Can Dietary Changes Reverse Periodontal Disease?

If you've been told you have inflammation of the gums or even periodontal disease, we have some good news for you.  Simple dietary changes may help to reverse this disease.

A little background first:  there are two types of gum disease: gingivitis and periodontitis.  Gingivitis is the swelling of the gums that is caused by the accumulation of bacteria along the gum line. If the gingivitis is left untreated, it leads to periodontitis. Symptoms of periodontal disease include receding gums, inflammation along the gum line, pain, and sensitivity to changes in temperature.  Eventually this disease can lead to bone and tooth loss.  Almost 50 percent of adults over age 30 in the United States have some form of periodontal (gum) disease based on findings by the Center of Disease Control and Prevention.

It's clear that that sugar leads to tooth decay, and that a healthful diet supports oral and systemic health alike.   What's new is that research is has demonstrated that eating certain foods can actually reverse conditions like periodontal (gum) disease.   It makes sense - a periodontal lesion is essentially a wound, and certain nutrients must be available for optimal wound healing.   Further,  periodontal disease, like heart disease or rheumatoid arthritis, is an inflammatory condition and some food studies have shown that certain foods decrease inflammation.  Here's what two recent studies on oral inflammation have shown: 

Just this past July, BMC Oral Health published a small study demonstrating the impact of diet on periodontal inflammation – a hallmark of gum disease – where the gums appear red and puffy.  For four weeks, test group participants followed a diet that was low in carbs and rich in Omega-3 fatty acids, vitamins C and D, and fiber.  A control group followed their normal eating habits.   By the end, those who ate the “oral health optimized diet” improved greatly with respect to inflammation.  In fact, the inflammation in the experimental group decreased to approximately half that of the baseline values.  These changes were not noted in the control group, which did not follow the "oral health optimized diet."

This builds on a 2009 study in the Journal of Periodontology, which looked at “The impact of the Stone Age diet on gingival condition in the absence of oral hygiene.” “Gingiva” is the clinical term for the gums.  Here, participants followed a "paleo"-type diet for four weeks and didn’t brush their teeth or otherwise follow normal hygiene habits.  A paleo-type diet includes anything we could hunt or find – meats, fish, nuts, leafy greens, fresh vegetables, and seeds. The results showed that those following the paleo-type diet had a decrease in tongue bacteria and gum disease symptoms improved. What made the difference?  In both studies, the researchers believe the lack of refined sugar and hyper-processed foods led to the decreased inflammation.

These are just the latest in a growing body of research connecting the dots between our oral health and diet.  Our message to our patients with periodontal disease is that eating healthier may, in a relatively short amount of time, lead to a decrease in gum inflammation and a slowing or even stopping of the progression of the disease.   Because many people with periodontal disease may be at risk for other inflammatory conditions, such as heart disease, these simple dietary changes may have an even greater impact on their overall health.   

Just to be perfectly clear - dietary changes are NOT an alternative to the ongoing treatment of periodontal disease.    It's vital that we continue to monitor and provide you with care.   If you have periodontal disease, we invite you consider these dietary changes as a complement to the oral therapy that you receive in the dental office and the recommended oral hygiene regiment we advise you follow at home.    Questions?  Concerns?  Give our friendly staff a call at 919 755 3450 or schedule online.   

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Gum Disease Bacteria Triggers Joint Inflammation, Latest Research Suggests

     Your mouth is a busy place, with millions of bacteria constantly on the move. While some bacteria are harmless, other bacteria multiply and produce toxins that can sneak in beneath the gumline, breaking down the bone and connective tissue in and around the teeth leading to periodontal (gum) disease. Left unchecked, gum disease can progress to the point where bone and connective tissue are destroyed, and teeth become loose and may have to be removed.

