Life Extension Magazine September 2008
Disease Prevention Begins in the Mouth
By Dale Kiefer
By Dale Kiefer
Nutritional Support for the Gums
In addition to brushing and/or rinsing with botanical-fortified dentifrices (preparations for cleaning the teeth), supplementation with vitamin C may also help support gingival health. Vitamin C is crucial for the maintenance of healthy connective tissue, such as the gums. In fact, one of the clinical signs of scurvy, the disease associated with vitamin C deficiency, is bleeding gums.44 (Vitamin C should not be applied to the teeth topically as ascorbic acid may erode enamel.)
The B vitamin, folic acid promotes gingival health by reducing redness and bleeding of these delicate tissues.17
Vitamin D is also important for oral health.45 Since many people do not generate adequate levels of the “sunshine hormone,” supplementation with vitamin D may be necessary to help ensure gum health.
Power of Pomegranate
Pomegranate is currently finding important applications in the field of dental health. Clinical studies have shown that this popular antioxidant superstar attacks the causes of tooth decay at the biochemical level, with remarkable vigor.12,46-49 When used regularly in combination with toothpaste that has been reinforced with bioactive botanical extracts and CoQ10, pomegranate-containing mouthwash may fight dental plaque and tartar formation by inhibiting the activities of the microorganisms that cause plaque. Additionally, pomegranate compounds possess anti-inflammatory properties that may help soothe irritated tissues.50,51
Pomegranate gets to the root of the problem by literally hitting bacteria where they live. Fascinating research shows that pomegranate extract suppresses the ability of these microorganisms to adhere to the surface of the tooth.12 The trick is to inhibit a common species of Streptococcus, preventing it from producing chemicals that create favorable conditions for fungi and other microorganisms to thrive. Plaque may involve four or more different microorganisms combining forces to colonize the surface of the teeth. Remarkably, nature’s own pomegranate fights the organisms’ ability to adhere by interfering with production of the very chemicals the bacteria use as “glue.”52
In fact, a recent study conducted by Brazilian researchers showed that pomegranate extract was more effective against the adherence of biofilm microorganisms than a pharmaceutical antifungal, when three or four microorganisms were involved.12 The results of this study suggest that “this phytotherapeutic agent might be used in the control of adherence of different microorganisms in the oral cavity,” concluded researchers.12
A study conducted at the Human Nutrition Center at Ohio State University in 2007 examined the effects of using a mouthwash containing pomegranate extract on the risk of gingivitis.53 Investigators noted that pomegranate’s active components, including polyphenolic flavonoids (e.g., punicalagins and ellagic acid), are believed to prevent gingivitis through a number of mechanisms including reduction of oxidative stress in the oral cavity,54-56 direct antioxidant activity; anti-inflammatory effects;57,58 antibacterial activity;59 and direct removal of plaque from the teeth.47 They also noted that a published pilot study has already shown that pomegranate extract can reduce the clinical signs of chronic periodontitis.46
For the Ohio State study, researchers recruited 32 healthy young men and women, who were randomly assigned to rinse with pomegranate mouthwash, or placebo, three times daily for four weeks. Subjects were instructed to rinse for five minutes per rinse. Saliva samples were evaluated for a variety of indicators related to gingivitis and periodontitis. Subjects rinsing with pomegranate solution experienced a reduction in saliva total protein content,53 which is normally higher among people with gingivitis60 and may correlate with plaque-forming bacterial content.61
Pomegranate-treated subjects also experienced significant decreases in the salivary activity of the enzyme aspartate aminotransferase. This enzyme is considered a reliable indicator of cell injury and is elevated among patients with periodontitis.62 Pomegranate rinsing also lowered saliva activities of alpha-glucosidase, an enzyme that breaks down sucrose (sugar),63 while it increased activities of ceruloplasmin, an antioxidant enzyme.64 “The pomegranate extract-induced increase in ceruloplasmin activity can be expected to strengthen antioxidant defenses,” noted investigators. Subjects who rinsed with placebo solution did not experience any of these changes.53 Taken together, researchers concluded that these changes in saliva content indicated that routine rinsing with a pomegranate mouthwash, “…could promote oral health, including affecting processes related to gingivitis.”53
Double-Pronged Attack on Plaque
Commercial toothpastes rely largely on mechanical abrasion to remove the sticky film on teeth that, left unchecked, develops into plaque. Over time, plaque provides the perfect environment for the erosion of tooth enamel, leading to cavities. Mouthwashes may contain antibacterial compounds, flavorings, and other cosmetically appealing ingredients, but, until now, none have included the power of pomegranate.
