Periodontal Disease Articles
Healthy Mouth, Healthy Body – by Raymond G Hatland, DDS
Ozone & Caries Reduction – by Kevin Boehm, DDS
Reversing Periodontal Disease – by Raymond G Hatland, DDS
Your Heart Health and Gum Disease – by Dr Kevin Boehm
Gum disease is caused by a number of things. There are always bacteria present in the mouth with the potential to create the gum disease state, but how the body reacts to their presence may be the most important thing.
In a healthy mouth, the gum disease causing anaerobic bacteria are generally present but in far fewer numbers than in an unhealthy mouth. The normal aerobic bacteria are present in abundance which helps our immune system with a check and balance system synergistically limiting the harmful pathogens from rapid population growth. Normal brushing and flossing daily and maintaining a healthy diet of as many organic, non-processed foods all aid the immune system in maintaining this healthy state.
Gum disease worsens through many factors. If improper or insufficient daily care is negligent, the normal highly aerobic bacterial balance shifts to higher anaerobic gum disease producing numbers of bacteria. Our immune system becomes challenged to fight the problematic anaerobes. Our white blood cells release chemical mediators and cell to cell messages to bring reinforcements in to gain the upper hand in this fight. Some of these anaerobes, once killed by the white blood cell response, release what are known as endotoxins, a normal bacterial cell component which when released damages our own healthy cells causing cell death. In essence, it is a friendly fire-like circumstance. In our killing of the harmful pathogens, the bacteria release their chemical time bombs that kill our healthy gum and or bone cells, thereby increasing the amount of collateral damage caused. Certain men and women lack certain chemical safeguards that would protect themselves from their own enzymes’ killing of their own healthy tissues. For example, if endotoxins kill off osteoclast cells (our normal bone remodeling cells), they can release large quantities of the collagenase enzyme. Collagenase is a normal body enzyme that in a controlled setting by our healthy cells is enormously useful, but in this instance, lethal to a lot of surrounding tissue if that enzyme can’t be neutralized quickly enough.
Looking at this from a vascular standpoint here’s what happens to blood vessels in the immediately affected areas of gum disease. Our immune system has used chemical messengers, cytokines and prostaglandins to not only call more white blood cells to fight the ever growing infection, but also these chemicals tell our capillaries (small blood vessels) to open up gaps within their walls to allow the newly arriving white blood cells access in fighting the infection. More bacteria are killed, more endotoxins are released, and now we have blood vessels wide open allowing the invading bacteria and their toxic by-products access to anywhere they would like to go within our body through our blood delivery system. You now have a bigger problem.
The same endotoxin, among other things, has the same lethal effects on muscle, lymphatic, heart, brain and every other differentiated human cell type. Turning this potent killer loose on your heart or brain tissue can certainly cause havoc to be frank. If tunica intima cells (cells that line the inside of your arteries) are damaged, this can certainly lead to scar tissue formation, arteriosclerosis, and hypertension over time. This puts added burden on the kidneys and the heart muscle itself. Over a couple decades if the vascular damage cannot be corrected, renal failure, stroke, heart attack, and quite possibly death can be the result. Heart disease is among the top three causes of morbidity and mortality today, as it has been for a number of years. As we in the holistic field know full well, this is looking at the bigger picture. Proper oral care performed daily limits these risk factors. Failing to do so can have catastrophic effects if left unchecked and untreated. Brushing and flossing is not just about teeth and gums anymore. It’s about raising awareness of the potential for bacterial penetration of our vascular system and allowing a localized infection to spread systematically with the above mentioned outcomes as a partial list of possibilities to the unsuspecting host.
The age adjusted death rates for coronary heart disease and stroke have each reduced about 30% since 1999, according to the latest data in the American Heart Association’s heart disease and stroke statistics (2009 update published online in Circulation: Journal of the American Heart Association). These reflect the latest data for 2006. “The American Heart Association is proud of the progress this country has made against America’s number one single cause of death and the number three killer,” said Association President Timothy Gardner, M.D. (News release, American Heart Association, Dallas December 15, 2008)
If heart disease is 30% better and still the number 3 killer of Americans, it certainly seems like we have a long way to go.
