What’s Really Behind
Periodontal Disease?

Dr. Al Danenberg ● Nutritional Periodontist

December 11, 2022

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Periodontal disease is prevalent in our society.

  • 93.9% of adults in the United States had some form of gum inflammation (gingivitis).[1]
  • 47.2% of American adults had advanced periodontal disease (periodontitis) while 70.1% of adults aged 65-years-old and older had periodontitis.[2]

Are you at risk of developing it? And if so, is there a way to avoid it? Read on, and I’ll tell you what’s really behind periodontal disease. I’ll even give you some tips on how you can reduce your risk.

 

Underlying Causes of Periodontal Disease

For example, three important facts were recently discussed in a couple of peer-reviewed medical journals. One paper was published in October 2022[3] and the other was published in November 2022[4]. The facts are …

  1. The last 25 years have brought a paradigm shift from periodontitis regarded as an infection in the gum tissues around the teeth to an overreactive response of the immune system!
  2. Those with periodontal disease often have overloaded their immune system before they developed periodontal disease with unhealthy habits. Two unhealthy habits were eating unhealthy fats and processed sugary foods. These and other poor food choices have led to the development of chronic diseases related to the disturbance and dysfunction of the gut and of the immune system!
  3. Emotional stress has been implicated as an important causal factor in periodontal disease.

 

The Gut & The Immune System

Our gut is a tube – like a plumbing pipe. What is inside the tube is isolated from the rest of the body. Our body produces a variety of enzymes to break down ingested food. The process of digestion changes the food we eat into the smallest molecular nutrients. These basic nutrients are allowed to slowly penetrate the lining of the gut to get into your circulation to give the body all the nourishment it requires to be healthy and stay healthy.

To assist our digestion and the overall function of our gut, about 38 trillion microbes make the gut their home. These microbes help with …

  • Breaking down food into bioavailable nutrients
  • Creating their own bioactive substances to support the health of the gut and the rest of the body
  • Signaling the immune system when they sense something is not right in the gut

However, if potentially pathogenic microbes in the gut begin to overgrow, then these bad guys could erode the healthy lining of the gut. The integrity of the gut lining would break down, and stuff inside the gut that should never enter the circulatory system would begin to leak out. Also, certain elements in the food we eat could damage the integrity of the lining of the gut.

This pathological change in the lining of the gut is called a “leaky gut”.

Ultimately, the elements that get into the blood system from the leaky gut can spread far and wide in the body. These elements are toxic to the body. And this toxic waste can cause chronic systemic inflammation affecting every organ system in the body. And it increases a person’s risk of developing chronic diseases and autoimmune diseases. But the manifestations of these diseases may take months, years, or decades to make themselves known.

Below is a graphic of a healthy gut and a “leaky gut”. The picture to the left shows a normal, healthy gut with a balance of good bacteria within the top light blue area and a healthy mucous layer protecting the one-cell-layer-thick epithelial barrier below. To the right is a picture of a “leaky gut” where unhealthy bacteria and toxic elements are breaking down the mucous layer and weaking and penetrating the epithelial lining (the red-colored cells) on their way to affecting the entire body.

 

 

All along, the person with a chronic leaky gut could be having a variety of symptoms that seem to be unrelated to the gut. And one of the results of this chronic systemic inflammation is an increase in the risk of periodontal disease.

This inflammation could cause the mouth’s healthy garden of bacteria and immune system to become unhealthy resulting in periodontal disease. The infection and inflammation from periodontal disease could spread into the jawbone, blood vessels, nerve canals, and soft tissues of the body. Debilitating and life-threatening diseases could occur just from this leakage of infection and inflammation from the mouth into the body. According to Alessio Fasano, MD, probably all chronic diseases start with a leaky gut. And dental diseases are chronic diseases.

Below is a graphic of a healthy mouth and a “leaky mouth”. The picture on the left shows a normal, healthy tooth in the jawbone. To the right is a picture of periodontal disease (the red area) beginning to penetrate the jawbone on its way to affecting the entire body.

 

 

Poor Food Choices & the Gut 

A diverse garden of microbes in the gut and the mouth are important to maintain health. The gut or mouth microbiome should never be indiscriminately destroyed. For example, when the garden of bacteria in the gut is compromised from the use of systemic antibiotics and gut dysbiosis occurs, an increase in periodontitis and jawbone loss from around the teeth has been observed in a recent study using mice.

Biologically available, animal-derived nutrients in their natural and balanced ratios with other symbiotic elements can supply our body and our gut with all the nutrients required to thrive. These animal sources can maintain a diverse garden of microbes in the gut. It’s important that these animals must be organically and compassionately raised and humanely slaughtered.

Regenerative rotational farming and animal grazing using no chemicals are methods to provide healthy animal products for our consumption. Some fruits and a very select number of vegetables can be healthy and included in your lifestyle eating plan.

However, many vegetables, processed fats and oils, added sugars, grains, and almost all nuts and seeds contain “antinutrients” that potentially are damaging to the gut, encouraging chronic systemic inflammation, and leading to chronic debilitating diseases – and these include dental diseases. The potentially damaging foods should be avoided if you want to be proactive for the health of your mouth and for your overall wellness.

Here are several resources to help explain how the foods we eat can benefit the health of the gut and the overall health and wellness of the body.

  • This seminal paper published in 2021 explains the evolution of the human species over 2.5 million years.
  • The International Center for Medical Nutritional Intervention in Budapest, Hungary publishes Case Reports of their successes with their patients. This clinic has treated over 6,000 patients with severe and sometimes “incurable” chronic diseases and cancers. Their patients have been treated and sometimes cured using a strict animal-based diet with no supplements and no prescription drugs. Go to their website and then click on “Scientific Work and Articles”. The doctors at the clinic state that a healthy gut and intact gut lining are essential for success with their patients.
  • This peer-reviewed article describes the critical importance of a healthy gut.

