Periodontitis and Cavities
Tooth Loss, Nutrition, and Diet
Approximately 60% of United States adults are missing at least one tooth, and 10% have no teeth at all (Marcus 1996). Besides the aesthetic value of a nice smile, there are harmful health repercussions to lacking functional teeth, including a greater risk of malnutrition (ADA 2003). People missing their teeth have about 20% of the chewing capacity of people with teeth, and tend to avoid eating fruits, vegetables, and whole grains (Moynihan 2001). This can quickly lead to malnutrition as well as serious vitamin and mineral deficiencies.
Nutrition for a Healthy Mouth
Good oral hygiene, regular tooth brushing and flossing, tongue cleaning, regular dental check-ups, and use of high-quality oral care products can prevent or reduce the risk of cavities. At the same time, because of the risk of a dangerous inflammatory response, it is important that people with gum disease protect themselves with powerful anti-inflammatories. The following nutrients support healthy gums and reduce inflammation.
Coenzyme Q10. In one study, topical application of coenzyme Q10 (CoQ10) to periodontal pockets significantly reduced gingivitis, bleeding gums, and pocket depths after 5 to 7 days of treatment (Hanioka 1994). In another study, symptoms of gingivitis and periodontitis improved 3 weeks after beginning CoQ10 treatment (Wilkinson 1975). Topical application of CoQ10 improved adult periodontitis alone and in combination with non-surgical periodontal therapy (Hanioka 1994).
Hydrogen peroxide. Hydrogen peroxide, which is included in many brands of toothpaste, is valuable for its ability to reach bacteria hiding among gingival folds and gaps. Hydrogen peroxide is also added to some mouthwashes to reduce gingivitis and whiten teeth (Hasturk 2004). Hydrogen peroxide has been used effectively for years in dentistry.
Essential Oils. Mouth rinses containing essential oils such as eucalyptus oil and menthol significantly reduced both gingival inflammation and bleeding when used in conjunction with fluoride toothpaste (Beiswanger 1997). Tea tree oil (Melaleuca alternifolia) is an antiseptic, fungicide, and bactericide that is effective against oral bacteria (Vasquez 2002; Carson 2001).
Tea tree oil, used as an oral rinse, has been proven to kill bacteria (Kulik 2000). In fact, research has shown that a tea tree oil concentration of 0.6% inhibited 14 of 15 oral types of bacteria. In one study, 49 subjects age 18 to 60 years with severe, chronic gingivitis were divided into groups, one of which was given a gel containing tea tree oil to apply with a toothbrush twice daily. The tea tree oil group had improved gingival index and papillary bleeding index scores attributed to the herb’s anti-inflammatory properties (Soukoulis 2004).
Folic Acid. Mouthwash containing folic acid is effective in treating gingivitis and its accompanying inflammation. Among pregnant women, who are prone to gingivitis, folate mouthwash has proven superior to oral folate supplementation in preventing gingivitis (Pack 1980, 1984; Thompson 1982).
Green Tea. Green tea extract is rich in a class of antioxidants called catechins. Two in particular, epigallocatechin gallate (EGCG) and epicatechin gallate (ECG), combat oral plaque and bacteria (Horiba 1991; Otake 1991; Rasheed 1998). These green tea polyphenols work as anti-plaque agents by suppressing glucosyl transferase, which oral bacteria use to feed on sugar. Other research has demonstrated that green tea extract can kill oral bacteria and inhibit collagenase activity. Collagenase, a natural enzyme that becomes overactive in the presence of bacterial overgrowth, can destroy healthy collagen in gum tissue.
Green tea extract applied topically inhibits S. mutans bacteria in the laboratory. These bacteria have been implicated in the development of dental cavities. The scientists suggested that certain green tea extracts might be especially helpful in preventing tooth decay by inhibiting the development of bacterial plaque (Hattori 1990). In a Chinese study, green tea extract was used to rinse and brush teeth. The study demonstrated that S. mutans could be inhibited completely after contact with green tea extract for 5 minutes. There was no drug resistance after repeat cultures, and researchers concluded that green tea extract is effective in reducing the risk of developing cavities (You 1993). Other studies have found that the catechins in green tea remain at active levels in saliva for up to 1 hour following application (Tsuchiya 1997).
Additional studies confirm the benefits of green tea in fighting gum disease, especially when combined with conventional treatments. In a pilot study, hydroxypropylcellulose strips containing green tea catechins as a slow-release local delivery system were applied to the pockets in periodontal patients once a week for 8 weeks. The green tea catechins inhibited the bacteria P. gingivalis and Prevotella spp., and a reduction in pocket depth was observed (Hirasawa 2002).