Okay, heart disease runs in your family and you have been diagnosed with gum disease. What do you do? Unfortunately, we can’t get into everything that it would be wise to do in prevention, supplementation, or nutrition, but here are a few of each that are easy to do and remember.
On the hygiene front, brush 2-3 minutes at least twice daily, and preferably with an electric toothbrush (Oral-B, Sonicare, Rotodent, Crest, etc.) These are proven superior to hand brushing. Floss daily going lightly in an up/down direction making sure to get under the gum line to break up the anaerobes where they love to hide. For those with bridgework, use floss threaders, proxybrushes and/or super floss wherever you are able without causing damage. I prefer non-alcohol containing mouth rinses as another adjunct, and there are a lot from which to choose. For gum disease sufferers, a waterpik on low pressure can be a great thing to flush out problem areas and place medicaments where they can be of best benefit. And by all means, see your dentist at least twice annually.
With respect to nutrition and supplementation, let’s keep it simple. Eating a diet of as much organic whole, raw vegetables, fruits, nuts, and seeds with small amounts of meat, fish, and poultry, and limiting processed foods is as simple as it gets. You often will derive most of the vitamins, minerals, protein, fats, carbohydrates, and anti-oxidants you need just by doing this. If supplements are needed, and often times are, try these for starters: vitamin C, vitamin E, and CoQ10 are all powerful anti-oxidants that are very useful in our cardiovascular system and in gingival tissue, either diseased or healthy. They are able to neutralize toxins on a cellular level, which is what makes them so useful. There are large numbers of more obscure, or less well known, anti-oxidants, but almost everyone knows about these three.
Just because heart disease runs in your family and gum disease is found, doesn’t mean the executioner’s song is playing. You can alter things over time and effect positive change. But this often takes discipline in diet, hygiene and supplementation, which most individuals choose not to do as they should. Hiding from the problem won’t help. Look hard in the mirror and choose wisely. Accept that hard choices must be made, and do what’s necessary. Gum disease tends to be cyclical in nature and with the proper attention to all phases of health and hygiene, you can certainly do your best to limit your own risks and repair past damage in many instances.
Periodontal disease is probably the most common and pervasive disease in the world. It can be present in 13 on up to 80+ year olds who still have their teeth. It is the major cause of tooth loss after age 30. Also while it is quietly ravaging the gums and bone around your teeth, plaque creating bacteria from the diseased gums plug up our blood vessel walls, especially the coronary and carotid arteries. Some studies have shown that the chance of getting a heart attack is increased by 40% in older patients. Other studies have shown a causal connection to premature births, diabetes and a weakened immune system.
Periodontal disease is an inflammatory and infectious disease that breaks down the attachment of the gums to the teeth. This usually happens painlessly. Slowly the bone is reabsorbed creating deeper and deeper periodontal pockets and eventually the teeth become looser if this process isn’t stopped. Its insidious nature and symptomless progression makes periodontal disease one of the most under estimated of the common diseases.
Causes of periodontal disease fall into two camps: Individual host immune system factors and oral hygiene. A knowledgeable, skillful and diligent patient can overcome almost any host immune system deficiencies. Host factors such as poor nutrition, certain genetic factors, unawareness of the ongoing disease process, the presence of diabetes or other immune deficiency, smoking, high chronic stress which increases secretion of the inflammation hormone cortisol, and advanced states of diseased periodontal pockets can all be overcome with specialized professional help and home care skills.
What can be done?
1. Find out if you have any active gum disease by going to a dentist and have your gum pockets charted and a thorough examination of your gums. Charting of all your pockets tells you where you are at periodontally, and what areas need special attention. Success or failure of your home care program will be based on the changes in your pocket depths.
2. 95% of all gum disease starts in between the teeth where tooth brushing cannot reach. Dental flossing skillfully can stop gum disease in pockets that are 5 mm or less. Deeper pockets need the skillful use of an oral irrigator (the Hydrofloss oral irrigator is the best, or a Water Pik can work too) with a small amount of hydrogen peroxide in the tank.
