Sunday, July 20, 2008

Healthy Teeth and Gums: An ecosystem approach to oral care.

Do you have cavities? Do your gums ache and bleed after brushing? Over 75 percent of people over 35 have cavities and symptoms of gum disease. Gums naturally recede as we age, exposing the roots and increasing our risk of developing infection. Conditions that can make you more susceptible to gum disease include: diabetes mellitus, leukemia, AIDS, poor nutrition, hormonal changes, smoking, and poor oral hygiene. However, there is hope-modern day dentistry, and fluoridated water and toothpaste have helped many people keep their teeth well into old age. Our teeth and gums are active living tissue-designed to heal and repair. Our mouths are home to a complex micro-ecosystem of many types of organisms whose population composition directly effect the health of teeth and gums. By applying an ecosystem approach to our mouths, we can expect to have near perfect dental health our whole lives.

Dental Basics

Above the gum line, our teeth are covered by a thin layer of solid enamel, a calcium/phosphate mineral. Inside the enamel is dentin, similar to bone tissue; and below the gum line, the inner soft pulp contains nerves and blood vessels. The villain in most dental problems is plaque, a gelatinous mass of scavenging bacteria that coats the surfaces of the teeth and tongue. These unwelcome residents dine on leftover chewed starches and sugars, excreting acids and other byproducts. Plaque holds these acids next to the enamel, dissolving it and eating into the underlying dentin, creating a cavity. Plaque also hardens into tartar, a hard mineral shell that erodes healthy gum tissue enabling infection to penetrate deep into gums and jawbone, resulting in gum (periodontal) disease.

The Bacterial Ecosystem


Our mouths are teeming cities of bacteria. Some bacteria are neutral "good" citizens, others display anti-social tendencies: etching acid graffiti, dumping toxic materials, and in the case of gum disease, creating a milieu inviting to even more dangerous criminals.

The bacteria responsible for cavities, Streptococcus Mutans, sneaks into children's mouths before they are three and have fully developed immune systems. Being "grandfathered" in, the bacteria are free from antibody attack. Strep. Mutans produces more acid than other bacteria, creating an acidic environment repellent to friendly bacteria as well as damaging to enamel. Your mother was right that sugar causes cavities: sucrose specifically selects for Strep. Mutans, and from it, the bacteria creates the stickiest, thickest gel.

At Loma Linda University in Loma Linda, CA, dental researchers aim to completely eliminate cavities in young children and prevent their exposure to Strep. Mutans by minimizing the microorganism in their parents' mouths with anti-microbial mouthwash followed by careful dental hygiene and regular dental visits for the whole family. As children get older, their enamel thickens, reducing their susceptibility to cavities.

Gum Disease

Gingivitis, the first stage of gum disease, is characterized by inflamed or bleeding gums. As periodontal disease progresses, plaque penetrates the gum tissue, causing a spreading infection with severe gum recession, creating deep plaque pockets at the gum line which harbor even more bacteria. Eventually, the infection reaches and destroys the jaw bone, and teeth fall out.

The bacterial ecosystem gets really complex with gum disease, involving at least forty types of bad bacteria. Harmful bacteria are always present in the environment, and when these pathogens encounter a mouth with a healthy low population of "normal" bacteria, they find the environment inhospitable, and do not thrive, like criminals passing through a small town of good citizens.

However, poor mouth hygiene and a sugary diet lead to a high bacterial population-the oral equivalent of New York City-much to the denizens delight. One of them, Clostridium Perfingens, is suspected of being a major cause of atherosclerosis-entering the bloodstream and promoting blood clots and damaging heart muscle. Researchers also speculate that toxins released from gum infections of pregnant women may be responsible for many low-birth-weight babies.

Natural Protection

Fortunately, our bodies have a natural arsenal of bacterial defenses, beginning with the saliva we produce during our waking hours. According to Dr. George Lessard, professor of biochemistry at Loma Linda University, the saliva produced by our parotid glands is a slightly basic solution. It neutralizes acid, washes the mouth, and deposits a protective protein coating over the teeth. Saliva also contains phosphate and calcium ions that remineralize teeth, repairing cavities before they can develop. A smidgen of fluoride (the amount in fluoridated toothpaste) is necessary for this remineralization to take place.