     This bacterial inflammatory process may play a key role in the onset and progression of rheumatoid arthritis (RA), an autoimmune condition affecting about 1% of the population. Rheumatoid arthritis is a debilitating, joint destroying condition where the body's immune cells attack the joints, causing chronic inflammation, swelling, pain and stiffness. Patients with RA are eight times more likely to have periodontal disease. For years, doctors and dentists have observed that people with RA tended to have more periodontal disease, and people with periodontal disease tended to have more RA. It was assumed that periodontal disease was a result of RA itself (stiff, painful hands made oral hygiene difficult) or the medications to treat RA (drugs that suppressed the immune system inhibited the body’s ability to fight harmful bacteria in the mouth). Furthermore, some people with RA have diminished production of the mouth’s protective saliva, leaving it vulnerable to periodontal disease.

     Recent research suggests the connection is much more complicated.  More and more, scientists are finding that the accumulation of mouth bacteria may trigger the development, or influence the progression, of RA. Here is a summary of some of these studies:

• At least two studies found that tooth loss, a marker for gum disease, may actually predict RA and its severity, with the more teeth lost, the greater their risk for joint inflammation. 
• Several recent studies reported the presence of high levels of antibodies to oral bacteria as well as the presence of virulent perio pathogens in the synovial (joint) fluid of people with RA. The authors concluded that the perio pathogens were directly associated with the development of rheumatoid arthritis.
• Another interesting study found that a specific perio pathogen is the only microbe known to produce an enzyme capable of modifying specific proteins resulting in an autoimmune response to these proteins. This culminates in the joint destruction typically seen in RA patients. 
• Other researchers have examined the possibility that treating periodontal disease in patients with RA could alleviate RA symptoms. They found that study participants who had a professional "deep" non-surgical cleaning at the dental office had significantly less pain and morning stiffness and fewer swollen and painful joints than the group that simply cleaned their teeth at home. Even more impressive, researchers found that the deep cleaning actually decreased levels of an inflammatory protein in the blood that triggers inflammation. 

     There are still many unanswered questions. Not everyone with gum disease develops RA, and not everyone with RA had previous gum disease. However, with such a high prevalence of periodontal disease in patients with RA, a highly plausible biological connection between these two inflammatory disease processes, and evidence of a link between RA and gum disease, we strongly suggest that people who have RA, periodontal disease, or both be diligent in taking care of their oral health.

     If you have RA or periodontal disease we encourage you to do everything possible to improve and maintain your oral health. Schedule regular dental exams and cleanings, eat healthfully, brush and floss and, if you have trouble taking care of your teeth due to stiff, painful hands or jaws, speak us about ways to make dental care easier, including the use of special assistive devices. Prevention and early treatment of periodontal disease is our goal.

     Do you know someone with RA or periodontal disease? We invite you to share this article with them. The team at Jeff M. Morrison & Assoc. DDS has expertise in successfully treating periodontal disease and, as always, we  welcome new patients. Questions?  Would you like to make an appointment?  We invite you to get in touch!  

Sources:

Konig MF, Abusleme L, Reinholdt J et al. Aggregatibacteractinomycetemcomitans–induced hypercitrullination links periodontal infection to autoimmunity in rheumatoid arthritis. Science Translational Medicine . 2016.

Research suggests that taking care of your teeth may be a good way to take care of your joints. Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/comorbidities/gum-disease/ra-and-gum-disease.php

http://www.arthritis.org/living-with-arthritis/comorbidities/gum-disease/dental-care-relieves-ra-pain.php.  Treat Gum Disease to Relieve RA Pain and Stiffness:  A thorough dental cleaning can control symptoms.

http://www.dentaleconomics.com/articles/print/volume-100/issue-11/for-your_practice/periodontal-disease-and-rheumatoid-arthritis.html

Your New Year’s Dental Resolutions

These five resolutions could make a real difference for your oral - and overall - health.

Your dental health is an important part of your overall wellness, and the New Year is a great time to create resolutions for improving your health. Here are five resolutions that the dental office of Jeff M. Morrison & Assoc., DDS recommends for a healthier 2017.

1) Resolve to brush twice per day for at least two full minutes

Brushing your teeth - and doing it correctly - is important to your dental health as it removes bacterial plaque that adheres to your teeth. For successful plaque removal brush at least twice a day for a full two minutes. Use an appropriately sized, soft-bristle, manual or electric toothbrush and fluoridated toothpaste. Also, don’t forget to change your toothbrush every three months. Using a frayed, worn toothbrush is less effective at removing plaque – it’s basically just pushing paste around.  A good idea is to change your toothbrush with the change in season, and after an illness.

