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by Michael Olmstead, DDS
The mouth is more than just a nice smile; it is the gateway to the body. Good overall health is not possible without good oral health.
On the basis of research published over the last 25 years, we will discuss one of the most common diseases afflicting mankind – one that 47-80 percent of adults and 30-50 percent of children suffer from (the statistics vary, depending on study parameters). The effects of this disease are not confined to one area but have extreme consequences for overall health. Although many people do not realize it, periodontal disease, or “gum disease,” is a major source of chronic inflammation throughout the body.
Periodontal disease can range from mild, with just slight bleeding of the gum tissue, to severe, resulting in loss of bone in the jaw and loss of teeth. As it progresses, gum disease can affect our health in myriad ways. But before we discuss these, let’s talk about what this disease is and what causes it.
What is periodontal disease?
Peri means “around,” and dontal refers to the teeth. So, periodontal refers to the gum and bone tissue that surrounds and supports the teeth and retains them in the jaw. Periodontal disease begins as an inflammation of the gum tissue surrounding the teeth. You might notice this as redness, puffiness, mild gum recession, slight tenderness, and occasional bleeding when you floss or brush. This is called gingivitis. At this stage, fortunately, the damage is reversible through proper home and professional care, along with lifestyle changes.
If not addressed, however, inflammation progresses, leading to periodontitis, which progressively damages the tissue and bone surrounding the teeth. Possible indications that you may be developing periodontitis include bad breath, a foul taste in your mouth, and pain when eating, although the condition can occur without these symptoms manifesting.
From the microbiologic point of view, the inflammatory process produces waste products and chemicals that, over time, can destroy the connective tissue attaching the gum tissue to the tooth. Eventually, this process damages the periodontal ligament, which connects the tooth to the bony socket it rests in. As the “pockets” around the tooth deepen from the 1-3 mm physiologically normal level, which can be kept clean through good oral hygiene, they collect more bacteria-laden plaque that is not accessible to complete cleaning. This promotes increasing inflammation, and the pockets continue to deepen.
As time passes, the inflammation begins to affect the jawbone, which supports the teeth. Little by little, the bone dissolves away. Teeth become loose, gum tissue recedes further, and, ultimately, the process causes tooth loss. It can be a disfiguring and painful journey. This is not reversible. The best we can hope for is to stop the process and prevent recurrence, and this will involve professional treatment by a dentist or periodontist.
This local destructive process almost always progresses slowly. It may be years before the final acute phases occur, but once they do, options for treatment will be fewer and more costly. They also will have a less favorable and less predictable outcome.
What causes periodontal disease?
There are numerous factors that lead to gum disease:
- Improper home care (brushing, flossing, and tongue cleaning)
- Lack of regular professional care (cleaning and evaluation)
- Poor nutrition (too much refined sugar, starch, and processed food lacking nutritional value)
- Stress (increased production of cortisol and other hormones that favor inflammation)
- Poor and failing tooth restoration
- Regular use of tobacco products
- Acidic salivary pH (caused, for example, by sipping on “fizzy” drinks)
- Depressed immune system
- Mercury amalgam fillings
- Hormonal changes (in both men and women)
- Intimate, chronic oral exposure to someone who has gum disease
- Genetic predisposition (familial history)
You will note that age is not listed. Gum disease is not an inevitability of aging. It is the result of a lack of knowledge and a failure to heed the warning signs.
The most important causative factors in the disease process are the first four listed above: improper home care, lack of regular professional care, poor diet, and elevated stress levels. Let’s briefly cover each of the listed factors in more detail.
If we do not remove the dental plaque – a sticky material on the surface of the teeth that is composed of bacteria and a mucopolysaccharide complex (containing sugars and mucous from saliva) – at least twice a day, the inflammatory process begins very quickly. Plaque is produced constantly, and in just a few days, the gum tissue begins to react. At this stage, a toothbrush and dental floss can remove the plaque.
If the plaque is left on the teeth for a longer period – say, weeks – it begins to be calcified by the normal mineral salts in our saliva. The resulting barnacle-like deposits can then only be removed by a dental professional scraping them off the teeth. These plaque and calculus, or “tartar,” deposits are like apartment complexes for destructive bacteria, which quickly overcome the immune system, starting the process of gum disease.