 

Stress & the Gut

Stress can cause serious damage to your gut and eventually to your mouth.

Stress is one of those things that most people know about, occasionally think about, and often never do anything about. Yet stress can be one of the most important factors that can destroy your body slowly without you knowing it – until it’s too late.

Let me introduce you to a patient whom I will call Emma.

Emma is a 30ish-year-old woman who came to the dental office with the complaint of sore, bleeding gums. From a dental standpoint, there were no obvious causes for her oral problem. She had very little dental plaque around her gum tissues. And her dental x-rays did not indicate any active periodontal destruction in her jawbone.

Below are a “before photograph” and an “after photograph” of Emma’s mouth. They may seem disturbing because they look unnatural. However, the photography was done with the lips pulled back to show the teeth and gums for better viewing.

Here is how Emma’s mouth looked when she first came to the periodontal practice. You are looking at her red and swollen gum tissues around her teeth:

 

 

Since there were no obvious dental reasons for these lesions, she was referred to her medical doctor to check for possible systemic diseases that could be the cause. But no systemic diseases were discovered.

Emma eventually explained that she was continuously dealing with emotional and sexual abuse inflicted by her employer!

Finally, Emma was convinced to quit her current job with her abusive employer and found a new job out of state.

Four months later, she returned to the periodontal office. From the time she originally was seen until the time she returned after her move, she did not receive any medical or dental treatment for her mouth lesions. Her only treatment was the 100% removal of her emotional stress.

Here is the picture of her mouth after she returned to the office. All the gum lesions were gone – no soreness and no bleeding. Her original mouth condition was caused by severe emotional stress; her cure was the direct result of eliminating this stress from her life:

 

 

Unfortunately, most people who experience emotional stress from whatever sources are unable to reduce that stress completely. But Emma is a real-life example of a person who suffered the manifestation of severe psychological stress and healed completely after totally removing that stress from her life.

Emotional stress damages the gut microbiome, increases intestinal permeability (i.e. Leaky Gut), and increases systemic inflammation as a result of the immune system trying to heal itself.

If you were able to reduce your stress levels, you could improve your gut health and lower the levels of inflammation circulating in your body. That would improve your immune system’s ability to fight the fight that it is designed to fight.

Here are some studies that demonstrate how stress affects the gut …

  • This study published in 2013 looked at 37 military troops. They were involved in prolonged and intense combat-training. As expected, this training induced increases in stress, anxiety, and depression. However, the results also showed gastrointestinal symptoms, pro-inflammatory immune activation, and increased intestinal permeability – all resulting from acute stress.
  • In this study published in 2017, 73 soldiers were subjected to intense military training, which created significant emotional stress. No matter what these soldiers ate, stress caused unhealthy changes in the gut bacteria and the way bacteria metabolized nutrients. These changes resulted in increased markers of inflammation and leaky gut.
  • In this 2019 peer-reviewed paper, researchers used a mouse model to study the effects of stress. The investigators divided the mice into a control group and an experimental group which were subjected to severe emotional stress. This research showed that stress can cause negative and long-term changes to the gut microbiome by altering the composition and behavior of specific gut bacteria. These changes in the garden of gut bacteria could lead to destructive changes in the body’s immune system. Changes to both the gut microbiome and the immune system could make the mice more vulnerable to many chronic diseases.

The results of these three studies help explain how Emma’s stress affected her gut microbiome, her immune system, and ultimately her gum tissues. And when Emma was able to completely remove the emotional stress that affected her gut and immune system, the lesions in her mouth resolved. For Emma, these immune system changes were not permanent, probably because the stress was completely removed in short order.

 

My Thoughts

What we put into our body affects the gut. Our lifestyle choices and how we deal with stress affect our gut. And the health of the gut affects the immune system which affects the entire body. And that includes the health of the mouth[5],[6].

It only makes sense to me to understand why gum disease is not just a disease of improper oral hygiene. While an efficient oral hygiene program at home is very important, there is much more to the story. Prevention and treatment of periodontal disease must address the underlying causes which include unhealthy food and lifestyle choices, emotional stress, damage to the gut and its epithelial barrier, and the resulting dysfunctional effects on the immune system.

Do you have questions? I am here to help you. Check out my consultation services and coaching programs if you are interested.

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

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

[3] https://link.springer.com/article/10.1007/s00005-022-00662-9

[4] https://link.springer.com/article/10.1007/s10266-022-00768-8

[5] https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.21-0374

[6] https://www.frontiersin.org/articles/10.3389/fcimb.2021.752708/full

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5 Important Tools
for a
Robust Immune System

Dr. Al Danenberg ● Nutritional Periodontist

December 13, 2020

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Image by Bruno /Germany from Pixabay

I’m obsessed with getting it right.

From all the research I’ve read and from my personal cancer journey, there is one fact that stands out above all: A robust immune system is critical for wellness.

It’s vital for healthy people; it’s vital for sick people; it’s vital for all who want to be proactive as well as those who are reactive.

A robust immune system is the ticket for fighting diseases arising from external and internal sources. It protects us from pathogens as well as our own cells which become cancerous.

I’m fixated on recreating my robust immune system and evaluating my success along the way. And I’ve assembled a toolbox – my biological measuring tools. It includes 5 biomarkers which tell me what I need to know. I’ve used these measurements to guide me on my journey to a healthier immune system.

