About Periodontal Disease

According to the American Dental Association approximately 75% of our over twenty population has periodontal problems. Based on my practice, and speaking to dentists around the country, I believe this figure is closer to 90%. In either case, these statistics have widespread implications for our general population.

Do your gums bleed? Are they red or puffy? Has you dentist ever told you that you need to brush better or see the hygienist more frequently? If your answer to any of these questions is "yes", then you have some form of periodontal or gum disease.

What exactly is periodontal disease? As part of the answer, we need to understand how teeth are held in the mouth.. Teeth are not embedded in the jawbones but are totally surrounded by tissue called the periodontal membrane. Each tooth is totally surrounded by this tissue. The tissue acts as a shock absorber for the tooth.

Periodontal membrane is actually a continuation of the gum tissue that covers all the bone and tooth parts in the mouth with the exception of the crown of the tooth (the part we see).The periodontal membrane has thousands of tiny fibers called periodontal ligaments that go from the membrane and attach to the tooth and the bone.

In a normal healthy mouth there is always a slight space between the tooth and the bone called a pocket, which is usually about 1-2mm (about an eight of an inch). ⁽¹⁾

Poor oral hygiene will allow plaque, or hard deposits to form on the teeth. These deposits allow for the growth of bacteria that cause inflammation of the gum tissue. The bacteria also release minute amounts of toxins that help break down the tissue, helping the infection to progress. As the infection progresses, the gum tissue becomes red instead of its normal healthy pink color and will get puffy. As the infection continues, bleeding will occur, especially when you floss or brush. Aside from these effects the bacteria migrate into the pocket and begin to destroy the periodontal membrane. The toxins produced by the bacteria will also destroy the bone in the immediate area. The process can be seen by a deepening of the normal healthy pocket from 1 to 2mm to 3 to 4mm and in severe cases 7 to lOmm or more. The effect of this over a period of time, is that the teeth involved are loosened and will eventually fall out. The supporting structures, (the periodontal ligaments) having been completely destroyed at this stage.⁽²⁾

Periodontal disease can result from mechanical problems, usually from excessive pressure on a tooth either from a habit such as grinding or from a person's bite being off. More then normal pressure on a tooth will also cause disintegration of the underlying bone and result in problems. Dental restorations that do not fit properly can also be a factor by causing the gum tissue around the restoration to become irritated.⁽³⁾

While these local factors are causes of periodontal problems, they are not the main factors responsible. Periodontal disease is a symptom of the body being in trouble.There are commercials on television that show how all the germs in the mouth are killed when certain mouthwashes are used. The problem is that the germs will be back within a few hours. The bacteria that are being killed are part of the normal population that is always present. Disease is not due to the presence of bacteria, but rather to the body being out of balance in such a way that the bacteria responsible for the inflammation are breeding out of proportion. Killing the bacteria is not the answer. Placing the body back in balance is a much more effective method of treatment.

Stress will also play a major part in the development of periodontal disease. High stress levels cause a lowering of the immune system response and will deplete the body of many valuable minerals and vitamins that are needed for general maintenance and repair.

The body must maintain blood levels of calcium and phosphorus. If there is a shortage of calcium or phosphorus or other minerals the body will take them from nonvital areas so that the more important parts of the body still function well.⁽⁴⁾

As a dentist I am sorry to say that the mouth is not the most important part of the body and will lose out to other more life supporting parts in the race to have proper nutritional balance. What this means is that the body will take minerals from the jawbones and bring them to the body parts. This will result in a weakening of the bone that supports the teeth and for this reason, periodontal disease can be thought of as the beginning of osteoporosis.

When your diet is not what it should be, or stress is present, or you have a combination of both of these factors, the body will react. There are a number of bacteria that live in the mouth, some good, some harmless and some harmful. When you are healthy, the bacterial populations are kept in balance. Your healthy immune system has no problem dealing with this low level of harmful bacteria. When your general health starts to change for the worse, the mouth chemistry changes. Minerals that are in solution in saliva tend to precipitate out and form deposits on the base of the teeth. These mineral deposits are called plaque. The harmful bacteria are now finding that the mouth, is a great place to breed and they start to increase in number. The deposits of plaque tend to protect the bacteria which lodge in the pockets around the teeth and the infection process begins.

