The Best Way to Treat Gum Disease? Avoid it!

healthy gums
But how do you go about doing that?

You can start by not adding fuel to the fire:

  • If you smoke or use tobacco, quit. It’s the number one risk factor for periodontal disease and tooth loss.

  • Make sure you get 7 to 9 hours of quality sleep each night. If you brux (clench or grind your teeth) during sleep or suspect you may have sleep apnea, talk with your dentist about solutions so you can get a good night’s sleep. Research suggests that lack of sleep may be second only to smoking as a risk factor for gum disease.

  • If you eat a lot of sugar, flour-based foods, and other refined carbs, cut back on them. Gum disease is marked by chronic inflammation, and these foods make inflammation worse.

  • Evaluate the stress in your life and take steps to bring it under control.

Then there’s the matter of oral hygiene.

According to new research in the Journal of Clinical Periodontology, even just tooth brushing can make a difference. Participants who reported brushing at least twice a day were found to have deep periodontal pockets on about two fewer teeth, on average, than those who brushed less.

Those pockets deepen as the disease process causes the gums to pull away from the teeth. With healthy gums, the natural space between the gums and teeth – the sulcus – is one to three millimeters deep. Neglected, the spaces get even deeper, allowing more room for harmful bacteria to colonize and thrive.

Once this happens, tooth brushing can only be a partial help. At this point, additional tools such as floss and oral irrigators are needed to control the pathogens harbored within the pockets.

All of these are also tools that you can use right now to keep gum disease from developing in the first place.

Flossing is basic, but it needs to be done correctly in order to make a difference. And if your gums bleed, that’s all the more reason to get diligent about flossing. That bleeding is a sign of gum disease.

If you don’t like to floss, try cleaning with interproximal brushes instead. These small brushes fit between your teeth and are great for cleaning at the gum line.

You can also use these “proxy” brushes to apply ozonated oils to your gums. These oils are commonly made by infusing medical grade ozone into an organic oil such as olive, sunflower, coconut, hemp, or castor. Ozone is a powerful disinfectant that’s ideal for controlling oral pathogens. (We use it in a wide variety of ways here in our office!)

Oil pulling can be a helpful addition to your daily hygiene routine. A simple swish of a tablespoon of coconut oil every morning for 10 to 15 minutes before you brush can have a positive impact.

Oral irrigators such as Waterpiks have also proven quite helpful for keeping the gums healthy. Antimicrobial botanical tonics can even be added to the water to enhance their cleaning power. (The Dental Herb Company’s Under the Gums Irrigant is one good option.)

In addition to amped up hygiene, a few nutritional changes can have a big impact, as well. It’s not just about avoiding the harmful stuff but making sure you get the full complement of vitamins, minerals, and other nutrients your body needs to function as designed.

Also look to getting more movement into your daily routine. Research has consistently shown that exercise helps lower your risk of gum disease, as well as reduce chronic inflammation in general.

Unfortunately, there’s no silver bullet against gum disease. But working a variety of the above tools into your daily health routine will take you far in keeping perio problems at bay, keeping your smile healthy and whole.

Got Gum Disease? Treatment Could Save Your Life

ultrasonic scalingPeriodontal disease affects up to 80% of Americans. It’s not just a problem in the mouth, either. It’s been linked to many other conditions, including heart disease, stroke, diabetes, rheumatoid arthritis, and some cancers.

The good news? Periodontal therapy can help reverse gum disease. This may, in turn, help improve your overall health – and, as we noted before, even save you a good chunk of change in the long run.

For instance, a new review of the science suggests that non-surgical perio therapy may improve glycemic control in people with diabetes, at least in the short term.

Patients who underwent [nonsurgical] periodontal treatment had about half a percent lower HbA1c levels three months after treatment than those who did not undergo periodontal therapy.

“Evidence from the literature suggests that successful periodontal treatment, which results in the reduction of inflammation from the periodontal tissues, improves the metabolic control of people with diabetes mellitus,” the authors wrote.

Another recent study looked at the impact of intensive periodontal treatment on blood pressure. In this case, 95 patients were randomly split between control-treatment and intensive-treatment over the course of 4 weeks, then followed for 6 months.