Fortunately, pomegranate extract suppresses the activity of various oral bacteria and fungi, which join forces to cause tooth decay. When combined with toothpaste formulated with bioactive compounds, such as green tea leaf extract, aloe vera gel, CoQ10, lactoferrin, folic acid, and xylitol, this powerful dentifrice duo actively fights the root causes of plaque and gum disease.
Good oral hygiene is not simply a matter of maintaining appearances. In the absence of vigilant oral care, plaque and tartar will build up, resulting in gingivitis and possibly progressing to periodontitis. And periodontitis has been associated with increased risks of conditions ranging from heart disease to stroke and even pancreatic cancer. By harnessing natural bioactive components, such as pomegranate, green tea, CoQ10, lactoferrin, aloe vera, folic acid, and xylitol, these modern dentifrices have improved the odds of winning the battle against dental degradation and related systemic illnesses.
If you have any questions on the scientific content of this article, please call a Life Extension Health Advisor at 1-800-226-2370.
1. Mealey BL, Rose LF. Diabetes mellitus and inflammatory periodontal diseases. Curr Opin Endocrinol Diabetes Obes. 2008 Apr;15(2):135-41.
2. Moutsopoulos NM, Madianos PN. Low-grade inflammation in chronic infectious diseases: paradigm of periodontal infections. Ann NY Acad Sci. 2006 Nov;1088:251-64.
3. de Pablo P, Dietrich T, McAlindon TE. Association of periodontal disease and tooth loss with rheumatoid arthritis in the US population. J Rheumatol. 2008 Jan;35(1):70-6.
4. Demmer RT, Desvarieux M. Periodontal infections and cardiovascular disease: the heart of the matter. J Am Dent Assoc. 2006 Oct;137(Suppl 1)4S-20S.
5. Ruma M, Boggess K, Moss K, et al. Maternal periodontal disease, systemic inflammation, and risk for preeclampsia. Am J Obstet Gynecol. 2008 Apr;198(4):389-5.
6. Abou-Raya S, Abou-Raya A, Naim A, Abuelkheir H. Rheumatoid arthritis, periodontal disease and coronary artery disease. Clin Rheumatol. 2008 Apr;27(4):421-7.
7. Niemiec BA. Periodontal disease. Top Companion Anim Med. 2008 May;23(2):72-80.
8. Meyer MS, Joshipura K, Giovannucci E, Michaud DS. A review of the relationship between tooth loss, periodontal disease, and cancer. Cancer Causes Control. 2008 May 14.
9. Hanioka T, Tanaka M, Ojima M, Shizukuishi S, Folkers K. Effect of topical application of coenzyme Q10 on adult periodontitis. Mol Aspects Med. 1994;15(Suppl)S241-8.
10. Davis RH, Leitner MG, Russo JM, Byrne ME. Anti-inflammatory activity of Aloe vera against a spectrum of irritants. J Am Podiatr Med Assoc. 1989 Jun;79(6):263-76.
11. Lambert JD, Kwon SJ, Hong J, Yang CS. Salivary hydrogen peroxide produced by holding or chewing green tea in the oral cavity. Free Radic Res. 2007 Jul;41(7):850-3.
12. Vasconcelos LC, Sampaio FC, Sampaio MC, et al. Minimum inhibitory concentration of adherence of Punica granatum Linn (pomegranate) gel against S. mutans, S. mitis and C. albicans. Braz Dent J. 2006;17(3):223-7.
13. Lynch H, Milgrom P. Xylitol and dental caries: an overview for clinicians. J Calif Dent Assoc. 2003 Mar;31(3):205-9.
14. Szostak WB, Szostak-Wegierek D. Health properties of shark oil. Przegl Lek. 2006;63(4):223-6.
15. Kalfas S, Andersson M, Edwardsson S, Forsgren A, Naidu AS. Human lactoferrin binding to Porphyromonas gingivalis, Prevotella intermedia and Prevotella melaninogenica. Oral Microbiol Immunol. 1991 Dec;6(6):350-5.