The mouth is the ideal incubator for bacteria; it is dark, warm, and moist, with abundant food for them and many areas in which they can hide undisturbed. We acquire these bacteria from foods, beverages, and contact with other people, so exposure is unavoidable. However, they – and their waste products – do not simply stay in our mouths. They migrate – via such methods as swallowing, aspiration, and absorption through the gums – into the throat, lungs, and bloodstream and can affect and infect other areas of our bodies.
A diet rich in refined sugars and flours greatly favors bacterial growth. Moreover, processed foods are largely devoid of vitamins, minerals, and cofactors that support healthy bone and gum tissue. They also increase salivary acidity, which favors infection and inflammation.
Stress – especially chronic stress, whether mental, emotional, or physical – produces elevated levels of lactic acid and pro-inflammatory hormones, including cortisol. These promote the development of periodontal disease. Stress also causes our bodies to use up vital nutrients more quickly than usual.
Failing and poor dental restorations (fillings, crowns, bridges, etc.) collect dental plaque and bacteria. If there is a space between restorations – “open contact” – we will have a food impaction area. Even though we may think that flossing after every meal removes the food debris, the reality is different. Some of the food particles remain and act as a breeding ground for bacteria. This single factor is responsible for many periodontal issues.
Regular use of tobacco, including smokeless products, adds to the inflammatory burden in our mouths. It promotes both the development and progression of periodontal disease.
Increased salivary acidity also supports bacterial growth and inflammation. Normally, we want a pH of 6.8-7.2 in the saliva, but, as indicated above, excess refined sugars and starches, and carbonated beverages (even if sugar-free) shift the salivary pH in the acidic direction. Carbonated beverages have carbonic acid in them, and many also contain phosphoric acid, so it is best to avoid drinking them or to rinse immediately afterward.
Anything that depresses the immune system will lower our host resistance to destructive bacteria, including those in the mouth. Health conditions such as diabetes, lupus, leukemia, irritable bowel disease, viral hepatitis, and HIV/AIDS, as well as medical treatments such as chemotherapy, are among the factors that can compromise immune system function.
Much has been written about the harmful side effects of fluoide and of mercury amalgam fillings. We can add that both of these have negative impacts on periodontal health.
Fluoride irritates gum tissue and can weaken the bone that supports the teeth. As early as 1936, H. Trendley Dean, DDS, wrote in the Journal of the American Medical Association: “From observations that I made in areas of relatively high fluoride concentration (more than 4 parts per million of fluorine) there is sufficient evidence to suggest that there is an apparent tendency toward a higher incidence of gingivitis (periodontal disease).” Research has shown that fluoride causes gingival damage, is retained in the oral tissues, and has a negative effect on oral osseous tissues.[2-6]
A large study of 20,000 people, conducted at a German university, found a significant relationship between the number of amalgam fillings and the extent of periodontal problems. The researchers stated: “Some of the oral effects documented in the literature to be caused by amalgam include gingivitis, oral gum tissue inflammation, bleeding gums, bone loss, mouth sores, and oral lesions.”
Hormonal changes can also negatively impact our periodontal health. In women, this can occur with the onset of puberty, pregnancy, menstruation, and menopause. Typically, these changes affect the gum tissue by causing increased inflammation. In addition, the jawbone may lose mineral density at menopause. In men, declining testosterone levels are related to slow wound healing and osteoporosis. They may also negatively impact periodontal health because testosterone may have an inhibitory effect on gingival inflammation.  Interestingly, estrogen levels in men increase with age and have a protective effect on bone.
Diabetes predisposes us to periodontal disease in several ways. First, diabetics are prone to dry mouth syndrome, and saliva provides a protective influence on the gum tissue. Next, there is reduction in immune system function with diabetes. Finally, poor blood glucose control is associated with increased severity of periodontal disease, according to the National Institute of Dental Health and Research.
There is a well-established connection between familial history of periodontal disease and development of the condition. However, genetic predisposition is the least important of the causative factors and can easily be overridden by the others on the list, especially the first four. Genetic links are still being studied. To date, four genes have been found to be related to gum disease. Nonetheless, given the recent research in the field of epigenetics, it still appears that its development requires activation from one or more of the other factors listed above.[12,13]
What are the consequences of gum disease in the body?