After one month, systolic blood pressure – the top number – was almost 3 points lower in patients who had intensive treatments. After three months, it was almost 8 points lower. Diastolic pressure dropped, too, by nearly 4 points.

At 6 months, systolic pressure had dropped almost 13 points, and diastolic had dropped by nearly 10.

“The present study demonstrates for the first time that intensive periodontal intervention alone can reduce blood pressure levels, inhibit inflammation and improve endothelial function,” said study lead author Jun Tao, M.D., Ph.D., chief of the department of Hypertension and Vascular Disease and director of the Institute of Geriatrics Research at The First Affiliated Hospital of Sun Yat-sen University in Guangzhou, China.

The study was published last summer in the Journal of Periodontology.

Other research has found evidence that periodontal treatment may help those with chronic kidney disease and atherosclerosis (“hardening of the arteries). The latter was especially so for those “already suffering from CVD and/or diabetes.”

On the flipside, some research has found that patients who don’t respond well to periodontal therapy had “an increased risk for future CVD, indicating that successful periodontal treatment might influence progression of subclinical CVD.”

So what are the options for treatments?

While in its early stages, gum disease may often be reversed by more intensive home hygiene, nutritional improvements, and other lifestyle changes, dental help is needed when it becomes more advanced.

This can include frequent deep cleanings, such as with an ultrasonic scaler, along with regular ozone treatment to keep harmful bacteria under control. Probiotics may also be recommended to help right the microbial balance in your mouth.

Between cleanings, a system like PerioProtect can also help keep harmful bacteria at bay so friendly microbes can proliferate.

And when gum disease is particularly advanced? LANAP (Laser Assisted New Attachment Procedure) can be used to remove diseased tissue while preserving healthy tissue and destroying pathogens. It’s a kind of super deep cleaning for your gums and tooth roots, less invasive than conventional surgery yet potentially more effective. Research suggests it may even stimulate the growth of new bone in the jaw, restoring support to the teeth. And it’s comfortable for the patient, essentially pain-free.

Research published in the Journal of Periodontology has stated that LANAP should be considered the first line therapy in restoring health to diseased gums.

But the absolute best way to treat gum disease? Keep it from arising in the first place.

Fluoride in Your Tea

5001227590_1a883e0927_zThough we’ve blogged before on the benefits of green tea for healthy gums and its ability to relieve oral pain, we’ve not looked at the relationship between tea – green or otherwise – and fluoride

A recent entry on the Nourished Kitchen blog, a traditional foods blog, posed the question: Should you be worried about fluoride in your kombucha? If you have never even thought to ask the question, you’re not alone. Most of us don’t know where to look for fluoride.

In answering the question, the blog’s creator Jenny McGruther cites the Big Book of Kombucha:

Kombucha is made from weak tea, rather than strong, so there will be less fluoride in kombucha than a strong tea of the same volume.

On the surface, this answer might seem plausible. But it’s an incomplete answer. The reality is, since we don’t often consider what foods and beverages may contain fluoride; since many of us live with fluoridated municipal water supplies; since many of us use products like toothpaste and mouthwash that contain fluoride, we have no real way of knowing what our daily intake is.

The truth is, ingesting a known toxin daily at unknown levels can be problematic.

Though McGruther says she doesn’t “worry about relatively small amounts of fluoride in the modest amounts of kombucha my family drinks,” this might err on the side of simplicity.

If you’re wondering about fluoride in tea products, one of the best sources for scientifically based information is the Fluoride Action Network.

Five informative links to assist  your decision making:

  1. How fluoride ends up in a tea plant?
  1. Which tea contains high levels of fluoride?
  1. What kind of health issues a heavy tea drinker might expect?
  1. How much fluoride is in newer tea commodities, such as: packed teas, bottled tea, canned tea, and instant tea powders?
  1. How to minimize your exposure to fluoride in tea, and other products?

That said, it’s important to remember that drinking tea does have many benefits, some which may offset potential fluoride exposure. A well-researched approach can provide information that allows for balanced decision making.

