbal communication methods for reducing fear and anxiety during tooth extraction. The Saudi Dental Journal. 2016 Apr 1;28(2):80-5. 

Pulp Therapy in Primary Teeth: What Works in 2025?

Pulp therapy in primary teeth is about the delicate balance, where you aim to preserve function and extend comfort until natural exfoliation. The motto here is avoiding under- or over-treatment. Over the last few years, the armamentarium to achieve the goal has undergone massive changes. Formocresol, once the “gold standard,” is no longer recommended due to safety concerns1. Now we have more biocompatible and bioactive materials providing better outcomes. Choosing the Right Pulp Therapy First things first, let’s revise the differences between the pulp therapies. Pulpotomy vs. Pulpectomy Pulpotomy is indicated when the coronal pulp is inflamed but the radicular pulp seems healthy. Pulpectomy is needed when infection extends into the radicular pulp, but the tooth is restorable2. Clinical pearl: Always assess hemostasis after coronal pulp amputation. Early hemostasis with saline or sodium hypochlorite suggests radicular pulp is still vital, allowing you to proceed with pulpotomy.  Persistent bleeding, however, indicates the need for pulpectomy or extraction. What Materials Work Best in 2025? Here are newer materials that work best for pulp therapies - Mineral Trioxide Aggregate (MTA) Success rates >90% in long-term studies for pulpotomy3. MTA provides excellent sealing ability and is known for inducing dentin bridge formation. Despite being widely used, MTA can be slightly expensive and might cause some discoloration.  Biodentine Newer material, which is biocompatible and can repair or substitute damaged dentin.  It is also faster-setting and easier to handle when compared to MTA, which makes it practical for modern pediatric use. Studies report equal or superior success to MTA in primary pulpotomies4. Preferred in anterior teeth due to lower discoloration potentia New-Generation Bioceramics Pre-mixed calcium silicate-based materials like NeoMTA Plus, Theracal LC, calcium-enriched mixtures (CEM), EndoSequence, and BioRoot RCS are gaining popularity5. Bioceramics should have optimal mechanical strength, antibacterial properties, and manageable setting times to gain long-term success6. Zinc Oxide Eugenol (ZOE)  ZOE is the choice of material for pulpectomy fillings. It has a resorption mismatch with the roots, and may cause periapical irritation7. ZOE can also deflect the permanent tooth bud, and should be avoided. Trending alternative: Prefer calcium hydroxide–iodoform pastes like Metapex, Vitapex, that resorb more harmoniously and are easier to retreat. Practical Updates for Daily Practice Hemostasis control matters: Be cautious and use 1.25–2.5% NaOCl or ferric sulfate, avoiding overzealous cauterization that may damage radicular pulp. Radiographic monitoring: Monitor success by following up on the state of root resorption, along with the absence of symptoms.   Case selection: Teeth that are close to natural exfoliation or have furcation involvement are better managed with extraction.  Clinical tip: Always communicate with parents that pulp therapy is not a permanent solution. The goal is to maintain the tooth until natural exfoliation; by no means is it about creating a “forever tooth.” It is often misunderstood by parents of young children. Final Takeaway Pulp therapy is swiftly changing and has newer materials that have replaced formocresol.  While many dental practitioners have worked with formocresol during their training period, it is high time to take in newer materials like MTA, Biodentine, and other bioceramic cements.  