You also can use these tools to assess your progress and success.

 

5 Important Tools

#1. Healthy Gum Tissue

Your mouth can tell a lot about the health of your immune system. One prominent sign is the gum tissue around your teeth. It should never bleed unless it is cut. Never!

If you were to scrub your nails with a nail brush, you should be concerned if the cuticles around your nails started bleeding. Similarly, when you brush your teeth with a toothbrush, you should be concerned if you see any bleeding. The gums are as tough and protective as are your cuticles.

However, if you have a compromised immune system, the gum tissues may become inflamed or infected (i.e., gingivitis). They then may bleed when you clean or rub them. They even may bleed spontaneously. This is a strong indication that your immune system is not functioning ideally.

An excellent method to determine if you have bleeding gums around any tooth is to use a TePe Easy Pick. This is a small, silicone brush used to clean between the teeth at the gum line.

If you see any bleeding when using the TePe Easy Pick around any tooth/gum area in your mouth, you have some form of gum disease. This suggests that you have a compromised immune system.

Here are two pictures demonstrating how to use the TePe Easy Pick between teeth at the gum/tooth margin.

 

#2. Ketone Breath Meter

Metabolic flexibility is necessary to support a responsive immune system. And ketosis is part of being metabolically flexible.

I want to be in ketosis 6 days a week and then cycle into a carb-burning mode on the 7th day. The benefits of ketosis and carb-cycling are documented in the medical literature. Travis Christofferson summarized the unique qualities of ketones in his book, Ketones: The Fourth Fuel.

To help me gauge my ketone levels and document how well I’m doing, I researched three options.

  1. Urine ketone strips are easy and inexpensive. But they are not accurate once your body begins to utilize its blood ketones efficiently and effectively.
  2. Blood ketone levels can be monitored with finger sticks using a blood ketone meter. The readings are accurate, but I would need to prick my finger several times a day, every day. Not for me! I don’t know about you, but it hurts when done repeatedly. Another drawback is that it only gives a static picture at that moment in time.
  3. A ketone breath meter recently came on the market that has clinical research to support its efficacy. It’s was created and is sold by MyBiosense. This meter is unique because it registers acetone levels that are blown out in the latter part of the exhale, which is called Deep Lung Sampling. The readings correlate to the mmol/L of blood ketone levels. Using this device, I can monitor my ketone levels as often as I want with no finger sticks! And the data is stored in the MyBiosense App on my phone for me to review.

My goal is to average a ketone level between 1.5 – 2.5 mmol/L per day while in ketosis. On my “carb” day, my ketone levels will drop below 0.5 mmol/L that day.

 

#3. Standard Deviation of Glycemic Variability

Glycemic variability is the up and down variations in blood glucose level. It indicates the efficiency of insulin to make glucose available as a fuel or to store it appropriately. If insulin is not effective, glucose levels will get out of control leading to diabetes and various forms of metabolic dysfunction.

Various medical papers have shown that the standard deviation of glycemic variability directly correlates with the risk of chronic disease and cancer. It is inversely correlated with the robustness of the immune system.

I want my glycemic variability to be as low as practical.

I could take finger sticks frequently using a glucometer to register my moment-in-time blood glucose level. But that would not give me a running graph 24/7. It certainly would leave me with painful fingertips. I prefer not.

However, a continuous glucose monitor (CGM) by NutriSense is a device that is worn for two continuous weeks. The CGM inserts a microfiber into the interstitial tissues and attaches to an inconspicuous area of the body with an adhesive. It is painless to insert and wear. But it registers glucose levels every 5 minutes, 24/7. The data is transferred to a NutriSense App, which calculates the standard deviation.

 

#4. Alpha Diversity of Gut Microbiome

The gut microbiome is made up of about 38 trillion microbes. Our body only has about 30 trillion human cells. We are more “microbial” than “human”!

Many studies have been published describing the variety of species in the gut. These medical papers clearly demonstrate that the greater the diversity and numbers of specific microbes, the healthier the immune system. [1],[2],[3]

A measurement including (1) the diversity of various microbial species in the gut and (2) the number of each of these species is called “Alpha Diversity”. It is generally reported as a percentile compared to the microbial ecosystem in a population of metabolically healthy individuals.

BiomeFx is a stool test marketed by Microbiome Labs and evaluated by CosmosID. Among the many biomarkers reported in this test, Alpha Diversity stands out to me as one of the most significant results.

 

#5. Blood Level of Vitamin D

Recently, blood levels of Vitamin D have been widely reported as important in the fight against the COVID-19 virus.[4] Previous to the Pandemic, much research has been published emphasizing the importance of adequate levels of Vitamin D to assure a robust innate and adaptive immune function.[5], [6],[7],[8]

Vitamin D is reported to …

  • Prevent excessive expression of inflammatory cytokines
  • Increase the “oxidative burst” potential of macrophages
  • Stimulate the expression of potent anti-microbial peptides, which exist in neutrophils, monocytes, natural killer cells, and in epithelial cells lining the respiratory tract where they play a major role in protecting the lung from infection
  • Affect the action of T cells, key players in adaptive immunity

My Personal Results

#1. Healthy Gum Tissues:

My gums do not bleed. I use the TePe Easy Picks every day.

If you have bleeding gums, you need to address your diet, the health of your gut microbiome, and your oral hygiene techniques. You also need to seek the services of a general dentist or a periodontist (a dentist specializing in periodontal disease).

 

#2. Ketones:

I stay in ketosis with my animal-based diet 6 days a week. My highest mmol/L while in ketosis has been 2.8; the lowest on those days has been 0.5. My average for 6 days running is 1.5. On my cycle day out of ketosis, I eat between 100 – 150 grams of carbs for that day, and my ketone reading drops to an average of 0.3.

