
More recently, these results were confirmed in studies in the US, Canada, Great Britain, Sweden and Germany. The first signs of many systemic diseases may be seen in the mouth, for example many diabetics may have gum disease that does not respond to traditional therapies. Pale gums could be a symptom of leukemia. Large oral ulcers that do not heal by themselves could be an early symptom of HIV infection.
Researchers from University of Minnesota and Columbia University reported that older adults who have a higher portion of four periodontal-disease-causing bacteria in their mouth also tend to have thicker carotid arteries- a strong predictor of stroke and heart attack. People with periodontal disease are almost twice as likely to suffer from coronary artery disease than those without periodontal disease.
Recommendation.

- Patients with artificial heart valves, pacemakers and some congenital heart defects may need antibiotic prophylaxis prior to dental treatment. Many regular heart murmurs no longer need to be premedicated according to the new American Heart Association guidelines.
- Ulcers that takes over two weeks to heal may be due to some other underlying disease.
- Patients with leukemia and other blood disorders may exhibit bleeding gums.
- HIV positive patients may have large ulcers and other lesions growing on the gums and oral mucosa. An example is Kaposi Sarcoma which is a reddish-purplish lesion seen in the mouths of some AIDS patients.
- Patients with Herpes sometimes have ulcers that show up in the mouth usually heals by themselves in 7-10 days.
- Diabetic patients sometimes have severe gum disease.