		Treatment for Periodontal Disease

Traditional treatment for periodontal disease involves surgical removal of the infected tissue and antibiotics. There are problems with these treatments. Surgery is a very painful and expensive procedure that many people will need to have redone within five years because it removes the symptom rather then the cause. The problem with antibiotics is that a person can become sensitized to the antibiotic; the weaker bacteria are killed off while the stronger bacteria become resistant to the antibiotic. This is happening throughout the medical world.

There are other methods to control periodontal disease that are safer, less expensive and more natural. While periodontal disease has generally been considered a local problem, holistic methods of treatment, with the help of modern medical research, are showing that this is not the case.

According to Dr. Robert Genco, the editor of the Journal of Periodontology, research is showing infection and inflammation caused by periodontal disease as significantly increasing the risk for coronary heart disease.⁽⁵⁾ In the Sept 1997 Journal of British Medicine, research showed that there can be a causal relationship between periodontal disease and an increase in heart problems. In some of the populations studied the likelihood of getting heart disease doubled when periodontal problems are present.⁽⁶⁾

In 1980, I published Nutrition Eases Dental Problems.⁽⁹⁾ This was a short paper that stated all dental problems are the result of nutritional deficiencies. Since that time I have been treating my patients with nutritional methods and getting excellent results.

My philosophy has always been "keep it simple." The least invasive procedure should always be done first. Since our office has been treating even advanced cases non-surgically, surgery is never considered during the first six months of therapy.

Scaling and root planing are necessary to break up the mats of bacteria and to remove most of the tarter and calculus that is adhering to the teeth. No matter what procedures are used all the calculus is never removed. The point is that when debris and bacteria are taken away, the area can be kept clean and healthy by repeated irrigations. The best way is to change the chemistry of the body (and the mouth) so that the bacterial populations are changed back to normal healthy populations. Irrigating the area with the Natural Dentist Herbal Mouth Rinse has been shown to be an excellent way of removing the bacteria and healing the tissue over a period of time. Research has found that The Natural Dentist Mouth Rinse and Toothpaste were among the most effective methods of treating periodontal problems.⁽¹²⁾

Home care is ongoing from the beginning of therapy. Self-treatment is the most important part of the entire process. Repeated treatments are successful only if the patient is doing what is required on a daily basis to facilitate the removal of the diseased state.

		Diet & Supplementation to Assist in Healing Periodontal Disease

While non-surgical periodontal therapy is based on each individual patient's needs, here are some things you can do:

1. Diet analysis - This involves writing down everything you eat including the time and how much. For example, if you're having eggs and toast for breakfast just writing down eggs and toast is not sufficient. Breakfast may be two eggs fried in butter with toasted white bread, filled with cream cheese and jam. Followed by two cups of coffee; no juice or vitamins. By keeping a complete record of what you are eating a few things happen:
   
   
   • You become aware of what you eat You see how much you eat (most people are shocked at the amount of food they consume)
   • You see when you eat
   
   
   All of this is important because many problems with health can arise due to habitual eating habits. For instance, if you are eating a high protein meal shortly before bedtime, you can easily put yourself into an acid condition. This will lead to a shift in your mineral balance and could cause a host of health problems.
   
   
2. Go on a detoxification diet. If there are no medical problems that would require this be modified, a detoxification diet is the following:
   
   Breakfast
   Fruit - any type
   
   Lunch - Monday, Wednesday and Friday
   1 or 2 types of fresh fruit in season (berries, pineapple, apples, pears, grapes, peaches etc.)
   OR apricots
   OR figs, currants (dried fruit may be soaked)
   AND avocado
   
   Lunch - Tuesday, Thursday, Saturday and Sunday
   Small RAW vegetable salad (must have romaine lettuce and sprouts plus two or three other vegetables)
   AND avocado or rice cakes or three ounces of raw nuts (almonds, filberts, walnuts, pecans)
   
   Dinner

   Monday - Large RAW vegetable salad and baked potato or lentils or chickpeas. And, if needed, one steamed vegetable (cabbage, asparagus, broccoli, brussel sprouts, etc.)
   Tuesday - Large RAW vegetable salad and baked yam or avocado.
   Wednesday - Large RAW vegetable salad and baked potato or corn or lentils. And, if needed, one steamed vegetable.
   Thursday - Large RAW vegetable salad and avocado or beans (garbanzo, fava, mung)
   Friday - Large RAW vegetable salad and baked potato or corn or lentils. And, if needed, one steamed vegetable.
   Saturday - Large RAW vegetable salad and brown rice and beans and lightly steamed diced vegetables.
   Sunday - Large RAW vegatable salad and six ounces of ricotta cheese or pot cheese or cottage cheese. And, if needed, one steamed vegetable.

