Fighting Gum Disease with Food

We’ve long known that periodontal (gum) disease is a major problem here in the US, but now a study just published in the Journal of Dental Research puts it into numbers.

And they’re not pretty.

One of every two adults over 30 has some form of gum disease.

Among seniors, it’s about 7 in 10.

Rates are highest for Mexican-Americans, current smokers, those living below the federal poverty line and those with less than a high school education. And more men are affected by it than women (56.4% vs. 38.4%).

According to Dr. Bicuspid’s summary, this data came from the 2009-2010 National Health and Nutrition Examination Survey (NHANES), which for the first time included a full mouth perio exam. Before, only partial mouth exams were done. But “because periodontal disease is not evenly distributed in the mouth, prevalence estimates from surveys…may have underestimated the severity of the disease.”

Consequently, the new findings are considered the most accurate to date.

Of course, one of the things that makes such numbers so troubling is that gum disease, like tooth decay, is almost entirely preventable. Good oral hygiene, of course, is part of it. So is good nutrition. Not only can it help lower your risk; it can help manage or reverse the course of perio disease if it does occur.

Because it inovlves inflammation – a major factor in its link with heart disease, stroke, diabetes and other conditions – a good, broad and basic approach to getting the best of perio problems can be an anti-inflammatory diet such as this one from Dr. Weil.

And there are specific nutrients that offer great help, as well.

For instance, one study published about a year ago in the Journal of Clinical Periodontology confirmed the significant impact of vitamin D, calcium and antioxidants on gum health. Reviewing “the evidence for nutritional exposures in the etiology and therapeutic management of periodontitis” – that is, the cause and treatment of advanced gum disease – the authors concluded that

For prevention and treatment of periodontitis daily nutrition should include sufficient antioxidants, vitamin D, and calcium. Inadequate antioxidant levels may be managed by higher intake of vegetables, berries, and fruits (e.g. kiwi fruit), or by phytonutrient supplementation.

But while supplementation can help, whole, natural foods should be your first and best source of all essential nutrients (along with, in the case of Vitamin D, sunshine). Here are a couple of references to help you make your “perio happy” shopping list:

• Best Sources of Antioxidants in Fruits & Vegetables
• Calcium & Vitamin D: Top Food Sources

Image by Dr Parveen Chopra, via Flickr

HPV, Oral Cancer & Gum Disease

According to the CDC, more than 36,500 new cases of mouth and throat cancer are diagnosed every year. The 5 year survival rate is only about 50%.

But that rate is a whole lot better in cases where the cancer is detected early. That’s why, in my office, oral cancer screening – using VelScope – is included in every adult patient’s exam at least once a year.

A recent paper underscores why this matters.

Published last month in Head & Neck Oncology, the study confirms that

oral sex with multiple partners is one of the significant risk factors for oral cancer and oropharyngeal cancer. Young people, who increasingly practice oral sex especially with many partners, may be driving the increase in these cancers.

The culprit, as we’ve discussed before, is HPV (human papillomavirus). More known for causing cervical cancer, HPV is also a major cause of oral cancer. In fact, it’s surpassed tobacco as the leading risk factor: While smoking rates have plummetted, oral cancer rates have soared. And that risk increases along with sexual activity. According to the current research,

HPV infection is likely to be sexually acquired with increased risk of oropharyngeal cancer with either many (more than 26) lifetime vaginal-sex partners or six or more lifetime oral-sex partners.

Why is the mouth so vulnerable to HPV transmission?

It must be remembered that the oral cavity is a battlefield of healing mucosal micro abrasions which could in the right circumstances of altered local host defenses allow viral inculcation, infection and entrenchment leading to somatic genetic change. Changes in immuno-tolerance at these “special” immuno-modulating sites…combined with further environmental triggers then lead to cancerous changes. Basically, viral “genes load the gun and environment pulls the trigger.”

So maybe it’s no surprise that earlier research has suggested a connection between gum disease and oral cancer. The initial study found that precancerous lesions were twice as prevalent – and tumors, four times as prevalent – in those with periodontal disease than those with healthy gums. Inflammation appears to be the key factor, as lead author Dr. Mine Tezal recently discussed in an interview with Dr. Bicuspid about her ongoing research:

The results of our recent study suggested an association between chronic local inflammation and tumor HPV status of head and neck cancers. HPV infects only basal cells of the epithelium and gains access through breaks in the mucosa….