Loma Linda scientists have discovered that tooth pulp actually produces a fluid which flows outward through the dentin and even the enamel, naturally cleansing the teeth. This fluid is high in microminerals, such as chromium, often in short supply in current diets. One substance appears to stop this outflow of cleansing fluid cold-sucrose, common table sugar.

Although gum disease is almost ubiquitous in this country, it is not inevitable. It has been the experience of New York holistic dentist Dr. Reid Winick, that gum disease can be prevented, reversed, or at least halted in anyone who is willing to carefully improve their oral environment through dental hygiene, diet, and dental monitoring. Even deep infected gum pockets, with effort, can become clean and free from active infection. Following a healthy diet and lifestyle will help keep the immune system functioning at its peak.

Prevention Techniques

A Diet for Prevention

Dental infection is not normal, but a sign of imbalance. Eating the right foods is a key part of controlling your oral environment by encouraging healthy bacteria as well as strengthening your body's overall defenses.

  • Optimize immunity, wound healing, and salivary composition by eating nutrient-dense foods such as vegetables, whole grains, beans, tofu, and nonfat dairy products.
  • Minimize consumption of table sugar (sucrose), and refined carbohydrates. Select whole grains instead.
  • Eat fibrous, crunchy foods to clean the teeth. Our ancestors' high fiber diet was partly responsible for their dental health.
  • Avoid excessive acids, such as high intake of citrus fruits, juices, sports drinks, and vinegar. Avoid cola drinks, even diet cola, because of their high phosphoric acid content. Limit toddler's juice intake and don't put babies down with a bottle.
  • Foregoing alcohol and tobacco will help diseased gums repair.
  • Eat less meat. The saliva of non-meat eaters contains more of certain amino acids, affecting the composition of oral bacteria. Finland research suggests vegetarians have less cavities and gum disease.
  • Brush after every meal or snack. Dr. Lessard suggests you chew sugar free gum if you can't brush to remove food and increase saliva.

Herbs and Supplements

Echinacea, famed for its ability to boost immunity, is as effective at jump-starting your ability to fight gum disease as it is in helping you fight off a cold. It is also an effective antibacterial.

Myrrh, an antiseptic, has been used since biblical times for soothing and healing gums and mouth sores. New research suggests it may stimulate the immune system as well. Look for myrrh in rinses and mouthwash.

Goldenseal, another herb with a long history of use in treating gum problems, contains astringent, antiseptic chemicals that reduce inflammation, soothe irritated gums, and kill microbes. Avoid if you have hypertension or are pregnant.

Tea Tree Oil was used by Australian aborigines as an antibiotic poultice for thousands of years. Research has confirmed that it is a highly potent oral antimicrobial and mild anesthetic which, unlike many antibiotics, does not damage healthy tissue. It causes local irritation in a few people and should not be swallowed.

Vitamin C is critical in maintaining connective tissue and fighting infections. Spongy gums are one of the first signs of scurvy, but even mild vitamin C deficiency causes gum problems. Vitamin A is also necessary to maintain gum integrity and fight off infection.

Zinc's ability to stimulate the immune system has been observed for years, but only recently have been documented by good research. Zinc seems to be particularly effective at reducing oral and respiratory bacteria.

Coenzyme Q, produced naturally by the liver, but also available as a supplement, has been used for years to fight gum disease. However, well conducted scientific studies have not been done to confirm anecdotal reports of its effectiveness.Dr. Andrew Weil, in his newsletter Self Healing (Jan. '97), recommends taking 60 to 100 mg of supplemental Co-Q a day, for gum problems.

Dental Hygiene

Pathogenic dental bacteria thrive in a crowd, so limiting the total bacterial number selects for healthier varieties. And removing plaque gets acid and toxins away from teeth and gums.

The American Dental Association recommends we brush and floss twice daily and visit our dentist every six months for tough plaque removal and monitoring.

Brush each tooth carefully but gently with a soft bristle brush. Dr. Winick recommends brushing four minutes with tea tree oil or peelu toothpaste, pushing it under gums and between teeth for its natural antimicrobial effects. Dr. Lessard, on the other hand, stresses the importance of brushing with fluoridated toothpastes. Avoid any abrasive toothpastes.