Hyperimmune egg extract. Agricultural scientists discovered long ago that they could immunize hens against germs that threaten humans. This immunity was then passed on by the hen to the egg (Dias da Silva 2010; Dean 2000; Cama 1991). Scientists have now been able to customize eggs to provide different types of immunity. At least 24 different organisms have been used to immunize a single hen, which then lays eggs that offer passive immunity to all of the organisms (Dean 2000).
Hyperimmune egg extract has been shown to reduce the volume of dental plaque, which in turn cuts down on the total load of inflammation in the mouth (Hatta 1997). Animals supplemented with hyperimmune egg against the leading bacterial cause of dental caries developed significantly lower dental caries scores than control animals (Otake 1991; Mitoma 2002). Oral hyperimmune egg rinses have also been used successfully in humans to reduce disease-causing bacteria; the extracts remain active and present in the mouth at least overnight, offering long-standing protection (Carlander 2002; Wang 2003; Zhou 2003).
Pomegranate. Researchers are finding important applications for pomegranate in the field of dental health. Clinical studies have shown that this popular antioxidant vigorously attacks the causes of tooth decay at the biochemical level (Vasconcelos 2006; Sastravaha 2005; Menezes 2006; Sastravaha 2003; Taguri 2004). Pomegranate attacks bacteria where they live. Research shows that by interfering with production of chemicals the bacteria use as “glue”, pomegranate extract suppresses bacteria’s ability to adhere to the surface of the tooth (Vasconcelos 2006) (Li 2005).
A study conducted in 2007 examined the effects of a mouthwash containing pomegranate extract on the risk of gingivitis (DiSilvestro 2007). Investigators noted that pomegranate’s active components, including polyphenolic flavonoids (eg, punicalagins and ellagic acid), are believed to prevent gingivitis through a number of mechanisms including reduction of oxidative stress in the oral cavity, direct antioxidant activity (Seeram 2005; Chidambra 2002; Battino 1999), anti-inflammatory effects, antibacterial activity (Madianos 2005; Aggarwal 2004), and direct removal of plaque from teeth (Menezes 2006). 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 (DiSilvestro 2007), which is normally higher among people with gingivitis (Narhi 1994) and may correlate with plaque-forming bacterial content (Rudney 1993).
Cranberry. Cranberries may offer important benefits for healthy teeth and gums. The berries contain a special chemical that may inhibit and even reverse the formation of dental plaque deposits that often lead to tooth decay (Weiss 1998). Cranberry constituents may also help reduce inflammation in gingival or gum tissues, which could offer protection against periodontitis (Bodet 2008). These promising findings suggest that cranberry may soon find a place in dental health care regimens.
Xylitol. Pure xylitol, a white crystalline substance that resembles and tastes like sugar, is found naturally in fruits such as plums, strawberries, and raspberries. Xylitol is used commercially to sweeten sugarless gum and candies. Xylitol has also been shown to inhibit the formation of plaque. In a double-blind and controlled study, Swedish researchers had 128 children chew gum containing either xylitol or the sweeteners sorbitol and maltitol, 3 times daily for 4 weeks. While both were effective against the buildup of dental plaque, only the xylitol-sweetened gum eliminated microbes found in saliva, particularly a strain of bacteria implicated in tooth decay (Holgerson 2007). Xylitol could thus be an essential ingredient in a targeted strategy to avert dental disease.
A double-blind, placebo-controlled study of 2,630 children compared a standard fluoride toothpaste with 1 containing 10% xylitol. Over a 3-year period, children given the xylitol-enriched toothpaste developed notably fewer cavities than those using the fluoride-only toothpaste (Sintes 1995).
Probiotics. Probiotics have been defined as “living microorganisms which upon ingestion in certain numbers exert health benefits beyond inherent general nutrition” (Gorbach 2002). Scientists have been interested in the makeup of microbes that live in the mouth (oral flora) for decades, seeking to identify factors that promote growth of healthy organisms and reduce growth of those implicated in disease and inflammation (Li 1999; Marsh 1991; Marsh 1994; Marsh 2006).
Probiotics improve oral health and can help change the stubborn composition of dental biofilm and plaque (Marsh 2006; Kornman 2008). Reducing plaque through teeth brushing is always a desirable goal; however, complete elimination is not possible. Therefore, changing the actual composition of plaque from an inflammatory cytokine-rich environment to a more benign environment (dominated by neutral or even helpful organisms) can contribute to overall systemic health (Kamma 2009; Compend 2008; Pasquantonio 2008).
In laboratory studies, the probiotic S. salivarius helped inhibit formation of the sticky biofilm that can contribute to oral disease (Tamura 2009). Building on these results, an animal study showed that the S. salivarius probiotic helped displace biofilm from teeth, displacing cavity-causing bacteria and inhibiting tooth decay (Tanzer 1985). Another experiment demonstrated how effectively a second oral probiotic protects oral health (Ganeden 2009). In this experiment, a form of Bacillus coagulans (GanedenBC30™) was shown to competitively inhibit the cariogenic (cavity-inducing) bacterium Streptococcus mutans, which contributes to significant tooth decay.