In this inflammatory environment, HPV is also shed in greater amounts leading to increased risk of viral transmission. If prospective studies in cancer-free populations confirm that chronic inflammation is a significant factor in the natural history of oral HPV infection, the public health implications would be important.

Thus, another cancer-preventive measure, she suggests, is to control inflammation in the mouth. And she likewise confirms what the Head & Neck Oconology paper showed: frequency of exposure to the virus matters. A lot.

HPV is a commonly transmitted virus and the majority of the infections are cleared rapidly by the immune system without causing disease. Rather than the mere presence of the virus at one time point, its persistence is critical for the development of HPV-related diseases. [emphasis added]

Learn more steps you can take to lower your risk of oral cancer from my earlier post “The Oral Cancer Pandemic & How You Can Keep Yourself Safe.”

A Mouth Full of Bacteria, a Tablespoon of Oil

Did you know that there are more bacteria in your body than human cells?

Yes, really. Microbes outnumber them, 10 to 1.

That’s not a bad thing. For not all “bugs” are bad (despite what you see and hear in some ads). Some are essential to human health, doing things like

• Synthesizing and excreting vitamins
• Preventing colonization by pathogens (“bad bugs”)
• Inhibiting or destroying pathogens
• Stimulating tissue and antibody development

The human mouth alone contains an estimated 10 billion bacteria. Yet most of us grow up thinking that a “clean” mouth is a germ-free mouth. As professor of oral microbiology Dr. Phillip Marsh puts it,

What we’ve been brought up with is “Plaque is bad – get rid of it.” But it’s actually too much plaque and plaque in the wrong places that are bad for us. We want to prevent the buildup of levels of organisms, particularly in hard-to-reach places of the mouth, that could lead to disease. Pushing to have an ultraclean mouth isn’t beneficial to us; we should be trying to maintain our natural microbiota at levels compatible with oral health in order to preserve their beneficial activities.

Dr. Aaron Weinberg, dean of the School of Dentistry at Case Western Reserve, agrees:

You don’t want a sterile mouth; you want a mouth that has primarily good bacteria in it, in order to keep exogenous microorganisms out and prevent them from colonizing the mouth.

Seems common sense, doesn’t it? Keep the good, control the bad. And that’s what dental hygiene is really about: not eliminating but controlling bacteria, especially those that contribute to tooth decay and gum disease. As mentioned before, the mechanical actions of brushing and flossing are crucial in this, breaking up microbial colonies. Mouthwash, on the other hand, is often meant to kill – or at least slow down the proliferation of – pathogens, whether by chemicals or herbal extracts and essential oils. While rinse is seldom necessary, it can be a help, especially when periodontal (gum) disease is an issue.

But there are traditional, natural alternatives for controlling oral flora, as well – practices such as oil pulling.

Oil pulling comes to us from Ayurveda, a system of traditional medicine developed in India thousands of years ago. Often described by Western holistic practitioners as a way to “pull out toxins,” it effectively cleanses the mouth by controlling oral bacteria, especially along the gumline and in the periodontal pockets. Vitamins and minerals in the oil are absorbed, while pathogenic microbes are bound up in the oil and ultimately removed from the mouth. The natural balance of oral flora is restored, which allows tissues to regenerate.

Research (PDF) has demonstrated a marked decline in levels of decay-causing microbes after oil pulling. Other studies have found oil pulling to be at least as effective as chlorhexidine in controlling bad breath.

We’ve seen remarkable results in patients who have turned to oil pulling to take control of their periodontal health – much healthier gums, much smaller pockets.

Although some recommend using coconut or other oils, sesame oil is often preferred. According to a short paper published in the Indian Journal of Dental Research,

The sesame plant (Sesamum indicum) of the Pedaliaceae family has been considered a gift of nature to mankind because of its nutritional qualities and its many desirable health effects. The seeds of the plant are commonly known as ‘gingelly’ or ’til’ seeds. Sesame oil has a high concentration of polyunsaturated fatty acids and is a good source of vitamin E. The antioxidants present in it are mainly sesamol, sesamin, and sesamolin. Sesamin has been found to inhibit the absorption of cholesterol as well as its production in the liver. It reduces lipogenesis and exhibits an antihypertensive action.