 

#3. Glycemic Variability:

In July 2020, I wore the CGM from NutriSense for two weeks. My average standard deviation of glycemic variability for that time period was 10. Here is a table showing ranges and their interpretations:

 

#4. Alpha Diversity:

My Alpha Diversity was reported in the BiomeFx stool test I took in August 2020. The results indicated my Alpha Diversity was in the 98th percentile. That meant that 98% of metabolically healthy individuals had less variation of species and numbers of individual microbes than I had.

 

#5. 25 Hydroxy Vitamin D:

My last blood test for 25 Hydroxy Vitamin D was in 6/2020. At that time, my blood level was 89 ng/mL. and I was taking 5,000 IU of Vitamin D3 daily. I have reduced that dosage to every other day, and I’ll have another test shortly. As a cancer patient, I want to keep my Vitamin D level between 60-80 ng/mL.

 

Bottom Line

A robust immune system is our internal armed forces to fight the fight. My ultimate goal is to make my immune system as robust as I can. The 5 important tools I described will guide me along my path and document my success. They also will confirm that I am remaining where I want to be.

I firmly believe that my cancer journey has been as successful as it has because I have significantly improved my immune system along the way. You may find that my 5 Important Tools will help you monitor your journey to a stronger and more responsive immune system.

 

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906406/

[2] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200728

[3] https://www.frontiersin.org/articles/10.3389/fmicb.2016.00455/full

[4] https://articles.mercola.com/sites/articles/archive/2020/12/11/do-vitamin-d-supplements-help-prevent-respiratory-tract-infections.aspx?ui=baff764f733a1f4f602b56b0683839cc74ea77293ab586e40b1b7b0b93d42111&cid_source=dnl&cid_medium=email&cid_content=art1HL&cid=20201211&mid=DM744365&rid=1032114513

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406/

[6] https://health.ucsd.edu/news/releases/pages/2018-06-15-greater-levels-of-vitamin-d-associated-with-decreased-risk-of-breast-cancer.aspx

[7] https://www.mdpi.com/2072-6643/12/4/1140

[8] https://www.mdpi.com/2072-6643/12/5/1248

 

 

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Connecting The Dots:
HIIT, Mitochondria, Gingivitis

Alvin H. Danenberg, DDS • Nutritional Periodontist
May 30 2017

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Connecting The DotsIn my previously published book, Crazy-Good LIVING, I discuss my Four Pillars of Health. One pillar of health is efficient exercise. I explain how efficient exercise is made up of several activities. One effective activity is High Intensity Interval Training (HIIT). The importance of HIIT and the body’s quick and positive response to it are amazing. HIIT will improve the health of your mitochondria and in turn possibly improve your overall health as well as gingivitis. It’s a matter of connecting the dots.

 

HIIT

High Intensity Interval Training is the ultimate beneficial exercise for your mitochondria. You could perform this once a week for eight to twenty-six minutes in total. You might start with a warm up of two minutes before beginning the exercise cycles. Each cycle might consist of (1) seven to thirty seconds of all-out-to-exhaustion pedaling on a recumbent bike or sprinting outside, and (2) rest for about ninety seconds to regain your normal breath. This cycle should be repeated for two to eight times. Then, finish with a two-minute cool down.

I use a Nordic Track Classic Pro Skier®, a cross-country ski machine that is set up in my spare bedroom. Usually I use it once a week for four to six cycles depending how I feel that day. I warm up by “skiing” at a slow pace for two minutes. Then, I “ski” at the fastest speed I can muster for twenty-five seconds, and next I rest for ninety seconds. That completes one cycle, which I will repeat until done. At the end of my routine, I feel exhausted – but great.

 

Mitochondria

Inside almost every human cell, there are little vessels called mitochondria. The only human cells lacking mitochondria are red blood cells.

Mitochondria are like batteries floating inside the cells’ cytoplasm. Some very busy cells may have thousands of these batteries floating inside each cell. Mitochondria produce all the energy the cell needs to do its work. The mitochondria also assist in ridding our body of toxic substances and flushing out old and no longer useful cells. In addition, mitochondria help genes function optimally.

Mitochondria need nourishment. If they do not get all the nutrients they require, they will not function properly. A nutrient-dense diet, as I recommend, is ideal to provide these necessary substances.

Compare mitochondria to batteries in a flashlight. If the batteries are strong, the light shines brightly. If the batteries are weak, the light becomes dimmer, even though it may still work. The weak flashlight just doesn’t live up to the standards expected of it. But if you replace weak batteries with  fresh ones, the flashlight will function as it did when it was brand new.

If our cells’ mitochondria are not firing on all cylinders, individual cells may function, but the cells’ ability to do what they were designed to do will be compromised. Mitochondria must be kept fresh and strong for peak performance.

In this peer-reviewed paper, unhealthy mitochondria were associated with gingivitis and advanced stages of periodontal disease. In contrast, healthy and strong mitochondria might help prevent gingivitis, other forms of periodontal disease, and other chronic diseases.

 

Connecting The Dots

Connecting the dots is critical. Healthy mitochondrial function is critical to overall health. One method to improve our mitochondria is through efficient exercise. Healthy mitochondria are important for overall health but also could prevent gingivitis and other forms of periodontal disease.

Two recent papers reveal the significant benefits of HIIT.

