Periodontal Disease
Could Be Killing You

Dr. Al Danenberg Nutritional Periodontist

December 30, 2019

 

 

 

Periodontal Disease Could be Killing You

 

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.

 

 

The Middle

Dental plaque is healthy until it’s not healthy.[1]

 

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) [2],[3], 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.[4],[5] Then, unhealthy bacteria could proliferate and cause the progression of advanced gum disease[6].

 

One of the most virulent bacteria in periodontal disease is Porphyromonas gingivalis (P. gingivalis).[7],[8] Among other self-protective measures, this bacterium produces a biofilm, which is resistant to the body’s immune defenses.[9] 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.[10]

 

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.[11]

 

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.[12] 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.[13] 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.[14],[15],[16] 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.[17] Therefore, periodontal disease could be a source of degenerative chronic diseases originating from chronic systemic inflammation.

 

 

 

The Beginning

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.[18],[19],[20] 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[21] 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[22], 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.[23],[24],[25]

 

I should point out that unhealthy bacteria in the mouth in turn can interact further with unhealthy bacteria in the gut, and vice versa.[26]  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.

 

 

The Ending

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.[27] 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.

 

 

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132376/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892391/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937375/

[4] https://www.ncbi.nlm.nih.gov/pubmed/28476771

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126660/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653317/

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744328/

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276050/

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4925967/

[10] https://www.ncbi.nlm.nih.gov/pubmed/?term=10.1016%2Fj.autrev.2016.09.013

[11] https://www.ncbi.nlm.nih.gov/pubmed/28353075

[12] https://www.ncbi.nlm.nih.gov/pubmed/?term=20437720

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4460825/

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520251/

[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359961/

[16] https://www.ncbi.nlm.nih.gov/pubmed/28835673

[17] https://www.cdc.gov/chronicdisease/center/index.htm

[18] https://www.ncbi.nlm.nih.gov/pubmed/19405829

[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962497/pdf/12903_2016_Article_257.pdf

[20] https://www.ncbi.nlm.nih.gov/pubmed/?term=10.1111%2Fjcpe.13094

[21] https://www.sciencedirect.com/science/article/pii/S2319417018302634?via%3Dihub

[22] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695849/

[23] https://onlinelibrary.wiley.com/doi/abs/10.1111/cea.12723

[24] https://www.ncbi.nlm.nih.gov/pubmed/?term=10.1016%2Fj.cyto.2017.01.016

[25] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266996/

[26] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028810/

[27] https://www.ncbi.nlm.nih.gov/pubmed/31849397

 

 

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Kathryn Won the Battle
But Not the War

Dr. Al Danenberg Nutritional Periodontist
February 4, 2019

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Kathryn contacted me for a second opinion. Her problems are not unusual. She told me what she had gone through so far.

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It started when her dentist told her, “You have a gum infection, which is due to bacteria living under your gum tissues. Let’s kill these bacteria, and we’ll cure your disease.” So, her dentist prescribed an antimicrobial mouth gel to place around her teeth to kill these bacteria. After several weeks, the gum bleeding was gone. Kathryn thought her disease was cured.

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Then, several months went by, and she returned to her dentist for a dental cleaning. The hygienist told her, “Do you know you have active gum disease?” The dentist came into the room and confirmed that she had active infection. He recommended another round of antimicrobial gel.

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Kathryn realized something didn’t seem right, so she contacted me for a second opinion. I told her, “It sounds like you won the battle but not the war.”

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The Battle; The War

The “battle” Kathryn won was to end the acute infection in her gum tissues. Killing the bacteria stopped her gums from bleeding. Yet, she lost the war.

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The “war” she lost was to identify the various causes of her gum disease and to treat the hidden sources of her infection.

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The causes of periodontal disease are multifold. They relate to dysbiosis in the gut, chronic systemic inflammation, and a significant decrease in the immune response.  Stopping gum infection by killing oral bacteria is not a cure. It is not an effective means to restore overall health. It may be the first step when there is acute infection, but there is more to it. Indiscriminate killing of microbes is detrimental to the balance of bacteria throughout the mouth and the body. Indiscriminate killing of microbes can cause serious systemic problems.

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To win the war, acute infection in the mouth needs to be treated first as I stated. In addition, all other factors need to be discovered and dealt with effectively and in a timely manner.

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Most people don’t understand the importance of the gut and its relationship to disease. The gut needs to be treated and the resulting spread of chronic disease needs to be addressed. (I wrote a paper titled, Big Bang Theory of Chronic Disease. I’ll send the PDF article to you at no charge if you are interested. Please, send your request to my email: Dr.Danenberg@icloud.com)

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Two Niduses of Infection

I explained to Kathryn that she has two separate niduses of infection – one in her mouth and one in her gut.

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Her original nidus of infection started in her gut, which she is completely unaware of because she has no obvious gut symptoms. However, her gut problems created chronic systemic inflammation, which led to various chronic diseases. Gum (or periodontal) disease is just one manifestation of chronic disease.

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Once she developed periodontal disease, which is an imbalance in the overall oral microbiome, the infection established itself deep under the gum tissues. This became Kathryn’s second nidus of infection. The infection and inflammation around her teeth could spread through capillaries under the gum and eventually enter the blood system. As they course through her circulation, they could affect other organs.

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To treat this complicated disease, both the mouth and the gut must be treated to regain health. If only the mouth were treated, then out-of-balance bacteria in the gut would continue to be the culprit for further bouts of active periodontal disease and more.

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My Action Steps for Kathryn

After I explained my opinion of what was going on, I made specific recommendations and provided action steps for Kathryn to consider.

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  1. Do what is necessary to stop acute infection.x
  2. The dentist or the hygienist needs to do a deep cleaning under the gum tissues to remove tartar, which is irritating and acting like a splinter.x
  3. The dentist needs to treat decay, repair any broken or irritating tooth fillings, remove any toxic dental fillings or restorations, and extract any non-treatable teeth.x
  4. The dentist or the hygienist needs to demonstrate efficient tooth brushing, interdental cleaning, and tongue scraping. (How to Clean Your Mouth)x
  5. Kathryn needs to repair her gut by taking spore-based probiotics and specific prebiotics. (Protocol to Restore Normal Gut Bacteria)x
  6. Kathryn needs to change her diet to include nutritious foods that are anti-inflammatory and to remove foods that are inflammatory. (30-Day Reset Diet)

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If you want the 3 Protocols I recommended to Kathryn (underlined above), send your request to my email: Dr.Danenberg@icloud.com

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