Make sure that one of the times you brush is before going to bed. Not brushing at night allows bacteria to sit undisturbed, on your teeth and gums for 8 or 9 hours. Saliva flow, which protects your teeth from acidic, bacterial bi-products, decreases at night leaving your teeth defenseless. Give your mouth a fighting chance to be healthy by brushing at night!

2) Resolve to Floss Daily

Brushing alone usually only reaches about two thirds of your tooth surface.  That means that no matter how well you brush, one third of your tooth surface is not cleaned.  This is the area in between your teeth, and below your gum line where cavities and gum disease often start. Taking a minute or two to floss your teeth each day will help get rid of this bacteria decreasing the likelihood of developing these oral health problems.

The bacteria which accumulates in these areas can also lead to diseases beyond your mouth. Research has shown that bacteria and inflammation in the mouth, and gum disease, are linked to heart disease, rheumatoid arthritis, difficulty controlling blood sugar levels in diabetes, low birth weight/pre-term births and even Alzheimer’s disease. Put floss by your bed or even floss while watching TV, just don’t forget to do it once per day!

3) Resolve to stop drinking sugary and acidic beverages

The disease-causing bacteria in your mouth thrive off sugar you consume – the more sugar you eat, the more sugar bacteria eat. These bacteria deposit acid on your teeth. This acid weakens, or decalcifies, your teeth – which is how cavities begin. If your drink of choice is acidic and sugary - such as a soft drink or energy drink, your teeth are not only being weakened by the acid from bacteria, but getting a double-dose of acid from the drink itself.

If you are going to have that Coke or Gatorade, use a straw so your teeth aren’t being bathed in as much sugar and acid. Don’t sip either; drink it and be done with it so your mouth has a chance to recover from the acid attack. Along the same lines, drink water after a sugary and/or acidic beverage, to help wash away the sugar and help bring your mouth back to being pH balanced.

4) Resolve to Quit Smoking or Using Other Tobacco Products

If you use tobacco, you  hear this all the time! However, it's a message that needs repeating. Using tobacco can harm your mouth in a number of ways, increasing your risk for tooth discoloration, cavities, gum recession, gum disease and throat, lung and oral cancer. Smokers are about twice as likely to lose their teeth as non-smokers. It’s not just smoking tobacco that has negative effects on your oral health: use of smokeless tobacco can be just as harmful to your oral health. The good news is that the risk of tooth loss decreases after you quit smoking or using smokeless tobacco.

5) Resolve to keep regular and recommended dental appointments

Regular dental appointments allow our team to monitor the health of your entire oral cavity. Many oral health problems, such as chronic gum disease and cavities, don’t hurt in the beginning stages. It’s only when they have progressed to a point where treatment is quite extensive (not to mention expensive) that you actually feel any discomfort. For instance, a cavity tends to only hurt once it has reached the center of the tooth where the nerves are located. At this point, a filling may not take care of the problem. A root canal and a crown may be required, if the tooth can be saved at all. For something like oral cancer - you may not feel any pain or see evidence of a problem until it has significantly progressed. This is why detecting problems early is so important.

Hygiene appointments are more than “just a teeth cleaning.” Remember how oral bacteria from gum disease has been linked to diseases in the body? Our hygienists remove this disease-causing plaque full of bacteria, and the hardened/calcified plaque (tarter or calculus) during your regular cleaning. I also evaluate your head, neck, and tissue in the mouth for any indication of abnormalities, such as cancer. Some diseases and disorders show symptoms in your mouth before your body; like diabetes, vitamin deficiencies, and autoimmune disorders. During your exam we will notice any changes and alert you to underlying issues that may be present.

Let us know how you are doing with your New Year's dental resolutions at your next visit. If there is any way we can help you achieve your goals for this year get in touch!

Michael Anne, our Scheduling Coordinator and an avid runner, will be stepping it up this year.