Likewise, from the first study cited above,

Sesame lignans have antioxidant and health promoting activities (Kato et al., 1998). High amounts of both sesamin and sesamolin have been identified in sesame (Sirato-Yasumoto et al., 2001). Both sesamin and sesamolin were reported to increase both the hepatic mitochondrial and the peroxisomal fatty acid oxidation rate. Sesame seed consumption appears to increase plasma gamma-tocopherol and enhanced vitamin E activity which is believed to prevent cancer and heart disease (Cooney et al., 2001).

Even so, a good number of naturopaths advocate sunflower oil instead. It also contains vitamin E, as well as a number of nutrients key to good dental and oral health, including vitamin D, calcium, magnesium and trace minerals.

Sesame or sunflower, whichever you use, do be sure to use a good quality oil: organic, cold-pressed and unrefined.

The technique itself is simple:

1. Anytime between waking and breakfast, brush your teeth or scrape your tongue.
2. Put 1 tablespoon of oil in your mouth and slowly, gently work it around the oral cavity – like using mouthwash but in slow motion, less vigorously. Do this for 10 to 20 minutes.
3. Spit out the oil (which will look thin and milky white).
4. Rinse with warm salt water. (Optional)

The first time you try it, you may find the practice feels slightly uncomfortable. Don’t worry. Most people quickly get used to it. If it becomes too uncomfortable, though, just spit out the oil and try again.

One last note: Oil pulling can have detoxifying effects, so you might want to start off with just a few days a week and gradually work up to daily practice.

Images by wellcome images and FotosVanRobin, via Flickr

Understanding How Cigarette Smoke Destroys Your Gums

fxp/Flickr

 

A couple weeks ago, I wrote about the effects of secondhand smoke on children’s dental health. In passing, I also mentioned how smoking affects the smoker’s oral health, as well – especially the strongly increased risk of periodontal disease and associated bone and tooth loss.

We’ve known about this link for quite a while, but we still don’t entirely understand the mechanism – how tobacco does the damage it does to the periodontal tissues and underlying bone. Answers continue to emerge, though, including some from a new study I learned of shortly after publishing that post.

This study, published in the Journal of Dental Research, considered the effects of cigarette smoke condensate (CSC) – the particulate matter of smoke – and a microbe called P. gingivalis, which is one of the main players in the development of gum disease. Specifically, they wanted to see the effect of these combined factors on the collagen-degrading capability of human gingival fibroblasts – connective tissue cells found in the gingival crevice (the small space between a tooth and surrounding gum tissue).

Three groups of cells were tested. One was exposed just to CSC, one just to P. gingivalis and one to both factors. Looking at the effects of each exposure, the researchers found that the combination of CSC and the pathogenic microbe was more destructive than either component alone and did so by destroying specific secreted proteins in the extracellular matrix.

This is the kind of tissue destruction that ultimately progresses and manifests as receding gums. It’s also entirely preventable, potentially reversible through proper treatment and care, and offers just one more reason to quit smoking now.

 

Share

Dental Care Great, Dental Health Worse?

An article in the Vancouver Sun this week suggested that Baby Boomers have “unique” dental problems. Although, as a group, Canadian Boomers “are keeping their teeth clean and healthy, they are also experiencing an increase in such problems as exposed gums, dry mouth, acute sensitivity and tooth root cavities.” We see similar trends in the US.

Dr. Steven Weiner, an Ontario dentist featured in the article, generally attributes the phenomenon to better care early in life, more saved teeth and longer lifespans.

“In previous eras, if you had a toothache, you pulled the tooth. Then you had to deal with other issues that involved. People now are retaining their teeth longer – for a lifetime – and that wasn’t the goal back then.

“We see so many perfect teeth now, through orthodontics, great home and dental care, but what we have as a result of the aging population is great teeth and poor gums.”

 

 

How is it that a person can have “great home and dental care” yet have “poor gums” and other dental problems? And is this really unique to Baby Boomers? Or is it more that theirs is just the first generation to have these problems in large numbers?