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Treating Gum Disease May Lower Blood Sugar Levels

gum diseaseEarlier this week, folks observed World Diabetes Day in response to growing concerns about the global epidemic. A joint project of the International Diabetes Federation and World Health Organization, the annual campaign reaches a billion people in 160 countries around the world.

But despite casting such a wide net, half of all people with diabetes will stay undiagnosed. Considering that more than 370 million have the condition, that’s more than a few in the dark about their health. And those numbers are only expected to grow.

What you may not know is that the mouth suffers right along with the rest of the body when it comes to diabetes. As a 2012 study in the Journal of Pharmacy & BioAllied Sciences puts it,

Diabetes is a systemic disease which is a serious oral co-morbidity. Most oral complications occur in uncontrolled diabetics, involving the periodontium, the calcified tissue, and the oral mucosa. Therefore, poor metabolic control, periodontal disease, dental caries, xerostomia (dry mouth), and fungal infections go hand in hand.

The good news? Treating your gum disease may actually lower your blood sugar levels and keep diabetes in check.

Another great video for getting to know more about the link between your mouth and diabetes is Dr. Evie Lalla’s “Unscrambling the Periodontitis-Diabetes Connection.” Though her talk is geared toward doctors, don’t let that scare you. It’s valuable information. It’s also likely to spark questions you can ask your dentist or doctor.

We see education as a vital component of good oral health. It provides a foundation of understanding – the first step toward action. Good oral practices can prevent or control inflammation, helping you return to your desired state of health.

Image by AJC1

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Your Mouth Is the Gateway to Your Body

In honor of October’s designated status as National Dental Hygiene Month, we’d like to share an excellent video we recently ran across – “Gums to Guts: Periodontal Medicine,” Professor Mark Ryder’s talk on oral health and its relationship to the body’s systematic health.

It not only offers great visuals and useful info on markers of health and disease; it supports the importance of seeing the mouth as an integrated part of the body, not a separate feature.
 

 
If it’s been awhile since your last hygiene visit and exam, remember this key message: The mouth is a gateway to the body and has much to do with what’s going on in your body. Good oral health not only supports good body health and wellness; it’s a key factor in it.

Dietary Balm for Gum Disease

toothy grin with gum diseaseYou do all the right dental things. You brush at least twice a day. You floss (even if some insist there’s “no scientific evidence”). You schedule your next hygiene appointment before you leave your last one. Still, you have gum disease.

So what base might you be missing? It could well be diet.

A recent pilot study suggests that switching to a low inflammation diet may help that gum disease finally heal.

The small study focused on 15 adults with gingivitis and an apparent appetite for carbs – a major contributor to chronic inflammatory conditions. Ten of them followed a low-carb, anti-inflammatory diet. They were also directed to increase their intake of omega-3 fatty acids, vitamin C, vitamin D, and antioxidants.

The remaining five served as the control group and kept on eating their typical high-carb diet. All participants were told to stop using floss or other interdental cleaners but otherwise keep up their usual oral hygiene habits. Each group followed their plan for six weeks.

After the four observational weeks, the experimental group showed significantly reduced gingival and periodontal inflammation compared with the group who did not change their diet. Specifically, reducing carbohydrates led to a significant improvement in gingival index, bleeding on probing, and periodontal inflamed surface area. In addition, increasing omega-3 fatty acids and fibers improved plaque index.

The improvements pose many questions for further studies to explore. First, since the periodontal health indicators occurred despite both groups showing no change in periodontal values, the authors question the actual role plaque plays in the development of gum disease.

Further research will likely be done to determine if one particular component of the anti-inflammatory diet was more significant than another. But one thing’s certain from this very limited study: Dietary pattern plays a significant role in the development of periodontal disease.

In the meantime, you don’t need to wait. You, friend, can be an experiment of one. Give the study’s protocol a try:

  1. Put the kibosh on carbs.
  2. Get on your omega-3 fatty acids.
  3. Welcome the vitamin C and vitamin D.
  4. Eat a rainbow of antioxidants.
  5. Fiber up!

And by all means, keep practicing your effective oral habits!