3. In my office I train all my periodontal patients in how to use an oral irrigator skillfully. This has resulted in patients being able to eradicate all periodontal disease and reduce their pockets depths 20-60% WITHOUT SURGERY in over 200 well documented success stories.
4. Scaling and root planning (the cleaning and smoothing of the exposed root surfaces) is critical to successfully reverse gum disease. This is a painless procedure when done with local anesthesia and usually with just mild post-op symptoms.
5. Good nutrition and supplementation can reduce one’s susceptibility to periodontal disease and help overcome predisposing gene factors or diseases. Ubiquinol (a highly absorbable and active form of coenzyme Q 10) is a star supplement for your gums. High amounts of vitamin C and vitamin D, the bioflavonoid and polyphenol antioxidants (from fruits and green tea), calcium and magnesium all help to control inflammation and improve the immune system.
6. If you smoke, stop or at least start stopping. High stress or excessive chronic stress increases an inflammation response to bacteria as well as disrupting our healthy habit routines.
Periodontal disease flourishes with ignorance. Awareness is its greatest enemy. If you start early, it can be easily overcome and prevented from ever starting again.
In order to discuss how ozone has the capability to eradicate decay in some instances we should begin with how decay begins. In the initial stages of decay there is tooth structure that is affected by acid production from the numerous species of bacteria that colonize the mouth. The bacteria present consume whatever nutrients they find in the oral environment and make more bacteria plus acidic waste products. These begin leeching the mineral content from the adjacent tooth structure upon contact. Slowly over time if the conditions are not corrected, very small demineralized areas grow large enough to be detected by dental exam, which may need restoration of some sort to arrest the damage from decay. If the decay isn’t stopped further weakening of tooth structure results and can lead to tooth loss and systemic infection.
Thorough brushing 2-3 times per day and flossing daily certainly helps the most in decay prevention. Other factors involved related to decay prevention include limiting sugary/starchy foods and limiting sugary/carbonated beverages. Limiting acidic intake from carbonated drinks and reducing sugar lower acid content and reduce the bacteria’s number one and most easily digestible food source. By limiting sugars and acid content we preserve the alkaline oral environment, which is most important in reducing decay risk factors. Some individuals enjoy using battery operated toothbrushes, waterpiks, hydroflossers to help lower their risks. All these things are great as long as they are used often enough and used well by their users.
I’m going to attempt to condense about 450 pages of text by a brilliant Italian PhD who is quite prolific in his ozone writings. In Velio Bocci’s book “Oxygen-Ozone Therapy, a Critical Evaluation” he writes of the immense power that ozone possesses to benefit mankind if it is used properly. Ozone was first discovered in the 1800’s and is simply a gas made up of 3 atoms of oxygen temporarily joined together. However, this arrangement of oxygen atoms is unstable and degrades fairly quickly at room temperature. This is the same substance that makes up the ozone layer that protects the Earth to a degree from the Sun’s harmful ultraviolet radiation. On the positive side ozone is a very potent antiviral, antifungal, antiparasitic, and antibacterial agent. Because of antioxidants contained in our cell membranes ozone is harmless to us as long as it’s delivered in small concentrations. Certain white blood cells in our own immune system produce ozone again in very minute quantities to fight off disease. It is very highly soluble in water which makes it ideal for just about any moist environment, which would certainly include the oral environment. About the only drawbacks to ozone are if too high a concentration is used excess free radical formation makes our cells vulnerable to membrane damage and or possible cell death. Free radicals are damaging molecules formed every day in the body due to metabolism and a variety of other environmental sources. The other drawback is that ozone is a respiratory irritant unless it’s sent through olive oil prior to being breathed in which renders it breathable. If ozone is to be used in the body it must be produced from a pure oxygen source.
