Newest News:
Gut, Periodontal Disease, & RA

Dr. Al Danenberg Nutritional Periodontist

October 7, 2019




Newest News


Dentists need to be aware; medical doctors need to be aware; patients need to be aware.


The newest news and research are uncovering an important truth. The truth is that a healthy gut and its healthy microbiome are critical for the avoidance of most – if not all – chronic diseases. And a damaged gut could be the source of many diseases. It’s interesting that over 2,000 years ago, Hippocrates was reported to say that “all disease begins in the gut”. Maybe he knew something that we are just beginning to comprehend and to prove.


As you know, I have written about the gut microbiome and the importance of restoring it to a healthy state. The food we eat, the substances we avoid, and our overall lifestyle affect the gut. Specifically, these affect the bacteria in the gut, the gut’s protective mucosal layer, and the all-important epithelial layer that separates the lumen of the gut from the rest of our body. The healthy gut lining is the gatekeeper that allows nutrients that our body requires to enter our bloodstream and protects us from all the other junk in the gut that the body does not need.


Many scientific articles have been published that prove the direct causal effects of the gut microbiome on the health of various organ systems.


A 2019 medical article published in the International Journal of Molecular Sciences reviews the newest research and discusses the potential connections between periodontal disease, rheumatoid arthritis, and the health of the gut.


In essence, this paper supports the theory that periodontal disease and rheumatoid arthritis may have their beginnings in an unhealthy gut. Yes, the gut!


If this theory is correct, then effective treatment should include the restoration of a healthy gut as well as specific treatment modalities for both periodontal disease (PD) and rheumatoid arthritis (RA).



Periodontal Disease

PD is the most common cause of tooth loss and one of the world’s most prevalent chronic inflammatory diseases. Pathologic bacteria around the tooth margins at the gum line penetrate the tissues and create a cascading progression of inflammation in the soft tissues. Often this leads to bone destruction around the roots of the teeth. The causes of this chronic disease are considered to be multifactorial. Genetic predisposition and a compromised immune system are two major factors that allow an unhealthy balance of bacteria in the mouth to progress to PD.


Rheumatoid Arthritis

RA is a chronic autoimmune disease. Patients with RA experience synovial inflammation and hyperplasia leading to irreversible damage of the cartilage and bone in the joints, loss of function, chronic pain and progressive joint disability. The causes of rheumatoid arthritis are multifactorial like periodontal disease, and these causes are similar to those of PD.



Gut Connection

Unhealthy changes in gut bacteria will create a series of changes in the immune system. These changes will cause specific bacteria (P. gingivalis and A. actinomycetemcomitans) to proliferate. Both of these bacteria can lead to local protein alterations by process called “citrullination”. Citrullination is the conversion of the amino acid arginine into the amino acid citrulline. Evidence suggests that increased citrullination may participate in tissue destruction associated with periodontal disease and rheumatoid arthritis. Citrullination may be a key mechanism allowing both PD and RA to affect one another.


Treating an unhealthy gut will not automatically treat periodontal disease or rheumatoid arthritis. But a healthy gut could be an important therapeutic result for an inclusive treatment plan for both diseases.


I have developed a Protocol to Restore Normal Gut Bacteria, which I could send in a PDF. Email me at, and I will send it to you.



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Periodontitis – Rheumatoid Arthritis:
Which Came First?

Alvin H. Danenberg, DDS Nutritional Periodontist
September 5, 2017



Periodontitis - Rheumatoid ArthritisPeriodontitis is a chronic inflammatory disease. Rheumatoid arthritis (RA) also is a chronic inflammatory disease. In addition, both have autoimmune characteristics. Many people who have periodontitis have rheumatoid arthritis. Likewise, many people who have rheumatoid arthritis have periodontitis. Which came first? Current medical research offers a robust discussion. Yet, the dilemma continues – which came first?


There is another question that may be more basic: Could there be a common cause for both diseases?


Chronic Inflammation

A common cause for periodontitis and rheumatoid arthritis might be chronic systemic inflammation. If that were the case, then the manifestations of periodontitis and rheumatoid arthritis could depend on individual genetic predispositions and host response.


Chronic systemic inflammation is a complex system of “healing events”, which does not shut off naturally. Inflammation doesn’t shut off because an acute injury, which created the inflammatory response in the first place, persists.


In a healthy situation, when the body is harmed, the immune system creates inflammation to heal the injury. However, if the insult to the body becomes constant, then the body cannot turn off its internal “emergency reaction”. The immune system continues to be activated. Normal inflammation becomes chronic. Elements of chronic inflammation begin to destroy healthy tissue throughout the body and manifest into many chronic diseases.