Clean between teeth daily using floss or a water irrigator. (Dr. Winnick prefers a water irrigator with a dental herbal mixture to clean out gum pockets.) Flossing cleans areas where the brush can't reach. Use a clean section of floss for each tooth. Wind floss around your fingers and unwind as you go. Slip between teeth and under the gum line to wipe plaque from the sides of the teeth.

The American Dental Association recommends replacing your toothbrush at least four times a year. A new generation of toothbrushes feature "natural" bristles made from boar hair or plant materials. Others use nylon bristles which are rounder, softer, and less hospitable to harboring bacteria. New shapes feature bristles which hug the teeth and curved recyclable handles to make it easier to reach all teeth surfaces.

Natural toothpastes and dentifrices eliminate synthetic ingredients and include many of the oral health herbs listed on page 2, especially tea tree oil, to kill gum bacteria. Fluoride is often added to enhance mineralization of teeth.

Baking soda, used as a mild abrasive to clean teeth since the beginning of this century, gives a clean feeling to the mouth.

Hydrogen peroxide, released from effervescent tooth powders, combines with baking soda to create unstable carbonic acid, which fights plaque, promotes mineralization, and then quickly disappears.

Mouthwash reduces bacteria in the mouth and encourages fresh breath. Traditional mouthwashes used alcohol and strong chemicals to kill bacteria, while new natural products use herbs and essential oils such as peppermint or eucalyptus as antimicrobials. Herbal mouthwashes may be used with a water irrigator.

Tongue scrapers, the latest addition to natural dental hygiene, lower the number of oral bacteria by scraping them off the tongue, a bacterial reservoir. If you don't use a tongue scraper, dental practitioners suggest using your toothbrush on your tongue.

Mercury Fillings,... are they safe?

Silver fillings (dental amalgam), the most common dental cavity filling material for the past 150 years, is composed of silver, copper, tin, and mercury. As concern about the dangers of mercury has increased, so have questions about mercury used in amalgam. In response, both US and Canadian governments conducted reviews of amalgam's safety. The US Public Health Service concluded, there is "no persuasive reason to believe that avoiding amalgams or having them removed will have a beneficial effect on health." The American Dental Association agrees. The Canadian investigation conceded that some mercury is absorbed from amalgam but at levels so low they are usually safe.

It is clear that amalgam fillings do release absorbable mercury vapors. A recent Swedish study found people with amalgam fillings had higher mercury levels, which were lowered after filling removal. "It was induced that amalgam fillings are a significant source of mercury in saliva and feces" (Toxicol Appl. Pharmacol 1997 May:144(1), 156-62). However, no one has demonstrated a slight increase above baseline environmental mercury levels causes health problems in amalgam wearers. Dentists have considerably higher mercury levels but no higher death rates than the general population. And a recent study found no higher mercury levels in people who believe they have amalgam-induced mercury poisoning than in a control group.

Like lead, mercury is extremely neurotoxic, with no safe "threshold" level. Current background levels are higher now than previously, and concern is mounting that this exposure may be dangerous. Mercury's health effects may be subtle and individual. And amalgam critics question the rationality of assiduously reducing exposure to every other mercury source-but not amalgam.

Most amalgam health studies focus on adults, but babies may be in greater jeopardy, as their neurological systems are highly sensitive to mercury. Two recent studies observed mercury exposure in pregnant or lactating women. One concluded, "The findings suggest that placement and removal of "silver" tooth fillings in pregnant and lactating humans will subject the fetus and neonate to unnecessary risk of mercury exposure" (Biol Trace Elem Research 1997 Feb 56 (2), 143-5). And a Swedish study correlated maternal amalgam with breast milk mercury levels that expose babies to one half the officially tolerable intake for adults! "We concluded that efforts should be made to decrease the mercury burden in fertile women" (Arch. Envir. Health 1996 May-June 51 (3), 234-41).

Should you have your amalgam fillings replaced if you plan to have a baby? Unfortunately, you may not be able to turn to your dentist for advice-dentists in most states are prohibited by law from advising patients to have amalgam fillings replaced for health reasons. Choose a dentist who uses careful precautions, including a latex dental dam exposing only the pertinent tooth and a sophisticated suction system to prevent swallowing amalgam. Before considering replacing amalgam fillings, however, you should know body mercury levels can temporarily rise 33 percent when four or more amalgam fillings are removed in a day (J. Canad. Dental Assoc. 1996 Jul 62 (7), 547).

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