How can we use ozone in decay prevention? I use ozone every day during every procedure I perform from fillings to crowns to extractions to ensure the areas are as clean and pathogen free as I can make them before restorations are placed or surgical wounds are sutured. In individuals with high caries (tooth decay) risk we make custom trays with an inlet and outlet for the ozone delivery to the tray and hook up the suction for excess ozone elimination. While the ozone circulates through the tray enclosed environment it kills the harmful pathogens with which it comes into contact. Because it is so permeable it travels through the microscopic tubules that are contained within the tooth structure to get into places that aren’t easily reached. The only problem involved in using this method is that repetition is needed for it to be effective. Once a tooth is decayed into the dentin (one of the 4 main components of teeth) or the layer of tooth underneath the enamel the soft, demineralized, decayed tooth must be removed. However, for individuals with a lot of incipient or early enamel decay this can work like a charm and may prevent formerly needed dental work in some cases when used with remineralizing agents such as calcium phosphate products which attempt to harden the enamel again.
Look to the future for some new inventions that will attempt to make this underutilized adjunct more commonplace in dentistry’s fight to lessen dental decay and improve our patient’s lives.
Having a healthy mouth can be critically important for you to be successful at improving the health of your entire body. Besides the obvious threat that oral diseases has to your teeth, gums and your ability to chew food well, there are many chronic and degenerative disease processes throughout the body that can be greatly aggravated by unhealthy conditions in your mouth.
Most gum disease is a slow, usually painless and even symptom free bacterial infection that gradually destroys your gums and the bone that holds your teeth. Eventually if the disease process is not stopped the teeth become loose, sometimes painful and have to be extracted.
The same bacteria and toxins found in the plaque on our teeth have also been found in the plaque that plugs up our blood vessel walls. Research has shown there is a direct cause-and-effect with these oral bacteria actually creating new and enlarging old plaque formations in the blood vessels. Besides producing millions of free radicals and speeding up the aging process, people with gum disease later in life have a 40% increase in heart attack risk. So don’t think that the occasional bad breath, puffy gums or bloodstained toothbrush are just little nuisances.
Many healthy foods require a high degree of chewing efficiency. If you have pain when you chew food you will likely choose foods that are soft and many times will a lot less healthy for you. Have your dentist take care of any decay that you may have in your mouth before it violates the nerve and gets very expensive. The best way to avoid decay is to stop eating sweets. I know that sounds tough, but it really works. If you do have decay and have fillings done, make sure your dentist uses the most biologically friendly materials.
How our upper and lower jaws relate to each other when you eat, sleep or during daily activities is an often forgotten area that can have a big effect on our physical comfort. Most headaches and many pains and stiffness in the neck, back and shoulders can be directly related to oral habits such as night time bruxing (grinding) or daytime clenching.
Snoring is another night time activity that can have serious health consequences. All of these above dental problems need to be treated by a dentist who has special training.
WHAT CAN YOU DO?
1. First it is extremely difficult to diagnose yourself correctly, so see your dentist and ask about your special problems and concerns.
2. If you have any concerns about gum disease have your dentist do a periodontal baseline chart of your gum pockets depths This is an objective measurement that can find hidden gum disease and can help your dentist determine whether or not you need further professional treatment to stop it from progressing.
3. Also get an oral irrigator and flush between your teeth daily. Use a small amount of a safe bactericidal agent in the water to kill bacteria
4. Good nutrition and some supplements can also be critically important for the gums. Besides vitamin C and the minerals calcium, magnesium and zinc, coenzyme Q 10 and a diet or supplement program rich in antioxidants from fruits, herbs and even the powerful antioxidant unprocessed (sugar free) chocolate have all shown excellent benefits for the gums and the entire body.
5. To prevent decay skillful brushing, flossing, a healthy low sugar diet and chewing xylitol gum have all been proven to be very effective.
6. If you know you clench or grind your teeth, stay away from any caffeine or caffeine like stimulants. An expertly adjusted night guard can help a lot as well as expert bite corrections.
7. Cosmetic dentistry can also contribute to your health. Having a beautiful smile can increase your self-confidence and improve your self-image, self-esteem and sense of well-being. These all can have a positive effect on our endorphin levels and lower our stress hormone levels that speed up the aging process.