  • In a study published in 2016, twenty-five sedentary men were divided into three groups: nine performed three weekly sessions of HIIT for twelve weeks; ten performed three weekly sessions of moderate exercise for twelve weeks, and six men served as the non-exercising controls during the study. The details of the study are described in this paper. The final results of this study showed that the men who performed HIIT after twelve weeks improved their biomarkers of heart health and metabolic health easier and faster than those who performed traditional exercise training.
  • In this study published in 2017, HIIT improved mitochondria function better than other exercise programs tested.

 

Closing Thoughts

Science shows healthy mitochondria promote overall health as well as oral health. Researchers have reported that HIIT is an efficient exercise program that could improve the health of the mitochondria within all the cells of the human body. In my opinion based on the published research, supporting the mitochondria through an efficient exercise program in addition to a nutrient-dense diet could go a long way to possibly supporting periodontal health and preventing gingivitis as well as other chronic diseases.

 

 

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Nutrition & Gingivitis:
A Marriage In Science

Alvin H. Danenberg, DDS • Nutritional Periodontist
May 8, 2017

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Nutrition & GingivitisPeer-reviewed medical research continues to prove a link between nutrition and gingivitis. I see this link to be a marriage in science. The link is not just a correlation; it’s causation. Good nutrition equals gum health; poor nutrition equals gingivitis.

 

Naysayers need to read the science.

 

My goal is to educate patients, medical and dental professionals, and anyone else who is interested in the facts. Prevention of gingivitis isn’t as simple as flossing and brushing. Gum health is based on nutrition of the entire body, starting with every cell. Good nutrition and bad nutrition are not only correlated with the health of gum tissues; they are a direct cause.

 

Difference between Correlation and Causation

Correlation is a relationship between events. When researchers find a correlation between two variables in a medical study, they have found a relationship where one event occurs when another event occurs. This relationship can be positive or negative. However, there may be many more variables affecting this relationship, which the researchers don’t know anything about. Unless all variables are controlled for, there only can be a correlation – not causation.

 

An example of correlation is the Super Bowl Indicator, which is highly correlated at 82%. The correlation: When an AFC team wins the Super Bowl, the US Stock Market will end the year with a loss; when an NFC team wins the Super Bowl, the US Stock Market will end the year with a gain. Obviously, the result of the football game does not cause anything to happen in the stock market.

 

Causation, on the other hand, signifies that researchers have found a specific change in one variable that directly caused a change in the other variable – end of story.

 

An example: Jumping off a cliff will cause physical harm.

 

In order for researchers to prove causation in a study, scientists need to split the participants in the project into different groups. Investigators would assign one random group the behavior they wanted to study and would maintain a control group that was exactly like the other group but not required to participate in the behavior to be studied. This is known as a randomized controlled trial (RCT).

 

The following two peer-reviewed papers are randomized controlled trials. They show good nutrition causes healthy gum tissue and poor nutrition causes unhealthy gum tissue.

 

Peer-Reviewed Research

Dr. Woelber’s Research Published In 2016

 

Dr. Woelber’s team chose fifteen people at random for this RCT. Researchers only selected those who had signs of gum disease and were eating a diet heavily based on carbohydrates. Ten individuals made up the experimental group, and five individuals made up the control group.

 

The experimental group had to change their diet. Their new diet consisted of foods low in carbohydrates, rich in omega-3 fatty acids, and abundant in vitamins C and D, antioxidants and fiber. The control group did not change their eating habits.

 

As far as oral hygiene was concerned, researchers instructed all fifteen participants not to clean between their teeth with dental floss or interdental brushes. However, the subjects did not have to change the way they brushed their teeth.

 

The study began after each group had two weeks to acclimate to these changes I mentioned above. Then, the four-week study began.

 

Investigators recorded the signs of gum disease (bleeding-on-probing, pocket depths, degree of gingival inflammation) in all participants at the start of the four-week study and at the end.

 

At the conclusion of the trial, all disease parameters decreased significantly in the experimental group by approximately 50% from the starting point. In contrast, all inflammatory markers increased from the starting point in the control group.

 

Dr. Jockel-Schneider’s Research Published In 2016

 

Dr. Jockel-Schneider’s researchers enrolled 44 patients with chronic gum disease. Patients were divided into two groups. At the start of the study, doctors recorded the health of the gum tissues. Also, the researchers measured the level of nitrates in the saliva of all 44 participants. One group, the experimental group, drank a glass of lettuce juice daily for two weeks. The other group, the control group, drank a similar liquid that did not contain any natural nitrates.

 

At the end of two weeks, the group that drank the lettuce juice, which was high in natural nitrates, had significantly healthier gum tissues and significantly higher levels of nitrate in their saliva compared to the control group.

 

My Conclusions

There will be those who claim that these studies don’t prove a thing. Some will demand more studies with more subjects to prove that nutrient-dense foods cause healthy gum tissues and that innutritious foods cause unhealthy gum tissues. For me, these two papers prove the science that has been reported in the past. Previous papers have demonstrated that our primal ancestors rarely had gum disease based on skeletal remains. And, researchers have reported that primal societies living in remote areas of the world today rarely have gum disease. Our primal ancestors didn’t have toothbrushes or dental floss. Today, primitive societies don’t have toothbrushes or dental floss. They all basically consumed (and are currently consuming) nutrient-dense foods.

 

Enough said!

 

 

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Want Healthy Gums?
Then, Don’t Use Mouthwash

Alvin H. Danenberg, DDS • Nutritional Periodontist
January 9, 2017

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Want Healthy Gums

Doesn’t mouthwash kill bacteria? Don’t bacteria cause gum disease? What about healthy gums?

 

Yes, antibacterial mouthwash kills bacteria. Yes, bacteria can cause gum disease. Yes, you want healthy gums.