ZOE pulpectomies are not a great idea; use calcium hydroxide–iodoform pastes instead. Other than better materials, careful case selection, and clear parental communication are the best ways to go. References Issrani R, Prabhu N, Bader AK, Alfayyadh AY, Alruwaili KK, Alanazi SH, Ganji KK, Alam MK. Exploring the properties of formocresol in dentistry—a comprehensive review. J Clin Pediatr Dent. 2023;47(3):1-10. Baik SA, Al Mkenah A, Khan A, Alkhalifah A, Al Makinah A, Alquraini H, Al Khars A, Almakinah A, Almakinah D, Almalki A. Pulpotomy vs. pulpectomy techniques, indications and complications. Int J Community Med Public Health. 2018 Nov;5(11):4975-4978. Beldar TL, Jawdekar AM, Mistry LN. Success of pulpotomy with MTA in primary teeth: A systematic review and meta-analysis. Bioinformation. 2025;21(8):2574–2580 Vilella-Pastor S, Sáez S, Veloso A, Guinot-Jimeno F, Mercadé M. Long-term evaluation of primary teeth molar pulpotomies with Biodentine and MTA: a CONSORT randomized clinical trial. Eur Arch Paediatr Dent. 2021 Aug;22(4):685-92. Dong X, Xu X. Bioceramics in Endodontics: Updates and Future Perspectives. Bioengineering (Basel). 2023 Mar 13;10(3):354.  Alshalan AS, Almutiri FA, Al-Battat AH, Alqahtani AM, Binzamil KA, Alabdan RM, Alrabghi KK, Aldohailan AM, Alshammari EA, Khurayniq AS, Alshahrani MT. Bioactive Materials in Pediatric Endodontics: Current Applications and Future Directions. Cureus. 2025 Aug 22;17(8):e90718. Najjar RS, Alamoudi NM, El-Housseiny AA, Al Tuwirqi AA, Sabbagh HJ. A comparison of calcium hydroxide/iodoform paste and zinc oxide eugenol as root filling materials for pulpectomy in primary teeth: A systematic review and meta-analysis. Clin Exp Dent Res. 2019 Mar;5(3):294-310.

Space Maintainers & Interceptive Ortho Made Practical

Premature loss of primary teeth is one of the most common challenges in pediatric dentistry. It can lead to space loss, crowding, malocclusion, and ultimately ortho treatments later in life1. The fix is very simple, theoretically, just give a space maintainer. But how many dentists actually deliver space maintainers?  The usual concerns are poor compliance, failures, or simply confusion about appliance choice. So, here is a simplified guide to help make the right choice. Picking the Right Space Maintainer Band and Loop Indicated for single posterior primary molar loss. The band and loop space maintainer is simple, reliable, and does not necessarily need too much compliance2. Generally well-tolerated and is the most suitable when the permanent tooth is expected in 2-3 years. Distal Shoe Ideal in case of loss of the second primary molar before eruption of the first permanent molar. Guides the eruption of the permanent tooth. Requires regular follow-up, hence should be avoided in immunocompromised or uncooperative children. Lingual Arch / Nance Ideal for bilateral loss of molars in children. Known to provide long-term arch preservation3. Requires excellent hygiene and regular review. Clinical pearl: Always check root resorption of adjacent teeth before prescribing a fixed appliance. Most failures happen due to poor case selection. How to Integrate Space Maintainers in Daily Practice? Fabrication: CAD-CAM maintainers are quickly becoming a game-changer in the field of interceotive orthodoctics. They are supposedly more accurate and require fewer lab visits. Prefabricated band-loop kits can cut chairside time, thereby increasing efficacy4. Review: Regular follow-ups every 3–6 months are mandatory. Most failures occur due to neglect, and not the appliance itself. Parent instructions: It is important to educate parents about avoiding sticky foods, brushing appliance margins, and reporting immediately if it feels loose. A printed or WhatsApp care card with all instructions in one place improves compliance. Hygiene hack: Apply fluoride varnish around band margins at recall to minimise any decalcification Interceptive Ortho: When to Act Early? Space maintainers are a great option to preserve arch length, but malocclusion