Dr. Al Danenberg ● Nutritional Periodontist
December 30, 2019
Periodontal disease could be killing you. It is often considered a causal factor for many chronic diseases. But you need to know the complete story – not just part of it. While periodontal disease could be a nidus for chronic systemic inflammation and spread of infection, this is only part of the story. The story has a Beginning, a Middle, and an Ending. Let’s start in The Middle.
Dental plaque is healthy until it’s not healthy.
Periodontal disease develops from unhealthy dental plaque. Unhealthy plaque results when healthy plaque is transformed into unhealthy dental plaque because of an underlying compromised immune system and unhealthy food choices. It’s fundamental for you to appreciate that a compromised immune system has its roots in unhealthy changes in the gut (i.e. gut dysbiosis) ,, which causes chronic systemic inflammation.
A compromised immune system and unhealthy food choices could allow the hundreds of bacteria in dental plaque to get out of balance and become unhealthy., Then, unhealthy bacteria could proliferate and cause the progression of advanced gum disease.
One of the most virulent bacteria in periodontal disease is Porphyromonas gingivalis (P. gingivalis)., Among other self-protective measures, this bacterium produces a biofilm, which is resistant to the body’s immune defenses. As the body continues to fight the resistant P. gingivalis, additional chronic inflammation results. This chronic inflammation can cause the tissues surrounding the infected gum spaces to break down allowing their toxic elements to leak into the general circulation. Additionally, autoimmunity may play a role in the progression of periodontal disease.
It is important to remove unhealthy plaque through an efficient personal oral hygiene protocol performed daily. However, it is also critical to understand that gut dysbiosis leads to pathological changes in the healthy community of bacteria in the mouth. Therefore, gut dysbiosis must be treated to restore oral health, along with removing unhealthy dental plaque. I must emphasize that it is unhealthy to indiscriminately kill bad bacteria as well as good bacteria in the mouth by using antimicrobial mouthwashes or antibiotics on a daily basis.
It also is vital to be aware of periodontal disease because its prevalence is at epidemic proportions. In 2010, a published paper demonstrated that 93.9% of adults in the United States had some form of gingivitis. And in 2012, the Centers for Disease Control and Prevention (CDC) published their results in the Journal of Dental Research. The report was recently updated in 2015 in the Journal of Periodontology. It showed the prevalence of periodontitis was estimated to be 47.2% for American adults (approximately 64.7 million people). For adults 65 years old and older, the prevalence jumped to 70.1%. These findings were the result of the most comprehensive periodontal evaluation performed ever in the US.
So, statically you most likely have some form of periodontal disease, and it must be treated completely. Otherwise, once periodontal disease is established in the mouth, its pathological byproducts can seep into the bloodstream, lymph fluid, and bone structures to cause spread of infection and inflammation to all areas of the body. This mechanism of seeping into the body’s circulation is similar to the way that an unhealthy gut causes leakage of toxic elements into the bloodstream (i.e. leaky gut) – both creating chronic systemic inflammation.
The eventual result of chronic systemic inflammation is chronic disease.,, The Centers for Disease Control and Prevention stated that 60% of Americans live with at least one chronic disease, and chronic diseases are responsible for 70% of deaths each year in the United States. Therefore, periodontal disease could be a source of degenerative chronic diseases originating from chronic systemic inflammation.
Interestingly, there are three human research studies that showed a healthy diet alone can improve the health of the mouth. These studies also determined that removing dental plaque by brushing and flossing was not essential to improve oral health as long as diet was corrected. Specifically, the investigators demonstrated that changing from a diet abundant in high-processed-carbohydrate and inflammatory foods to a diet excluding high-processed-carbohydrate and inflammatory foods will decrease signs of gum inflammation.,, However, active periodontal treatment will be necessary if gum inflammation progresses into periodontitis, which destroys the jawbone surrounding the teeth.
In February 2019, a medical research article was published in Biomedical Journal entitled, “Association between periodontal pathogens and systemic disease”. The authors describe the correlation between periodontal disease and various chronic diseases and outcomes such as cardiovascular disease, gastrointestinal and colorectal cancer, diabetes and insulin resistance, Alzheimer’s disease, respiratory tract infections, and adverse pregnancy outcomes. The authors go on to state that there are conflicting studies, which try to prove causal relationships. However, there is significant research to show a strong correlation.
In another article published in August 2019 by Hashioka et al, the authors reviewed medical research that indicates a causal relationship between periodontal disease and various neuropsychiatric disorders including Alzheimer’s disease, major depression, Parkinson’s disease, schizophrenia, as well as the neurological event of ischemic stroke. The initiating cause of these neurological diseases is neuroinflammation, which is induced by chronic systemic inflammation. Periodontal disease causes chronic systemic inflammation by the release of pro-inflammatory cytokines and the invasion of periodontitis bacteria (specifically P. gingivalis) along with their inflammatory components (lipopolysaccharide or LPS) into the systemic circulation. Chronic systemic inflammation will activate the microglia, the immune cells in the brain, creating neuroinflammation.
But I want to emphasize again that systemic chronic inflammation is the result of a leaky gut from gut dysbiosis in most cases.
In essence, my research suggests that periodontal disease is not the seed of all systemic disease. As I suggested above, periodontal disease is just one of many chronic diseases occurring on the continuum of the spread of chronic systemic inflammation that starts in the gut. Since the mouth is visible and easy to examine, the mouth may be the first clinical area where disease is diagnosed. And as I mentioned earlier, the prevalence of periodontal disease is at epidemic proportions.
Once systemic disease spreads, a vicious cycle begins because all tissues affect all other tissues in the human body. All mucosal tissues use “crosstalk” to communicate with other tissues.,,
I should point out that unhealthy bacteria in the mouth in turn can interact further with unhealthy bacteria in the gut, and vice versa. In the case of periodontal disease, treatment for cascading chronic diseases must include healing both the unhealthy gut and the unhealthy mouth. But for the most part, the origination of mouth disease is in the gut before becoming visible in the mouth and other areas of the body.
To stop periodontal disease and prevent this infection from entering the systemic circulation, the infection must be treated efficiently. Treatment may often consist of a dentist, hygienist, or periodontist removing irritants that have become lodged under the gum tissues and initiating inflammation and infection. Removing these irritants will assist the body in healing. In more advanced stages, surgical procedures may be necessary to arrest this disease. Whatever treatment is necessary, an effective oral hygiene program should be instituted at a frequency based on the patient’s ability to take care of his or her mouth. The individual also must have a personal oral hygiene protocol to maintain a healthy mouth.
But whatever periodontal treatment is required, complete treatment must include repairing the gut, restoring the healthy balance of bacteria in the gut, and avoiding unhealthy processed foods and inflammatory foods.
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