My hunch is that there’s more truth in the latter.

The article mentions – almost in passing – some trends that I would argue are now having a big impact on people’s dental health. One of them is the increased use of pharmaceutical drugs, many of which cause dry mouth as a so-called “side effect” – drugs as varied as antidepressants, anti-anxiety medications, antihistamines and muscle relaxants. Dry mouth may not sound like anything too serious, but it’s got some significant dental implications, raising the risk of caries (cavities), tooth erosion and periodontal disease. This is because one of the functions of saliva is to wash away the microbes that make up dental biofilm (plaque) and food particles that feed them. Saliva is also a source of the calcium and phosophate particles that help keep tooth enamel strong. The less saliva, the more conditions favor decay and other tooth damage.

There are a number of safe and helpful products available to help increase saliva flow and alleviate dry mouth – products such as GC Dry Mouth Gel and the Dental Herb Company’s Tooth and Gums Tonic. Drinking more water can help, as can eating more foods that require chewing, especially foods like crunchy vegetables.

This brings us to another major trend I see affecting people’s dental health: diet. Since the Boomers came of age, highly processed convenience foods and sugary soft drinks have become much more common – more available and consumed in larger amounts. High fructose corn syrup has become ubiquitous in processed foods, increasing our overall consumption of added sugars. Our intake of refined carbohydrates has skyrocketed, and few of us eat nearly enough whole grains, fresh vegetables and fruit. The result is a diet that is highly acidic, promoting tooth decay and inflammation. (Gum disease, like heart disease, is a chronic, inflammatory condition.) Moreover, the acids and sugars in sodas, energy drinks and similar beverages further contribute to tooth erosion, as a great many studies have shown.

If we, as a society, continue in these directions, we can expect the “unique dental problems” mentioned by Dr. Weiner to be the new norm. But it’s not too late to turn things around. By making positive, healthy life choices, we increase the likelihood of our having both healthy teeth and gums into our senior years.

 

Share

Secondhand Smoke Hurts Kids’ Teeth & Gums

When we think about the health effects of smoking, the first things that come to mind are usually diseases such as cancer and emphysema. But smoking does a number on a person’s dental health, too – and far beyond simple bad breath and stained teeth. For instance, smokers are four times more likely than non-smokers to develop periodontal disease, even if their home hygiene is exemplary. Gum health deteriorates, often leading to bone and tooth loss. Some periodontists – dentists who specialize in treating the gums – refuse reparative treatments to smokers if they continue to use, such is the ongoing damage.

More than half of all cases of periodontal disease can be attributed to smoking.

 

Furyk/Flickr

 

If you smoke, you might think, “Fine, but it’s my body. I can do what I want to it,” and that’s certainly your choice – though I would argue it’s far from the best you can make. But you’re not the only one exposed to the toxins in cigarette smoke. Just as secondhand smoke can cause cancer, emphysema and other diseases in non-smokers, so can it cause dental problems for a very vulnerable population: young children.

Two studies published over the past couple years have demonstrated that “passive smoking” (exposure to secondhand smoke) considerably raises young people’s risk of dental problems. The first, published in 2008 in the Archives of Oral Biology showed quite plainly that children exposed to cigarette smoke had more caries (cavities). They also showed higher counts of pathogenic oral bacteria, more acidic saliva and a lower rate of salivary flow – all factors contributing to the formation of caries.

The second study, published earlier this year in the Journal of Clinical Periodontology, found that children exposed to cigarette smoke also show deterioration of their gum tissues. Here, the researchers measured levels of continine – a primary metabolite of nicotine – in the children’s saliva, urine and gingival crevicular fluid (found in the small space between each tooth and the surrounding gum tissue), as well as conducted periodontal exams. Those children with higher continine levels showed lower clinical attachment levels (the attachment of gum tissues to the alveolar bone and tooth structure) – a marker of gum disease. Though it’s not clear why, this effect was more pronounced in children whose fathers smoked compared to those whose mothers smoked.

The moral of the story? If you choose to continue to smoke, avoid doing so around others, especially children. But best of all – for kids’ health as well as your own – is to quit tobacco use altogether. For those of you ready to take that step, here are some resources from the CDC and info on a few natural remedies to help you get started stopping.

 

Share