needs more than that. Here is how you can proceed: Screening age: Screen children at the age of 6–7 years when the eruption of the first permanent molars and incisors occurs. Red flags: Notice if there are any upcoming malocclusions, like posterior crossbite, severe crowding, ectopic eruption, or habits like thumb sucking or mouth breathing. Interceptive tools: Suggest simple expanders for crossbite, habit-breaking appliances, or serial extractions where crowding is severe5. Pro Tip: If the developing issue looks like it cannot be controlled with a single appliance, refer early rather than waiting. Final Takeaway Space maintenance and interceptive ortho are preventive orthodontics, and these are not optional. Guide more children and parents about space maintainers, as it can help avoid lengthy ortho procedures later on. Additionally, hand out more information about dietary advice, hygiene protocols, and timely ortho referral. References Shakti P, Singh A, Purohit BM, Purohit A, Taneja S. Effect of premature loss of primary teeth on prevalence of malocclusion in permanent dentition: A systematic review and meta-analysis. Int Orthod. 2023 Dec;21(4):100816. Casaña-Ruiz MD, Aura-Tormos JI, Marques-Martinez L, Garcia-Miralles E, Perez-Bermejo M. Effectiveness of Space Maintainers in Pediatric Patients: A Systematic Review and Meta-Analysis. Dent J (Basel). 2025 Jan 14;13(1):32. Khalaf K, Mustafa A, Wazzan M, Omar M, Estaitia M, El-Kishawi M. Clinical effectiveness of space maintainers and space regainers in the mixed dentition: A systematic review. Saudi Dent J. 2022 Feb;34(2):75-86. Dhanotra KGS, Bhatia R. Digitainers—Digital Space Maintainers: A Review. Int J Clin Pediatr Dent. 2021;14(Suppl 1):S69–S75. Khalaf K, Mustafa A, Wazzan M, Omar M, Estaitia M, El-Kishawi M. Clinical effectiveness of space maintainers and space regainers in the mixed dentition: A systematic review. Saudi Dent J. 2022 Feb;34(2):75-86.

Managing Common Oral Mucosal Lesions: A Practical Guide for Dentists

Most dental work is related to restorations, extractions, and routine care, but a sizable portion comes with oral mucosal complaints. For dentists, it is critical to spot and manage common mucosal conditions in daily practice. They should be able to recognise what looks benign, treat what is straightforward, and make an urgent referral when required. Here is the practical guide to help you with every step. Why mucosal care matters in primary dental practice? Oral mucosal disease management is somewhat in the middle of medicine and dentistry.  Lesions in the mouth can be1: Local in the form of trauma or denture-related injuries Infectious, like oral candidiasis or herpetic lesions Immune-mediated, such as oral lichen planus Systemic due to nutritional deficiencies or Crohn’s Potentially malignant, like leukoplakia or erythroplakia Oral diagnosis remains fundamental for patients for a better prognosis. However, due to limited access, biopsies and further treatment is usually conducted by medical professionals. A practical chairside triage (quick checklist) Duration - If ulceration extends beyond 3 weeks, you should consider referring the patient for biopsy2. Appearance - Persistent red or mixed red-white patches are at higher risk than homogeneous white plaques. Location & behavior - Lesions on the lateral tongue, floor of the mouth, and lesions that are indurated, fixed, or bleed easily should be addressed on an urgent basis1. Predisposing factors - Consider predisposing factors like prolonged denture wear, xerostomia, diabetes, immunosuppression, tobacco/alcohol use3. Try to correct or address these when possible. Common conditions: What to do?  1. Recurrent aphthous stomatitis (RAS) It is seen as small, round/oval, painful ulcers on non-keratinised mucosa. Identify local trauma and obvious triggers for the condition. Use topical corticosteroids for symptomatic relief. You can also suggest the use of protective pastes and analgesic gels. If ulcers are unusually large or are accompanied by some systemic symptoms, refer to an appropriate medical professional. 