Here are some alarming research facts:
- Gum disease may increase the risk of cardiovascular disease, according to a report published in the American Heart Association journal Circulation. In fact, if you have periodontal disease, you have a much greater chance of a coronary event than someone who smokes but does not have gum disease. The cause of this appears to be circulating periodontal microbes, along with elevated levels of fibrinogen (a natural clotting agent) and increased systemic inflammation. Periodontal pathogens have been found in arterial plaques.[15-18]
- If you are pregnant and have gum disease, even mild to moderate, your risk of having a preterm, low-birth-weight baby may increase significantly. Periodontal bacteria can travel to the uterus, triggering the release of prostaglandins, which may induce premature labor.
- Preeclampsia (a pregnancy complication characterized by high blood pressure) is associated with periodontal disease.
- People with mild to moderate Alzheimer’s were found, in a small study, to have a 600 percent increase in the rate of cognitive decline when gum disease was present. In another study, periodontal microorganisms were found in brain samples from four out of ten Alzheimer’s patients but not in brain samples from healthy individuals.
- With periodontal disease, you may have up to a 20 percent increased risk of stroke.
- Your likelihood of respiratory disease is increased if you have gum disease, as the pathogenic periodontal organisms can migrate into the respiratory tract. “Pulmonary diseases can be severely disabling and debilitating,” said Donald S. Clem, DDS, during his tenure as president of the American Academy of Periodontology. “By working with your dentist or periodontist, you may actually be able to prevent or diminish the progression of harmful diseases such as pneumonia or COPD.”
- With gum disease, there is a 14-21 percent greater overall risk of cancer, and the risk increases greatly for leukemias (35 percent), and stomach, lung (36 percent), kidney (49 percent), pancreatic (54 percent), colorectal, and esophageal cancers.[26-31] In the case of pancreatic cancer, a British and American research team at Imperial College in London and Harvard University studied the health data of 50,000 patients, collected over 21 years, and found that a history of periodontitis was associated with increased likelihood of the disease.
- Post-menopausal women with gum disease have a 14 percent greater risk of breast cancer. Certain periodontal microorganisms were found in breast cancer tumors.
- If you have periodontal disease, you have an increased risk of developing diabetes. According to Ryan T. Demmer, PhD, MPH, lead author of a study published in Diabetes Care, “We found that over two decades of follow-up, individuals who had periodontal disease were more likely to develop type 2 diabetes later in life when compared to individuals without periodontal disease.” People with elevated levels of periodontal disease were nearly twice as likely to become diabetic over the 20-year study period, Demmer indicated. Participants with gingivitis had a 40 percent greater chance of developing diabetes than periodontically healthy subjects, while those with periodontis had a 50 percent increased risk of diabetes. An interesting point is that there seems to be a bidirectional relationship between diabetes and gum disease – each tends to promote and aggravate the other.
- Gum disease is a major cause of gastric and duodenal ulcers. H. pylori bacteria can migrate from the mouth and take up residence in the gut.
- Periodontal disease aggravates and may lead to rheumatoid arthritis. This is probably due, at least in part, to its systemic inflammatory effect.[36,37] All of this shows that the problems caused by gum disease are not limited to the mouth. Gum disease can cause life-altering health issues in the rest of the body.
What are the solutions?
Gaining as much knowledge as possible should precede action. We must be self-motivated. Speak to someone you know who has had gum disease and listen to their story. This will make the issue more compelling and personal. Then start first with the most important action steps listed above. There is an old saying, “Only brush those teeth you want to keep.”
Regular and proper home care
Morning: It is vital to clean your mouth before you eat or drink in the morning; otherwise, all the bacteria – and their waste products – that have accumulated during sleep will be swallowed with your first food and drink. Scrape the tongue, floss the teeth, and brush – in that order. (Tongue scraping is superior to brushing the tongue, and it is best to use a metal scraper.) After doing this, flush out other toxins in the body that have accumulated overnight, by drinking two to four glasses of warm water. (For some people, particularly those with kidney issues, four glasses of water at one time may be too much.)
Mealtimes: After meals, as a substitute for brushing, you can rinse your mouth within three to five minutes of ingesting foods or beverages. I advise vigorous swishing with plain water after eating. If you notice any food stuck between your teeth after meals, be sure to floss, as that food will begin to irritate the gums and will act as a breeding ground for bacteria.
Evening: Floss and brush again in the evening, the last thing before bed.
Flossing: Floss should be wiggled between the teeth, not snapped, and then moved gently and slightly below the gum tissue, as well as being wrapped around the tooth to remove plaque. Do not use dental floss that has Teflon (fluorocarbon) in it. Note: Some dentists recommend flossing only once a day, before bed, and say that it’s not necessary in the morning. I feel that it’s important to floss in the morning, too, because bacteria will have built up plaque between your teeth while you slept.