Image by Morgan

Your Body Requires Maintenance

None of us are getting any younger. And the truth is, as we age, we end up spending more time on body maintenance than our younger selves did. Along the way, most of us learn to identify and fine-tune what keeps us in our optimal health zone.

The benefit of all those years as they add up? We acquire a certain level of body wisdom.

Still, it’s a good thing that science is almost as keen on aging-related topics as we are. Case in point? The Journal of Gerontology’s recent study on age-related bone loss.

CoQ10 capsulesLooking at the specialized tissue that supports our teeth – the alveolar bone – the authors evaluated the effect of a life-long low coenzyme Q10 dosage along with one of two types of unsaturated fat based diets: polyunsaturated (omega-6), or monounsaturated (omega-6/omega-3 ratio).

Need a quick primer on omega-6 vs. omega-3 fatty acids? Here you go.

Fats are a hot topic these days. Much of what folks have believed over the last 40 years is being turned on its head. In 2013, the British Medical Journal stunned with a study that showed that “replacing saturated animal fats with omega-6 polyunsaturated vegetable fats is linked to an increased risk of death among patients with heart disease.”

And the American Heart Association was left scratching its head.

It’s not that omega-6 fatty acids are “bad” in and of themselves.. But they must be in a balanced ratio with omega-3 fatty acids for optimal health.

Similarly, saturated fats are turning out to be not at all the demon that the mainstream medical industry has made them out to be. In fact, a diet too high in polyunsaturated fatty acids and too low in saturated fats may actually cause oxidative damage to weak cell membranes.

In addition to heart disease, a high level of omega-6 fatty acids has also been correlated with bone loss and periodontal disease. Turns out, when it comes to your body’s ability to remodel its bone, too much omega-6 diminishes your ability to produce prostaglandin. Prostaglandin is critical to bone development.

And this is where our CoQ10 study comes in.

Results [showed] that exacerbated age-related alveolar bone loss previously associated to n-6 polyunsaturated fatty acid diet was attenuated by coenzyme Q10.

In other words, CoQ10 may mitigate the bone damage seen with high omega-6 diet. Gene expression analysis suggested that CoQ10 might increase that little powerhouse in your cells known as your mitochondria, restoring their ability to adapt to aging in gingival cells. This is likely due to an increase cell turnover and better oxidative and respiratory balance.

Considering that the typical American diet contains up to 25 times more omega-6 fatty acids than omega-3s, increasing CoQ10 intake could help a lot of people. But considering how badly it tends to drag down health overall, adjusting diet so you get a more balanced intake of omega-6 and omega-3 seems the more sensible route for long-term health and well-being.

However you approach your body’s maintenance, remember that reaching your goals requires daily habits that support the outcome you desire. When it comes to oral health, the daily habit of good nutrition combined with effective brushing and flossing techniques go a long way to keeping you at the level you consider to be optimal for you.

Know Your Nutrients: Iron

Periodontal disease isn’t just about your gums. It’s not even about your mouth. It’s about your whole body health.

The latest reminder? A follow-up study in the Journal of Indian Society of Periodontology recently confirmed that periodontitis – severe, advanced gum disease – may lead to anemia of chronic disease (ACD), a form of anemia seen in chronic infection and chronic inflammation. The researchers also found that treating the gum disease can improve anemic status.

iron from periodic tableGum disease triggers inflammation. In the short-term, this is exactly how your body should react. Over the long-term, though, inflammation is damaging, and that chronic inflammation is part and parcel of gum disease. Among other things, it interferes with your body’s ability to absorb iron.

Other factors that can lead to iron deficiency include blood loss, intense exercise or simply not getting enough through diet – especially during times of increased need, such as pregnancy, growth spurts, and lactation.

Lack of iron is a big problem. Your blood cells need it. Without enough, your red blood cells can’t carry enough oxygen throughout your body. Fatigue, dizziness, difficulty concentrating and other symptoms of anemia are the result. Your body isn’t getting what it needs to work properly.

It is getting more vulnerable to infections and illness.

So how much iron do you need? The general recommendation is 8 mg daily for men, 18 mg daily for women under 50, and 8 mg for women over 50. (Recommendations are even higher for women during pregnancy and lactation, and vary for children according to age.)