2. Oral candidiasis (denture stomatitis, thrush) It is seen as wipeable white plaques, erythematous mucosa, or angular cheilitis. Oral candidiasis treatment for dentists includes using topical antifungals and ensuring denture hygiene. Redo instructions and ask the patient to clean and soak the denture overnight. Check for predisposing causes like poorly-controlled diabetes, xerostomia, or use of recent antibiotics3. Topical therapies remain the first course of action, go on to antifungal medications for the extensive stage.   3. Oral Lichen Planus (OLP) It is seen as reticular white striae, which are often asymptomatic. There are also erosive/ or atrophic forms, which can be painful. For asymptomatic reticular lesions, only observe and document. For symptomatic lesions, start with topical corticosteroids and manage secondary candidal infection if present.  Arrange regular reviews in case of erosive oral lichen planus, as it carries a small malignant-transformation risk. Therefore, long-term surveillance is recommended4.  Refer to a specialist if there is no improvement for further investigation. 4. Traumatic and frictional lesions It can be seen as well-localised white patches or ulcers adjacent to sharp teeth, restorations, or ill-fitting prostheses. It is important to identify and remove the source. You can adjust or smooth sharp edges, or reline/repair a faulty prosthesis. Provide topical analgesia if needed. Healing is expected within ~7–10 days; if not healed after removal of the cause, refer to a specialist. 5. Leukoplakia, erythroplakia, suspicious patches It is seen in the form of persistent white or red patches that cannot be attributed to a known cause, and are leukoplakia and erythroplakia, respectively5. Try to exclude reversible causes like tobacco use or traumatic keratosis. If a patch persists beyond 2–3 weeks and is non-homogeneous or indurated, refer to a specialist for biopsy.  Erythroplakia in particular has a high malignant potential.  Documentation It is important to record lesion size, site, morphology and duration and document it. Click photographs of lesions with good lighting. They can help when you consult a specialist and also compare the lesions in upcoming follow-up. Red flags that need urgent action  Unexplained oral ulceration > 3 weeks.  Persistent red or mixed red-white patches (erythroplakia/erythroleukoplakia).  A firm/indurated lump, rapidly enlarging lesion, or persistent bleeding.  Final Takeaway For mucosal lesions in the mouth, consider the duration, appearance, and site, along with risk factors. Consider topical therapy and rectify any local causes. Always document the lesion at every visit and refer the patient in case of any red flags. Do not ignore any lesion, and remember that earlier biopsy and diagnosis can save lives.  References Atkin PA, Cowie R. Oral mucosal disease: dilemmas and challenges in general dental practice. Br Dent J. 2024 Feb 23;236(4):269-273. NICE Guideline NG12 (2025). Suspected cancer: recognition and referral. https://www.nice.org.uk/guidance/ng12 Taylor M, Brizuela M, Raja A. Oral Candidiasis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jul 4. Manchanda Y, Rathi SK, Joshi A, Das S. Oral Lichen Planus: An Updated Review of Etiopathogenesis, Clinical Presentation, and Management. Indian Dermatol Online J. 2023 Dec 22;15(1):8-23. Öhman J, Zlotogorski-Hurvitz A, Dobriyan A, Reiter S, Vered M, Willberg J, Lajolo C, Siponen M. Oral erythroplakia and oral erythroplakia-like oral squamous cell carcinoma – what’s the difference? BMC Oral Health. 2023 Nov 13;23:859.