Brushing: The bristles of manual or electric toothbrushes should be placed half on the tooth and half on the gum tissue. The brushing motion should be small, overlapping circles. Spend one minute brushing the upper teeth and one minute on the lower. Both manual and electric brushes should have extra-soft bristles to avoid abrasion of the tooth surface and recession of the gum tissue. Electric brushes are particularly useful for children, as well as geriatric and disabled patients. Two to three times per week, brushes should be cleaned by soaking the head of the brush in 3% hydrogen peroxide for 20 minutes. Brushes should be replaced every two to three months.
Avoid using toothpastes that contain any of the following: fluoride, triclosan, synthetic foaming agents (lauryl/laureth sulfates), gritty abrasives (large-particle calcium phosphate and carbonate, found in stain removal dentifrices and tooth powders), synthetic sweeteners, and artificial colors or flavors. Avoidance of these ingredients is especially important for children, as they swallow much of the toothpaste they use.
The following nutritional supplements are particularly good for the bone and gum tissue and to combat inflammation:
- Zinc for immune system strength
- Calcium, magnesium, boron, silica, and vitamin K2 (menaquinone) for bone health
- Vitamin D to promote calcium metabolism
- Vitamin C (liposomal has the best absorption rate) to improve connective tissue strength
- Bioflavonoid complex (rutin, hesperidin, and quercetin) for healing the gums and promoting connective tissue health
- Coenzyme Q10 for vascular health
- Oral probiotics to reestablish a healthy oral microbiome
- Vitamin A for epithelial tissue health
Regular cleanings: Teeth should be professionally evaluated and cleaned two to four times per year.
Gum tissue treatments: When gum disease has been identified, the first step in any treatment plan is always to remove plaque and tartar with deep cleaning and scaling. Once this is completed – and good home care has been established – reevaluation may indicate that no further intervention is required.
However, in many moderate to advanced cases of gum disease, where there has been bone loss, it may be necessary to surgically remove unhealthy tissue and/or do laser treatments, bone augmentation procedures, and even tooth removal. None of these sound very appealing, but with today’s skilled specialists, remarkable results can be attained.
It is very important to note here that there is no one perfect treatment for all cases. Each treatment modality has limitations, despite how it is promoted. Laser treatment, for example, is not the best choice for every situation.
Restoration options following tooth loss
If teeth have been lost or must be removed, the following restorative options are available to reestablish the chewing surface area. This is very important, so that we do not distribute the same chewing force over fewer teeth – a situation that would result in overstressing them and creating additional problems over time.
Removable appliances or partial dentures are the least expensive tooth replacement option. These are usually constructed of a plastic or metal plate to which a number of false teeth are attached. Because they are held in the mouth by the remaining teeth, some limitations and risks are involved in their long-term use.
Fixed (nonremovable) appliances are anchored to the teeth on either side of the missing one(s). The adjacent teeth require some preparation (removal of tooth structure) before the appliance is attached. Resin-bonded appliances are more conservative of the structure of the anchoring teeth than metal ones.
The last option is dental implants. These are titanium posts placed in the jawbone as root substitutes to which tooth restorations are attached. They are usually of two types, titanium and zirconia (a ceramic). The biocompatibility of the zirconia is likely to be somewhat greater, as it is nonmetal. Also, the zirconia implant can be made as a one-piece fixture so there are no connection seams that could potentially harbor bacteria. The long-term stability of implants makes them the best option. They are said to be a “one-tooth solution for a one-tooth problem” because they do not rely on removal of structure from the adjacent teeth. This makes them a more conservative treatment option as well.
What’s the optimal approach?
As always, prevention and regular maintenance are the best approach. It is also important that we help our children see the value of good home care and a healthy mouth early in life. If you have the feeling that something isn’t “right” in your mouth, or if you – or another family member – experience any of the symptoms previously discussed, you might want to get professional dental advice as soon as possible.
About the Author
Michael Olmstead, DDS, is a biocompatible dentist with an extensive background in all phases of dental and integrative healthcare. He is also a certified Maharishi AyurVedic health practitioner. An honors graduate of the University of Southern California School of Dentistry, he has authored many consumer-oriented articles and has been featured on both radio and television. He is available for consultations at www.dentalsecondopinion.com and may be contacted at 877-335-3069.
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