Lactoferrin. Lactoferrin, a naturally occurring antimicrobial agent, is found in saliva and gingival fluid, breast milk, tears, and other bodily fluids.
This protein is a well-known immune system booster involved in the body’s responses to infection, trauma, and injury (Kruzel 2007). Lactoferrin may bind to and slow the growth of periodontitis-associated bacteria (Kalfas 1991). In an animal study, locally applied lactoferrin powder appeared to support the healing of oral lesions (Addie 2003).
Aloe Vera. Aloe vera gel packings are sometimes used by dentists after tooth extraction to reduce the incidence of infection and dry socket (Poor 2002). They have also been shown to reduce the risk of developing ulcers in the mouth (Garnick 1998).
Propolis. A 20% ethanol propolis extract was compared to antifungal agents such as nystatin, clotrimazole, econazole, and fluconazole in a study designed to assess the susceptibility of Candida albicans, an oral bacteria. The researchers concluded that the propolis extract could be an alternative medicine in treating candidiasis, but further studies were needed (Martins 2002)
For More Information…
Additional chapters that may be of interest include:
The Value of Vitamin C, Vitamin D, and Calcium
Vitamin C has long been known for its ability to prevent gum disease and tooth loss. In fact, the use of vitamin C in dental disease is one of the earliest recorded uses of nutrient therapy in Western medicine. In 1747, a British Naval physician named James Lind noticed that lime juice, which is rich in vitamin C, helped prevent scurvy, which causes tooth loss. As a result, British sailors bottled lime juice for gum disease prevention. Incidentally, this practice later gave rise to the term “Limey.”
Modern studies have confirmed the value of vitamin C, in conjunction with other antioxidants, in promoting good oral health. In one controlled, double-blind study of patients with periodontitis, a multivitamin combined with regular brushing resulted in significant improvements in gum health and a reduction in pockets after 60 days (Munoz 2001). Clinical studies of people with vitamin C deficiencies show that gingival inflammation is directly related to ascorbic acid status, suggesting that ascorbic acid may influence the early stages of gingivitis, particularly bleeding (Leggott 1986).
Researchers have also examined the value of vitamin D and calcium, which are typically used to reduce the risk of osteoporosis. Supplementation with these two nutrients reduces the rate of bone and tooth loss in postmenopausal women and men. Calcium intake of 800 mg or more daily reduced the risk of periodontitis in females (Nishida 2000).
Reducing Gum-Related Inflammation
Because of the association between gum disease and systemic inflammation, researchers have begun looking at anti-inflammatory nutrients in the context of gum disease. In one study, 30 adults with gum disease were given a variety of polyunsaturated fatty acids, including omega-3 fatty acids from fish oil (up to 3000 mg daily) and omega-6 fatty acids from borage oil (up to 3000 mg daily). At the end of the study, clinically significant improvements were measured in both gingival inflammation and depth of gum pockets (Rosenstein 2003). Another preliminary human study found that omega-3 fatty acids tended to reduce inflammation, but called for more thorough research (Campan 1997). However, in light of the established connection between omega-3 and omega-6 fatty acids and inflammation, along with their lack of side effects, it is reasonable for people with gum disease to consider using these supplements. Other anti-inflammatory supplements include ginger and curcumin, although neither of these has been studied in the context of inflammatory gum disease.
Good oral health begins with a disciplined program of flossing, twice-daily brushing, and tongue cleaning with a tongue scraper to remove plaque and bacteria colonies on the tongue before they become incorporated in the biofilm. It is also important to visit a dentist for professional cleanings at least twice a year, and perhaps even more often. Because of the radiation associated with x-rays, Life Extension does not recommend annual dental x-rays, although occasional dental x-rays are necessary.
Avoid behaviors that contribute to gum disease and tooth decay, especially tobacco use and consumption of refined sugar. Instead, focus on consuming a diet rich in fruits and vegetables that provide important phytochemicals and nutrients. In addition, patients with gum disease and existing heart disease should monitor their levels of inflammation. C-reactive protein and homocysteine are both indicators of inflammation, which can be determined by blood tests. For more information on comprehensive blood testing, call 1-800-226-2370.
Your choice of toothpaste is also important. Today, the market is flooded with very strong toothpastes that contain high levels of hydrogen peroxide. A toothpaste is now available that has been fortified with coenzyme Q10, folic acid, and other nutrients that are directly delivered to the gums each time one brushes. This novel toothpaste also contains a mild solution of 0.2% hydrogen peroxide.
A mouthwash containing pomegranate, peppermint oil, aloe and other soothing nutrients may also be helpful.Patients with mouth sores (ulcers) should consider using aloe vera gel packs.