Systemic Diseases that Start in the Mouth

Little do we realise that the oral cavity is much more than teeth and gums. It often serves as the body’s first line of defence, where symptoms of systemic diseases are usually first observed. Dentists who examine the mouth regularly can detect these early changes and guide patients toward timely medical care. Why Systemic Disease Shows Up In The Mouth? Most systemic diseases have oral manifestations initially because of high vascularity. It is prone to immune reactions and easily reflects metabolic changes. Dental practitioners should be able to point out when the lesion is more than a local factor. Here are the most common systemic diseases that begin in the mouth. 1. Nutritional Deficiencies Iron, folate, or vitamin B12 deficiency commonly presents as recurrent aphthous-like ulcers, atrophic glossitis, or burning mouth1. These oral ulcers usually don’t respond to routine topical care. Dentists should consider recommending blood tests for nutritional status in case of recurrent or unexplained ulceration. 2. Autoimmune & Gastrointestinal Disorders Crohn’s disease can be seen in the form of cobblestoning of the oral mucosa, deep linear ulcers, or lip swelling.  The prevalence of oral symptoms ranges from 0.7% to 37% in adults and from about 7% to 23% in children2. Ulcerative colitis & celiac disease can cause recurrent aphthae and angular cheilitis. Systemic lupus erythematosus (SLE) can occur in the form of erythematous patches or lichenoid lesions3.  Dentists should take note of such lesions and refer the patient to the required medical professional 3. Endocrine & Metabolic Conditions Diabetes mellitus can cause symptoms like xerostomia, recurrent candidiasis, burning mouth, or delayed wound healing4. Thyroid disease may present itself as macroglossia or mucosal edema. Recognising such oral symptoms of systemic diseases by dentists can expedite diagnosis and further treatment of conditions. 4. Hematological Disorders Leukemia can first appear as gingival enlargement, spontaneous bleeding, or petechiae5. These changes may mimic periodontal disease, but the progression is unusually fast. Any sort of unexplained gingival swelling or bleeding should be immediately referred.  5. HIV & Immunosuppression HIV infection is known to present with symptoms of oral candidiasis, hairy leukoplakia, or persistent ulcers. Oral lesions can be seen in almost 50% OF HIV positive patients and almost 80% of AIDS patients6. Patients on long-term immunosuppressants are also at risk of infections and mucosal changes. Dentists should always notice any unusual, recurrent, or aggressive oral lesions.  Red flags to never ignore Ulcers persisting for more than 3 weeks7.  Any unexplained gingival enlargement or bleeding. Rapid and unexplained enlargement of mucosal lumps. Persistent candidiasis that is unresponsive to therapy Final Takeaway The mouth often speaks before the body does. For dentists, the ability to spot systemic diseases that start in the mouth is not only about oral care; it is about saving lives. By linking oral patterns with systemic disease, documenting carefully, and referring early, dentists can fulfil their role as vital gatekeepers of patient health. References Boukssim S, Chbicheb S. Oral manifestations of vitamin B12 deficiency associated with pernicious anemia: A case report. Int J Surg Case Rep. 2024 Jun 22;121:109931. Lauritano D, Boccalari E, Di Stasio D, Della Vella F. Prevalence of oral lesions and correlation with intestinal symptoms of inflammatory bowel disease: a systematic review. Diagnostics (Basel). 2019;9(3):77. Du F, Qian W, Zhang X, Zhang L, Shang J. Prevalence of oral mucosal lesions in patients with systemic lupus erythematosus: a systematic review and meta-analysis. BMC Oral Health. 2023;23:1030. Rohani B. Oral manifestations in patients with diabetes mellitus. World J Diabetes. 2019 Sep 15;10(9):485-9. Capodiferro S, Limongelli L, Favia G. Oral and maxillo-facial manifestations of systemic diseases: An overview. Medicina (Kaunas). 2021 Mar 16;57(3):271. Lomelí-Martínez SM, González-Hernández LA, Ruiz-Anaya AJ, Lomelí-Martínez MA, Martínez-Salazar SY, Mercado González AE, Andrade-Villanueva JF, Varela-Hernández JJ. Oral manifestations associated with HIV/AIDS patients. Medicina (Kaunas). 2022 Sep 3;58(9):1214 NICE Guideline NG12 (2025). Suspected cancer: recognition and referral. https://www.nice.org.uk/guidance/ng12.