Medical Research

Here are some thoughts from current medical research:


  • Chronic inflammation causes many chronic degenerative diseases. In this paper, the authors use the lens of evolution to describe various factors that affect the development of chronic inflammation. If insults, which create acute inflammation, are not removed within three to eight weeks, the body begins a destructive path leading to chronic diseases.

  • Dental plaque is made up of many types of microbes, which are in a balanced state during health. What can cause the dental plaque to become unhealthy? Environmental factors affect a person’s immune system. If the immune system is compromised, then the host response can be altered and become destructive. A compromised immune system and a negative change in the host response can allow various bacteria in dental plaque to overgrow and become extremely pathogenic. Some of these harmful bacteria are resistant to the immune system’s attempt to kill them. The result is further development of chronic inflammation. In turn, there is damage to the jawbone and potential spread of infection as well as elements of chronic inflammation to various parts of the body. This article helps explain this process.

  • A specific virulent bacterium associated with periodontitis, Porphyromonas gingivalis, uniquely produces an enzyme called peptidylarginine deiminase (PPAD). This research has linked this production of PPAD by P. gingivalis to the creation of specific antibodies, which might cause the development of rheumatoid arthritis. These antibodies can be identified many years before the patient experiences clinical symptoms of RA.



Chronic inflammation causes many different types of chronic disease. Specifically, the apparent initial cause of periodontal disease and rheumatoid arthritis is chronic systemic inflammation. Once periodontitis has become active, the production of PPAD and its resulting antibody production may cause the development of rheumatoid arthritis or aggravate existing rheumatoid arthritis. A vicious cycle is at work between periodontitis, rheumatoid arthritis, and chronic inflammation. So, what is a person to do?


First and foremost, whatever is causing the progression of chronic inflammation must be eliminated completely. If there are foods and chemicals in the diet that are stoking the flames of inflammation, these must be avoided. Other irritating environmental factors need to be identified and removed. If there is damage to the gut lining or an increase in pathogenic microbes in the gut, these must be treated. If there is active gum disease or any other source of active infection, these must be resolved. Eliminating all sources of chronic inflammation is essential for a healthy outcome. Only treating the symptoms of periodontitis and rheumatoid arthritis would not assure a healthy outcome.


So, which came first – periodontitis or rheumatoid arthritis? It could be a toss up, but treatment must eliminate the ultimate and common cause, which is chronic inflammation.



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Is Gum Disease an Autoimmune Disease?

evolution rGum disease (or periodontal disease) can be viewed as an acute infection as well as a chronic infection. Is the chronic phase actually related to an autoimmune reaction?


An autoimmune disease is a disease in which the body produces antibodies that attack its own tissues, leading to the deterioration, and in some cases to the destruction, of its healthy tissue.


In the acute phase of periodontal disease, bacteria can initiate an infection and inflammation with significant swelling and bleeding and pain. Taking an antimicrobial or removing the irritant causing the distress could relieve the acute symptoms and destroy some of the offending microbes. Acute means a condition of short duration but typically severe.


In the chronic phase of periodontal disease, inflammation exists for a long time or is constantly recurring. Chronic diseases don’t heal by themselves, and they grow worse over time. A chronic disease usually doesn’t have one single cause but rather several factors that give rise to the disease. Individuals with chronic disease generally also have complex symptoms.


Could chronic periodontal disease have many components, one of which being an autoimmune response?


Dr. Alessio Fasano has suggested that autoimmune diseases are a result of these three elements:

  • A genetic predisposition, and
  • An environmental trigger (like diet or bacteria), and
  • Leaky gut.


In his conclusion, if you could eliminate any one of these, then you could potentially eliminate the autoimmune reaction.


It is interesting to note that many inflammatory markers in patients with periodontal disease are the same ones present in patients with rheumatoid arthritis. Rheumatoid arthritis is considered an autoimmune disease. Some researchers have raised the question, “Which came first, Rheumatoid Arthritis or Periodontal Disease?”


In November 2013, several researchers published a paper demonstrating that specific intestinal bacteria were strongly correlated with newly acquired rheumatoid arthritis in their patient base. Also, these researchers showed that those specific bacteria when placed into the guts of sterile mice caused inflammatory reactions like those in their rheumatoid arthritis patients.


It is not a big leap to consider that specific unhealthy bacteria in the gut are actually initiating or contributing to the development and progression of chronic periodontal disease. Therefore, it would not be a big leap to consider improving the diet to eliminate the offending “foods” that cause unhealthy changes not only in the gut lining but also in the healthy microbiome of the gut. The lifestyle that might work the best could incorporate a Paleolithic-type diet.



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