16. Rosin M, Kocher T, Kramer A. Effects of SCN-/H2O2 combinations in dentifrices on plaque and gingivitis. J Clin Periodontol. 2001 Mar;28(3):270-6.
17. Pack AR. Folate mouthwash: effects on established gingivitis in periodontal patients. J Clin Periodontol. 1984 Oct;11(9):619-28.
18. Mustapha IZ, Debrey S, Oladubu M, Ugarte R. Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: a systematic review and meta-analysis. J Periodontol. 2007 Dec;78(12):2289-302.
19. Michaud DS, Liu Y, Meyer M, Giovannucci E, Joshipura K. Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study. Lancet Oncol. 2008 Jun;9(6):550-8.
20. Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol. 2008 Apr;35(4):277-90.
21. Salzberg TN, Overstreet BT, Rogers JD, et al. C-reactive protein levels in patients with aggressive periodontitis. J Periodontol. 2006 Jun;77(6):933-9.
22. Williams RC, Barnett AH, Claffey N, et al. The potential impact of periodontal disease on general health: a consensus view. Curr Med Res Opin. 2008 Apr 30.
23. Boehm TK, Scannapieco FA. The epidemiology, consequences and management of periodontal disease in older adults. J Am Dent Assoc. 2007 Sep;138(Suppl)26S-33S.
24. Blum A, Front E, Peleg A. Periodontal care may improve systemic inflammation. Clin Invest Med. 2007;30(3):E114-7.
25. Pischon T, Möhlig M, Hoffmann K, et al. Comparison of relative and attributable risk of myocardial infarction and stroke according to C-reactive protein and low-density lipoprotein cholesterol levels. Eur J Epidemiol. 2007;22(7):429-38.
26. Pischon N, Heng N, Bernimoulin JP, et al. Obesity, inflammation, and periodontal disease. J Dent Res. 2007 May;86(5):400-9.
27. Dalla Vecchia CF, Susin C, Rosing CK, Oppermann RV, Albandar JM. Overweight and obesity as risk indicators for periodontitis in adults. J Periodontol. 2005 Oct;76(10):1721-8.
28. Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y. A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol. 2005 Nov;76(11 Suppl):2075-84.
29. Wood N, Johnson RB, Streckfus CF. Comparison of body composition and periodontal disease using nutritional assessment techniques: Third National Health and Nutrition Examination Survey (NHANES III). J Clin Periodontol. 2003 Apr;30(4):321-7.
30. Michaud DS, Joshipura K, Giovannucci E, Fuchs CS. A prospective study of periodontal disease and pancreatic cancer in US male health professionals. J Natl Cancer Inst. 2007 Jan 17;99(2):171-5.
31. Available at: http://www.ada.org/prof/resources/topics/oralsystemic.asp. Accessed June 27, 2008.
32. Wilkinson EG, Arnold RM, Folkers K. Bioenergetics in clinical medicine. VI. adjunctive treatment of periodontal disease with coenzyme Q10. Res Commun Chem Pathol Pharmacol. 1976 Aug;14(4):715-9.
33. Matsumura T, Saji S, Nakamura R, Folkers K. Evidence for enhanced treatment of periodontal disease by therapy with coenzyme Q. Int J Vitam Nutr Res. 1973 Apr;43(4):537-48.
34. Hamilton-Miller JM. Anti-cariogenic properties of tea (Camellia sinensis). J Med Microbiol. 2001 Apr;50(4):299-302.
35. Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea—a review. J Am Coll Nutr. 2006 Apr;25(2):79-99.
36. Ho YC, Yang SF, Peng CY, Chou MY, Chang YC. Epigallocatechin-3-gallate inhibits the invasion of human oral cancer cells and decreases the productions of matrix metalloproteinases and urokinase-plasminogen activator. J Oral Pathol Med. 2007 Nov;36(10):588-93.
37. Ko SY, Chang KW, Lin SC, Hsu HC, Liu TY. The repressive effect of green tea ingredients on amyloid precursor protein (APP) expression in oral carcinoma cells in vitro and in vivo. Cancer Lett. 2007 Jan 8;245(1-2):81-9.
38. Hsu S, Farrey K, Wataha J, et al. Role of p21WAF1 in green tea polyphenol-induced growth arrest and apoptosis of oral carcinoma cells. Anticancer Res. 2005 Jan;25(1A):63-7.