Post-COVID Oral Infections: Black Fungus and More

COVID-19 had a huge impact on health beyond affecting the lungs. One of the major concerns is the rise of oral infections after COVID. During the pandemic, we witnessed black fungus gaining attention due to its aggressive nature. Though it is one of the common post-COVID infections, there are others you should be aware of. Why oral infections develop after COVID? Post-COVID patients were more susceptible to oral disease due to several factors: Lowered immunity due to infection or corticosteroid treatment. Higher blood sugar levels, more so in diabetics, increase the risk of having fungal infections. Reports show that almost 80% of black fungus cases had pre-existing diabetes1. The use of prolonged antibiotics, hospital stays, and oxygen therapy can also disturb the oral and systemic balance. Neglected oral hygiene during the infective stage can also predispose to infections. Here are common post-covid oral infections: 1. Mucormycosis (Black Fungus) Black fungus can appear in the form of painful ulcers commonly in the palate, black necrotic tissue, facial swelling, loosened teeth, or can involve the sinuses.  Uncontrolled diabetics, patients on long-term steroids, and immunocompromised people are at a higher risk2. The cases of black fungus need to be treated as an emergency. Immediately refer the patient to a specialist. Early antifungal therapy, like amphotericin B and surgical debridement, can be lifesaving in such cases. 2. Oral Candidiasis Oral candidiasis exhibits white plaques that can be wiped, erythematous mucosa, or angular cheilitis. It may happen due to antibiotics, dry mouth, steroid inhalers, or poor glycemic control. There was a significant increase in invasive fungal infections in COVID-19 patients due to immunosuppression or pre-existing health issues like diabetes. Mortality rate due to invasive candidiasis was around 19% to 40%, which increased to around 70% in ICU patients3. Topical antifungals are usually helpful. Patients with dentures should be informed about denture hygiene and reminded to soak and clean prostheses overnight. Severe or persistent cases may also need systemic antifungals4. 3. Herpes Simplex Reactivation It presents as painful vesicles or ulcers on lips, palate, or gingiva, that are often reactivated after immune stress5. Antivirals can provide symptomatic relief. If lesions are severe or atypical, it is important to refer the patient. 4. Periodontal and Opportunistic Infections Periodontal flare-ups are commonly seen during recovery due to reduced immunity and poor hygiene. Opportunistic infections like actinomycosis may also develop in necrotic tissues. The risk of severe COVID-19 symptoms was almost 3.25 times higher in patients with severe periodontal diseases when compared to milder cases6. A dentist should provide debridement, prescribe antibiotics if required, and reiterate the importance of oral hygiene maintenance. Documentation and follow-up A dentist should always note lesion size, site, and onset relative to COVID recovery Don’t forget to click clinical photos to monitor changes in every visit. Recommend consistent follow-up visits for immunocompromised patients as the condition can deteriorate rapidly. Red flags  Black, necrotic patches on palate or maxilla. Fast-spreading swelling or mobile teeth. Ulcers persisting longer than three weeks. Severe pain, fever, or systemic illness with oral lesions Final Takeaway The pandemic highlighted mucormycosis, but a dentist should be aware of the wider range of post-COVID oral infections. Being aware of common infections can help dentists recognise early signs and refer the patient when required. References  Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr. 2021 Jul-Aug;15(4):102146.. Ghalwash D, Abou-Bakr A, El-Gawish A. Comorbidities and final outcome of post COVID-19 associated oral mucormycosis patients: a cross-sectional study. Egypt J Otolaryngol. 2024 May 3;40:51. Jain A, Taneja S. Post-COVID fungal infections of maxillofacial region: a systematic review. Oral Maxillofac Surg. 2021 Oct 7;26(3):357-63. Bhujel N, Zaheer K, Singh RP. Oral mucosal lesions in patients with COVID-19: a systematic review. Br J Oral Maxillofac Surg. 2021 Nov;59(9):725-731. Shanshal M, Ahmed HS. COVID-19 and Herpes Simplex Virus Infection: A Cross-Sectional Study. Cureus. 2021 Sep 16;13(9):e18022. Sari A, Dikmen NK, Nibali L. Association between periodontal diseases and COVID-19 infection: a case–control study with a longitudinal arm. Odontology. 2023 Mar 3;111(4):1009–17.