While iron supplements are available, your best first source is – always and again – real whole foods. Meats and other animal source foods provide heme iron, while plants provide non-heme iron. Since non-heme iron isn’t absorbed as well as heme, it’s especially important for vegans to watch their intake and eat in ways that promote iron-absorption. Especially iron-rich foods include

  • Liver and other organ meats
  • Red meat
  • Egg yolks
  • Oysters, clams, mussels and squid
  • Chickpeas
  • Beans
  • Lentils
  • Spinach
  • Tofu and edamame (be sure to get non-GMO)
  • Quinoa

For healthy adults, there’s little risk of overdoing it with dietary iron. Iron supplements, however, – like all supplements – are best taken under a health practitioner’s guidance, as overconsumption can cause problems (as well as interfere with your ability to absorb other essential nutrients, such as zinc). If you are taking any pharmaceutical medications, talk with your doctor before you start taking any kind of supplement to avoid any potential negative interactions.

Image via Bertucio Design @ Shapeways

The Mouth-Body Connection: Obesity and Gum Disease

obese man in waiting areaThe numbers are not encouraging.

According to the latest numbers from Gallup and Healthways, the US obesity rate has climbed once again, nearing 28%. That’s more than one in four of us. Not just overweight but obese. Here in Texas, the rate is even higher: 30%.

Meanwhile, cancer specialists speaking at the annual meeting of the American Society of Clinical Oncology in Chicago cautioned that obesity may overtake smoking as the leading cause of cancer within the decade. According to Harvard oncology specialist Jennifer Ligibel, the relationship between the two conditions is “clear.”

“It’s the case with breast cancer, a prostate cancer, cancer of the colon and all the gynaecological cancers,” she said. She highlighted research showing that obesity increased the risk of womb cancer sixfold.

Experts said obesity was driving cancer because it results in hormones imbalances that can fuel tumour growth.

Cancer and obesity are also both inflammatory conditions – like periodontal disease, which has also been linked to both.

The obesity link, in particular, has been highlighted by recent studies, such as the new research review just published in the Journal of Clinical Periodontology. The studies that met the authors’ criteria included more than 42,000 subjects and all together showed that those

who became overweight and obese presented higher risk to develop new cases of periodontitis…compared with counterparts who stayed in normal weight.

A review in the Journal of Periodontology similarly found “that overweight, obesity, weight gain, and increased waist circumference may be risk factors for development of periodontitis or worsening of periodontal measures.”

Research published earlier this year in the same journal found more pronounced markers of periodontitis (advanced gum disease) among those who were overweight and less physically fit.

So are exercise and more healthful eating the ticket? Perhaps not entirely. For one of the other findings in the Gallup/Healthways report was that social and economic factors may be fueling the rise in obesity rates, as well. Environmental factors also play a role. For instance, a new study in Environmental Health Perspectives showed how BPA may be contributing to the obesity crisis, as well:

The study is the first to find that people’s bodies metabolize bisphenol-A (BPA) — a chemical found in most people and used in polycarbonate plastic, food cans and paper receipts — into something that impacts our cells and may make us fat.

The research, from Health Canada, challenges an untested assumption that our liver metabolizes BPA into a form that doesn’t impact our health.

“This shows we can’t just say things like ‘because it’s a metabolite, it means it’s not active’,” said Laura Vandenberg, an assistant professor of environmental health at the University of Massachusetts Amherst who was not involved in the study. “You have to do a study.”

Like most modern chronic health problems, obesity is multifactoral. But eating better and getting more active do make a great start. Ramped up oral hygiene and nutritional therapy can offer big help, as well, in putting the brakes on chronic inflammation.

Image by Tony Alter

Why Gum Disease Matters – & How We Can Help

periodontal biofilm

Periodontal biofilm

In the day to day, gum disease may not seem like such a big deal. Sure, your gums may bleed a bit when you brush and floss. They may look a little puffy. But on the whole, you don’t really don’t notice it affecting your health all that much – until it’s well advanced. Then you’re looking at possibly losing teeth due to the bone loss that accompanies periodontitis.