39. Hirasawa M, Takada K, Makimura M, Otake S. Improvement of periodontal status by green tea catechin using a local delivery system: a clinical pilot study. J Periodontal Res. 2002 Dec;37(6):433-8.
40. Wilkinson EG, Arnold RM, Folkers K, Hansen I, Kishi H. Bioenergetics in clinical medicine. II. Adjunctive treatment with coenzyme Q in periodontal therapy. Res Commun Chem Pathol Pharmacol. 1975 Sep;12(1):111-23.
41. Battino M, Bompadre S, Politi A, et al. Antioxidant status (CoQ10 and Vit. E levels) and immunohistochemical analysis of soft tissues in periodontal diseases. Biofactors. 2005;25(1-4):213-7.
42. Vazquez B, Avila G, Segura D, Escalante B. Antiinflammatory activity of extracts from Aloe vera gel. J Ethnopharmacol. 1996 Dec;55(1):69-75.
43. Davis RH, Donato JJ, Hartman GM, Haas RC. Anti-inflammatory and wound healing activity of a growth substance in Aloe vera. J Am Podiatr Med Assoc. 1994 Feb;84(2):77-81.
44. Dakovi D, Ljuskovi B, Mileusni I, Tepsi V. Changes in the oral caused by scurvy. Vojnosanit Pregl. 2003 Nov-Dec;60(6):753-6.
45. Dietrich T, Nunn M, Dawson-Hughes B, Bischoff-Ferrari HA. Association between serum concentrations of 25-hydroxyvitamin D and gingival inflammation. Am J Clin Nutr. 2005 Sep;82(3):575-80.
46. Sastravaha G, Gassmann G, Sangtherapitikul P, Grimm WD. Adjunctive periodontal treatment with Centella asiatica and Punica granatum extracts in supportive periodontal therapy. J Int Acad Periodontol. 2005 Jul;7(3):70-9.
47. Menezes SM, Cordeiro LN, Viana GS. Punica granatum (pomegranate) extract is active against dental plaque. J Herb Pharmacother. 2006;6(2):79-92.
48. Sastravaha G, Yotnuengnit P, Booncong P, Sangtherapitikul P. Adjunctive periodontal treatment with Centella asiatica and Punica granatum extracts. A preliminary study. J Int Acad Periodontol. 2003 Oct;5(4):106-15.
49. Taguri T, Tanaka T, Kouno I. Antimicrobial activity of 10 different plant polyphenols against bacteria causing food-borne disease. Biol Pharm Bull. 2004 Dec;27(12):1965-9.
50. Lansky EP, Newman RA. Punica granatum (pomegranate) and its potential for prevention and treatment of inflammation and cancer. J Ethnopharmacol. 2007 Jan 19;109(2):177-206.
51. Shukla M, Gupta K, Rasheed Z, Khan KA, Haqqi TM. Consumption of hydrolyzable tannins-rich pomegranate extract suppresses inflammation and joint damage in rheumatoid arthritis. Nutrition. 2008 Jul-Aug;24(7-8):733-43.
52. Li Y, Wen S, Kota BP, et al. Punica granatum flower extract, a potent alpha-glucosidase inhibitor, improves postprandial hyperglycemia in Zucker diabetic fatty rats. J Ethnopharmacol. 2005 Jun 3;99(2):239-44.
53. DiSilvestro R, DiSilvestro D, DiSilvestro D. Pomegranate extract Pomella® Mouth Rinsing Effects on Saliva Measures Relevant to Gingivitis Risk. Manuscript Submitted 12-07.
54. Seeram NP, Adams LS, Henning SM, et al. In vitro antiproliferative, apoptotic and antioxidant activities of punicalagin, ellagic acid and a total pomegranate tannin extract are enhanced in combination with other polyphenols as found in pomegranate juice. J Nutr Biochem. 2005 Jun;16(6):360-7.
55. Chidambara Murthy KN, Jayaprakasha GK, Singh RP. Studies on antioxidant activity of pomegranate (Punica granatum) peel extract using in vivo models. J Agric Food Chem. 2002 Aug 14;50(17):4791-5.
56. Battino M, Bullon P, Wilson M, Newman H. Oxidative injury and inflammatory periodontal diseases: the challenge of anti-oxidants to free radicals and reactive oxygen species. Crit Rev Oral Biol Med. 1999;10(4):458-76.