 

But before you think I’ve gone bonkers, give me a moment to explain. Bacteria, when the good guys and the bad guys are in balance, serve many necessary purposes in your mouth. Healthy gums are dependent on healthy bacteria. One benefit is to allow a specific pathway of digestion to occur that is critical for health.

 

Mouth Bacteria

I have written about the balance of bacteria in the mouth in past articles. When bacteria are killed indiscriminately, harmful bacteria and good bacteria are both killed. This delicate balance of bacteria goes awry. When a healthy balance is disturbed, tooth decay and gum disease are likely to occur.

 

Here is one of the many benefits of mouth bacteria. They play a unique role in the chemical pathway of certain foods. Specifically, the chemical pathway of “nitrate-to-nitrite-to-nitric oxide” is dependent on specific anaerobic bacteria in the mouth.

 

“Nitrate to Nitrite to Nitric Oxide” Pathway

Nitrate is naturally abundant in certain vegetables. It is converted into nitrite and then into nitric oxide and other nitrogen products during digestion. One end product, which is nitric oxide, has major benefits throughout our body. Nitric oxide reduces blood pressure, reduces the risk of cardiovascular disease, improves athletic performance, and improves gum health to name a few. Your mouth bacteria play an important role in the path of creating nitric oxide.

 

The pathway is somewhat technical, but it is good stuff. If you’re not interested in the details, then skip to the next section.

 

The pathway goes like this: The foods that are high in natural nitrate are chewed up in our mouths and swallowed. Nitrate is absorbed in our stomach and upper small intestine. A large percentage of the absorbed nitrate gets concentrated into our saliva. Once nitrate is in our saliva, the naturally occurring anaerobic bacteria on our tongues convert this “nitrate” into “nitrite”. Then we swallow.

 

Yes, we swallow this nitrite, which goes into our guts. Some nitrite is changed into nitric oxide by the acids in our stomach. Some nitrite is absorbed into our blood system and circulates to all of our cells where nitric oxide is formed. Still, some nitrite is converted into “nitric oxide” by bacteria in our intestines. There are many biological ways that nitrite is converted into nitric oxide and other nitrogen products.

 

In the mouth, nitric oxide has significant effects. Nitric oxide gets into the gum tissues and is strongly anti-inflammatory. It also has antimicrobial effects on pathogens. In this clinical study, nitric oxide derived from salivary nitrate helped reduce gingivitis. This study was a randomized, double-blinded clinical trial that was published in the Journal of Clinical Periodontology in 2016.

 

Don’t Kill The Bacteria

If you killed the bacteria in your mouth and on your tongue with antiseptic mouthwash, salivary nitrate wouldn’t be converted into nitrite. With less nitrite in your system, you would produce less beneficial nitric oxide.

 

High-Nitrate Foods

So, if nitrate is healthy, then what foods are the best sources? Here are some vegetables with the highest concentrations of naturally occurring nitrate. These vegetables are part of a nutrient-dense diet I recommend:

  • Arugula
  • Spinach
  • Butter Leaf and Oak Leaf Lettuces
  • Swish Chard
  • Beets and beet greens

 

One caveat: The artificial nitrate and nitrite that are added to processed meats and other foods are not healthy and should be avoided. Their chemistry is different from that of naturally occurring nitrate.

 

Take-Home Pearls

  • Eat foods high in natural nitrate.
  • Don’t use any mouthwash that can disturb the natural and healthy balance of bacteria in your mouth.

 

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Crazy-Good Living

I Write A Lot. I Read A Lot.
But, I Don’t Believe Everything I Read

      Alvin H. Danenberg, DDS   •   Nutritional Periodontist
      August 18, 2016  

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I Write A Lot; I Read A LotI write a lot; I read a lot, but I don’t believe everything I read. I am always reading papers of peer-reviewed research on PubMed.gov. PubMed is the go-to site for me to search what’s available in the worldwide archives of published science.

 

I was scanning through recent articles about periodontal disease on PubMed when I came across this paper. The title is, Primary prevention of periodontitis: managing gingivitis. It was published in the prestigious publication of the Journal of Clinical Periodontology in April 2015. Great article title, if you were a dental geek like me. Detailed review, if you wanted to delve into results of many published papers. But, way off the mark in its conclusions, in my opinion.

 

Just because you read peer-reviewed research that has been scrutinized by experts before it is published doesn’t mean it’s “correct”. The words “published” vs. “correct” may be as confusing as “normal” vs. “healthy”.

 

It may be “normal” to have occasional bleeding in the gums, but that condition certainly would not be “healthy”. “Normal” means the far majority of the population exhibits a particular condition. Occasional bleeding gums are “normal” because most people have that condition, but any bleeding gums certainly are not “healthy”.

 

This article presents information that was “published” many times before, but the conclusions are not “correct” because the human species over 2.5 million years of evolution proves otherwise.

 

Here is what the article concluded: “All people should brush their teeth twice a day for at least 2 minutes with fluoridated dentifrice”. Also, for patients with advanced gum disease, “2 minutes are likely to be insufficient.” In addition, patients with gum disease would need to clean between their teeth and use “chemical plaque control agents”.

 

I agree that brushing for at least 2 minutes and the use of interdental cleaning brushes are the best ways to clean around and between the teeth. I recommend that to all my patients. However, evolutionary dentistry clearly shows that tooth decay and gum disease are primarily a result of a lack of a nutrient-dense diet and the abundance of unhealthy gut bacteria. (HERE. HERE.) The human species is not deficient in chemical plaque control agents. We were not born with a genetic deficiency in fluoride. If anything, chemicals disturb the balance of healthy bacteria in the gut and mouth. (HERE.)

