What’s Really Behind
Periodontal Disease?

Dr. Al Danenberg ● Nutritional Periodontist

December 11, 2022

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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