57. Madianos PN, Bobetsis YA, Kinane DF. Generation of inflammatory stimuli: how bacteria set up inflammatory responses in the gingiva. J Clin Periodontol. 2005;32(Suppl 6):57-71.
58. Aggarwal BB, Shishodia S. Suppression of the nuclear factor-kappaB activation pathway by spice-derived phytochemicals: reasoning for seasoning. Ann NY Acad Sci. 2004 Dec;1030:434-41.
59. Badria FA, Zidan OA. Natural products for dental caries prevention. J Med Food. 2004;7(3):381-4.
60. Narhi TO, Tenovuo J, Ainamo A, Vilja P. Antimicrobial factors, sialic acid, and protein concentration in whole saliva of the elderly. Scand J Dent Res. 1994 Apr;102(2):120-5.
61. Rudney JD, Krig MA, Neuvar EK. Longitudinal study of relations between human salivary antimicrobial proteins and measures of dental plaque accumulation and composition. Arch Oral Biol. 1993 May;38(5):377-86.
62. Nomura Y, Tamaki Y, Tanaka T, et al. Screening of periodontitis with salivary enzyme tests. J Oral Sci. 2006 Dec;48(4):177-83.
63. Beighton D, Radford JR, Naylor MN. Glycosidase activities in gingival crevicular fluid in subjects with adult periodontitis or gingivitis. Arch Oral Biol. 1992;37(5):343-8.
64. Bielli P, Calabrese L. Structure to function relationships in ceruloplasmin: a ‘moonlighting’ protein. Cell Mol Life Sci. 2002 Sep;59(9):1413-27.
65. Van Dyke TE, Vaikuntam J. Neutrophil function and dysfunction in periodontal disease. Curr Opin Periodontol. 1994;19-27.
66. Kesavalu L, Bakthavatchalu V, Rahman MM, et al. Omega-3 fatty acid regulates inflammatory cytokine/mediator messenger RNA expression in Porphyromonas gingivalis-induced experimental periodontal disease. Oral Microbiol Immunol. 2007 Aug;22(4):232-9.
67. Back M, Airila-Mansson S, Jogestrand T, Soder B, Soder PO. Increased leukotriene concentrations in gingival crevicular fluid from subjects with periodontal disease and atherosclerosis. Atherosclerosis. 2007 Aug;193(2):389-94.
68. Padilla EC, Lobos GO, Jure OG, et al. Isolation of periodontal bacteria from blood samples and atheromas in patients with atherosclerosis and periodontitis. Rev Med Chil. 2007 Sep;135(9):1118-24.
69. Rufail ML, Schenkein HA, Koertge TE, et al. Atherogenic lipoprotein parameters in patients with aggressive periodontitis. J Periodontal Res. 2007 Dec;42(6):495-502.
70. Littarru GP, Nakamura R, Ho L, Folkers K, Kuzell WC. Deficiency of coenzyme Q 10 in gingival tissue from patients with periodontal disease. Proc Natl Acad Sci USA. 1971 Oct;68(10):2332-5.
71. Nakamura R, Littarru GP, Folkers K, Wilkinson EG. Deficiency of coenzyme Q in gingiva of patients with periodontal disease. Int J Vitam Nutr Res. 1973;43(1):84-92.
72. Nakamura R, Littarru GP, Folkers K, Wilkinson EG. Study of CoQ10-enzymes in gingiva from patients with periodontal disease and evidence for a deficiency of coenzyme Q10. Proc Natl Acad Sci USA. 1974 Apr;71(4):1456-60.
73. Hansen IL, Iwamoto Y, Kishi T, Folkers K, Thompson LE. Bioenergetics in clinical medicine. IX. Gingival and leucocytic deficiencies of coenzyme Q10 in patients with periodontal disease. Res Commun Chem Pathol Pharmacol. 1976 Aug;14(4):729-38.
74. Iwamoto Y, Nakamura R, Folkers K, Morrison RF. Study of periodontal disease and coenzyme Q. Res Commun Chem Pathol Pharmacol. 1975 Jun;11(2):265-71.
75. Figuero E, Soory M, Cerero R, Bascones A. Oxidant/antioxidant interactions of nicotine, Coenzyme Q10, Pycnogenol and phytoestrogens in oral periosteal fibroblasts and MG63 osteoblasts. Steroids. 2006 Dec;71(13-14):1062-72.