 

So, what should you do if you had gum disease or if you wanted to prevent gum disease? If you had gum disease, first the disease would need to be treated properly. Once it was treated, or if you only were trying to prevent this disease in the first place, you should be eating nutrient-dense foods and you should maintain a healthy and balanced level of good bacteria in your gut. (HERE.) Proper brushing and cleaning around your teeth are important, but proper diet and healthy bacteria are critical for health going forward.

 

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Should You Take Antioxidants to Stop Gum Disease?

Alvin H. Danenberg, DDS     February 15, 2016  

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Antioxidants and Gum DiseaseThe short answer is, “No, don’t take antioxidants to stop gum disease.”

 

Unfortunately, they aren’t what they are cracked up to be. Read what I have written about antioxidants in the past.

 

“So, why wouldn’t it be helpful to take antioxidants from a bottle to stop gum disease?”

 

Let’s examine what is really happening in the world of gum disease. My explanation may get a bit scientific, but this is interesting stuff. Try to hang in there.

 

Gum disease is a result of oxidative stress causing damage in the gum tissues. HERE. Oxidative stress is simply the imbalance between the production of free radicals (biological molecules that have lost an electron) and the ability of the body to neutralize their harmful effects through antioxidants (biological molecules that donate an electron). When there is an abundance of free radicals that are trying to steal electrons from other healthy cells, then there is damage to the body.

 

“But wait a minute; it sounds like antioxidants are the answer!”

 

Let me go on.

 

Recent evidence suggests that antioxidant supplements do not offer sufficient protection against oxidative stress or resulting cellular damage. Real foods contain much more effective antioxidants than those sold in bottles. However, it is becoming more obvious that the human body has mechanisms in place within every cell to create its own natural antioxidants. These are the best antioxidants – the ones that are naturally produced by our body.

 

The keys to decrease oxidative-stress-induced damage are to reduce or eliminate those things that are causing oxidative stress and to help the body produce its own natural antioxidants.

 

Oxidative stress to the tissues surrounding a tooth can result from unhealthy bacteria in the dental plaque, from irritation by tartar under the gum tissues, and from toxic chemicals that have damaged individual cells. Oxidative stress also can be caused by a leaky gut, emotional stress, over-exercise, or lack of efficient sleep. The general media would have you believe that antioxidant supplements could take care of the problem. As I have suggested, antioxidants are not what they are cracked up to be.

 

“So, what’s the answer?”

 

The solutions to eliminate gum damage from oxidative stress are to eliminate causes of acute infection, to make necessary lifestyle changes, and to incorporate healthy nutrition.

 

Eliminating acute gum infection includes reducing the damaging bacteria and removing deep tartar causing constant irritation. Lifestyle changes include learning good oral hygiene like proper brushing, flossing, and tongue cleaning. Other lifestyle changes include healing an unhealthy gut, getting enough sleep, engaging in efficient exercise, and reducing overall stress. Healthy nutrition includes eating nutrient-dense foods and avoiding foods that cause inflammation in the body.

 

My personal experiences as well as my research of peer-reviewed articles have brought me to this way of thinking. We can do so much more for our mouth and our entire body if we removed what was causing the problems and then gave our body what it needed to thrive. The last 2.5 million years of our species’ survival have convinced me.

 

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Gum Disease & How I Treat It:
Natural   Meets  Traditional  –  Part 3 of 3

      Alvin H. Danenberg, DDS       December 22, 2015

 

Gum Disease TreatmentIn Part 1, I explained how most of us have some form of gum disease. I also suggested how you could tell if you had this disease. In Part 2, you learned the differences between health and disease as well as the way a dental professional could determine if you had this disease. In this last Part of the series, I outline the causes of gum disease and my treatment methods combining natural and traditional treatments.

 

What Causes Gum Disease?

 

If you had gum disease, here are some generally accepted causes:

  • Bacteria form on surfaces of the teeth where the gums meet the teeth. The bacteria film is called dental plaque. When some of these bacteria become very unhealthy and get under the gum, they cause disease.
  • Some of these bacteria can harden around the teeth forming tartar or calculus. It attaches like barnacles form on the bottom of a boat that sits in the water. The irritation to the gums from the calculus is like a splinter in your finger that irritates the skin.
  • Habits of grinding or gritting your teeth can wiggle the roots in the jawbone. This will weaken the bone just like a stick that is wiggled in the ground will push the dirt aside while loosening the stick.
  • Bad dental fillings can act like irritants damaging the bone. If you had dental fillings that were broken, had rough edges, or didn’t fit properly, they could cause infection.

 

But, did you know there are other causes? These not-so-obvious causes may be even more important than dental plaque or tartar. They include:

  • Eating specific foods that cause bad bacteria to overgrow in your mouth and in your gut
  • Not eating nutrient-dense, anti-inflammatory foods that can strengthen your immune system and prevent infection
  • Toxic substances in your environment that could affect your immune system
  • Genetic changes that could make you more susceptible to gum disease

 

My Way Of Treating Gum Disease

 

It would be great to take a pill and all of a sudden gum problems would be a thing of the past. It doesn’t work that way. Here is what I recommend for my patients, progressing from what everyone should do to what those with significant disease should do:

  • One of the most important things you can do is to clean your mouth properly. Here is my article on how to do that.
  • If your diet or lifestyle were not healthy, you need to make changes. In my opinion, the healthiest diet for gum health and overall health is a Paleo diet.
  • A dental professional could help by removing any tartar that is irritating the gums. Think of this like removing a splinter in your finger so that the skin could heal. If deeper problems existed, then more advanced treatment might be necessary.
  • If there are broken or rough fillings in your teeth, they should be repaired or replaced.
  • If you have habits of grinding or gritting your teeth, some type of bite treatment or a bite guard must be included.
  • For deeper disease, there is a deeper type of cleaning called scaling and root planing, which is usually performed by a dental hygienist with your gums numbed.
  • For more advanced disease, bone surgery might be necessary. Today, LANAP® (Laser Assisted New Attachment Procedure) is a laser surgical procedure that can treat the infection and assist your own bone to regrow without cutting with a scalpel or using stitches. In my opinion, LANAP is a game changer for the treatment of advanced gum disease and may become the standard of care in the future. Again, this is my opinion, but about 25% of periodontists in the US have become licensed to perform LANAP. When I treat my patients with LANAP, I also provide specific herbs for my patients to support their immune systems while healing.

 

In this series of three articles, I have provided my summary of gum disease, its health consequences, and its causes and treatments. In my opinion and in my experience, incorporating traditional treatment with natural treatment provides the ideal way for my patients to improve their overall health and to improve their mouth health.

Gum Disease & How I Treat It:
Natural   Meets  Traditional  –  Part 2 of 3

   Alvin H. Danenberg, DDS       December 21, 2015

 

Gum Disease TreatmentIn Part 1, I gave you an idea how many people have gum disease. Its consequences to health are significant. I also explained how you could tell if you had this disease. In this Part, you will read the differences between healthy gums and unhealthy gums. You also will learn how a dentist can determine if you have this infection.

 

What’s The Difference Between Health And Disease?

 

When the gum is healthy with no disease, it is sealed around the tooth like a tight turtleneck sweater around your neck. The gum protects the underlying jawbone that holds your teeth in place.

 

In gingivitis (the early stage of gum disease), the gums usually become red or bleed easily. If the infection moves under the gums, the gum seal breaks down, and the gum separates from around the tooth just like a turtleneck sweater would not stay up around your neck if it were stretched out. When this infection begins to damage the underlying bone around the roots of the teeth (called periodontitis), the disease can become a problem throughout your body.

 

If you had bleeding gums in the past, but this bleeding has gone away, you may feel like your gums are healthy now. You may think that the problem has resolved by itself. Unfortunately, the problem may have progressed deeper under the gums without you knowing it.

 

How To Determine If There Is Disease?

 

The best way to determine if you have gum disease is to have a dentist or periodontist use a gum ruler (called a periodontal probe) to measure how deep the space is between the gum and the tooth. This measured space is called a gum pocket. Think about a gum pocket like a pocket in a jacket. The depth of the gum pocket would be like the distance your hand went into your jacket pocket until the tip of your longest finger stopped where the pocket ended. These measurements are usually taken around every tooth in your mouth. Healthy depths of gum spaces would usually measure between 1 to 3 millimeters. If pockets were deeper than 5-6 mm, you might have advancing periodontitis.

 

In addition, the dentist should check if the gum had receded around any teeth or if the teeth were loose. Also, the dentist should take specific x-rays to show the bone around the tooth roots.

 

In Part 3 of the series, I outline the obvious and not-so-obvious causes of this infection as well as my treatment for my patients combining natural and traditional treatment protocols.

Gum Disease & How I Treat It:
Natural   Meets  Traditional  –  Part 1 of 3

   Alvin H. Danenberg, DDS       December 20, 2015

 

Gum Disease TreatmentI am a periodontist, a dentist specializing in the treatment of gum disease. I have been treating patients for almost 42 years. I know what gum disease is; I know how to treat gum disease. Also, I know what you need to do to prevent gum disease from damaging your mouth and your overall health.

 

I come from a different perspective: I believe combining a natural approach along with a traditional approach creates the best of both worlds. So, I have put together my thoughts in a series of three Parts.

 

In this Part, I discuss the prevalence of gum disease and what you may notice if you have gum disease. In Part 2, you will learn the difference between healthy and unhealthy gums as well as how a dentist can determine if you have gum disease. In the last Part of the series, I go into the causes of gum disease and my unique approach to treatment.

 

What’s The Big Deal?

 

The big deal is that gum disease is pervasive in our society and affects the entire body.

 

A study published in 2010 reported that 93.9% of adults in the US had some form of gingivitis, which is the early stage of gum disease. Gingivitis usually causes redness and bleeding of the gum tissues surrounding the teeth.

 

Another study published in 2012 showed that 47.2% of the adult population over the age of 30 in the US had periodontitis (which translated to 64.7 million Americans). If you were over the age of 65, the chance of having periodontitis would jump to 70.1%. Periodontitis is the more advanced stage of gum disease where the gums are infected and the bone surrounding the roots of the teeth are breaking down. This disease leads to bad breath, loose teeth, loss of teeth, sensitive teeth, pain, gum recession, and even spread of infection to other parts of the body.

 

Gum disease can be a big deal.

 

How Do You Know If You Have Gum Disease?

 

If your gums bleed when brushing or flossing, you probably have some type of gum disease. But, that is not the whole story. You may have gum disease if your gums are not bleeding because the disease may be deeper under the gums. Sometimes the gums may be swollen or tender, but not always. The teeth may be loose or sensitive, but not always. You may have bad breath or a bad taste in your mouth, but not always.

 

Gum (or periodontal) diseases are divided between gingivitis, which only affects the gums, and periodontitis, which involves the gums around the teeth and the jawbone supporting the teeth.

 

In Part 2, I help you understand the difference between healthy and unhealthy gum tissues and how a dental specialist can determine if you have this disease.