You’re also looking at increased risk of other inflammatory conditions, including diabetes, heart disease, stroke, rheumatoid arthritis, kidney disease, Alzheimer’s and cancer.

In short: It’s serious. And it’s why we put such an emphasis on prevention. Gum disease? You just don’t want to go there.

But all too many do go there, which is why we’ve also invested in advanced, non-surgical alternatives to traditional perio treatment that can help you on your way to restored gum health – solutions like the laser therapy known as the LANAP® protocol.

LANAP stands for “laser assisted new attachment procedure,” which lets the dentist remove diseased tissue while preserving healthy connective tissue and destroying harmful bacteria and other pathogens. Here are the basics of how it works:
 

 
Think of it as a kind of super deep cleaning for your gums and tooth roots, less invasive than conventional surgery yet potentially more effective. “Clinically,” says Dr. Robert H. Gregg, II, who helped develop LANAP,

what immediately becomes apparent is that post operatively there is minimal discomfort, shrinkage of swollen, puffy gums and reduction of bleeding.

There’s also seldom any of the root sensitivity and long-looking teeth that can accompany traditional perio surgery. .

You can read more about the nuts and bolts of this procedure here.

Recently, we had the opportunity to chat with Dr. John McAllister – a practicing dentist in Downey, California, and clinical instructor of the LANAP protocol at the Institute for Advanced Laser Dentistry – and to ask him a few questions about the protocol, and about periodontal health and disease in general. Here’s what he had to say.

Q: You hear lots of different statistics on periodontal disease – that it affects 50% of the adult population, 75% or even more. Just how common is gum disease? And how serious of a problem is it?

A: Periodontal disease has been underdiagnosed in the profession for years. The challenge is that less than 20% of general dentists do yearly perio probes of their adult patients, according to the research. This same issue was shown in the recent CDC report that gum disease has been underreported by as much as 50%. The reason was that initial CDC statistics had been done with Periodontal Screenings Assessments, not full mouth charting.

So it is the profession that needs to take the lead and insist that patients and third party payers pay for and value full mouth periodontal probing. What gets paid gets done.

The other challenge is that periodontal disease does not hurt until it is too late. Our job is to educate our patients and inform them that periodontal disease is the number one cause of tooth loss.

Q: From the patient’s perspective, what makes LANAP superior to other protocols?

dental laserA: Regeneration, regeneration, regeneration!

Recently, the Journal of Periodontology did a systematic review of the literature, and it was clearly stated that the LANAP protocol should be considered the first line treatment in periodontal regeneration.

The beauty of LANAP for the patient, though, is that it is minimally invasive. No scalpels are used. No sutures are used. No biologics are used. Since it is minimally invasive, patients experience little to no pain. Patients tell me that their pain both the day after treatment and the week after is 2 to 4, on a scale of 1 to 10.

Q: We’ve heard anecdotal evidence that LANAP can stimulate bone growth. Has any research been done in this area yet? What evidence do we have?

A: Yes! Countless radiological bone fill before-and-after cases have been collected by numerous clinicians. But the most valuable science has been done with human histology published in peer reviewed journals done by two different clinicians. Both found evidence for new bone new cementum and new connective tissue attachment.

Q: Although you are not a periodontist, you obviously have a deep interest in perio issues. How did you become so interested in this aspect of dentistry? How does your interest influence your everyday practice?

A: I started in dental school with my first patient, a young lady in her 20s with advanced periodontal disease and mobile teeth. I asked the periodontist on staff, “What can we do to save her teeth?”

“Nothing. Dentures.” I was shocked! How can we get to the moon and not help someone keep their teeth?

Then, my first patient out of dental school was my uncle. He had advanced periodontal disease, and I couldn’t help him other than provide dentures. I was devastated and was on the quest to fight periodontal disease.

Consider: By definition, a dentist without a patient is unemployed. If you ask your patient, “How can I help you?” as long as they’re not in pain, they will tell you, “I want to keep my teeth! I want to keep my teeth!” Since periodontal disease is the number one cause of tooth loss, then it is only logical to accept that periodontal health is THE FOUNDATION to all our restorative dentistry.

Periodontal biofilm image by Mark Bonner, DMD