   Dressings - lemon juice and oil and dulse or kelp.

If you cannot modify your diet 100%, come as close as possible. The more you do, the better you will feel and eventually, you will be able to enjoy this diet. Remember this is only for a month! After one month you may use this as a guide and add other foods. This diet will allow the body to become alkaline in a short period of time.I also place my patients on whole food supplementation. I prefer whole food supplementation to the normal multivitamins because they contain many factors not found in vitamins that have been processed. Beta carotene, one of the precursors to Vitamin A has long been known as a highly effective antioxidant. Indeed, Beta carotene is sold in health food stores all around the country. It would be more effective to get the carotene complex rather then just Beta, since research is showing that some of the other carotene factors such as gamma and alpha are even more active.Supplements that will help periodontal problems:

• Vitamin C - 2-4 gms per day (Take as 500mg every few hours) Vitamin E - 200-400 iu per day Selenium - 200-micrograms per day Zinc picolinate - 30 mg per day Beta-carotene complex
• CO enzyme Q10 - 100mg per day

		Changing the Body's Chemistry Through Diet

While being too alkaline can result in disease, most problems seem to come from being to acidic . Monitoring changes through saliva and urine PH is an effective way of determining your acid/base level. The PH is a number that will tell whether something is acid or basic (alkaline). The PH levels are from l to 14 with 1-6.9 being acidic, 7.0 being neutral and 7.114 being alkaline or basic. While blood PH. is a little more complicated, saliva and urine PH are relatively easy to determine. For saliva, this can be done with litmus paper from a drugstore.

Check your saliva by spitting on the paper and recording the numbers. The PH test strips that you can purchase will come with a color-coded PH chart. Matching the colors will let you see how acidic your saliva is. Saliva should be neutral ⁽¹³⁾ or very slightly acidic (6.9- 7.1). If you test below 6.9, you probably have an acidic condition.

There are test strips that you can buy that are specific for urine and are easy to read. Check your urine every few hours by dipping the paper in a sample (1/2 cup) and record the numbers. This will enable you to chart how acidic or alkaline you are. Urine PH will vary, but usually it will be between 7.0 and 5.5.⁽¹⁴⁾

Saliva is the more determining factor of the two. If your saliva is acidic but your urine is not, you still should consider yourself acidic.

Saliva is a good indicator of what is happening inside the body. Salivary PH is indicative of alkaline mineral reserves. This is especially important in periodontal disease because balancing body chemistry is the main factor for restoring health. After eating, saliva PH should rise to 7.8 or higher. If you are not achieving this type of PH rise, try and remove foods that are acid producing such as meats and whole wheat. Refer to the detoxification diet that I mentioned a few pages back.

Urinary PH reflects the bodies building and tearing down cycles, through buffer salts and hormones. Start with the second urination of the day. The upon rising urine is a collection of acid and alkaline and should be discarded. Urine should be within a PH of 6.0 - 7.5.

Please Note: whenever you are checking your urine or saliva, its important to remember that this is a reflection of what foods you are putting into your body. Assuming there are no medical problems, changing your diet will cause changes in the PH levels.

If you are on the detoxification diet and are still having problems with an acidic PH (the paper is too yellow) try using cell salts. The homeopathic remedy Natrum Phosphoricum is excellent for producing alkaline shifts.⁽¹⁵⁾ Natrum Phosphoricum will help change lactic acid to carbonic acid and water. Natrum Phosphoricum is also necessary for dissolving uric acid in the blood.If you are to alkaline (the paper is too green ), eat acid forming foods such as Brown rice, lentils, tomatoes, whole grains, seeds and vinegars.

If your urine is to acidic, again try the detox diet mentioned before. Carrot, spinach and celery juice are a healthy way to reduce acidity. If you are find that you are too alkaline, eating the acid forming foods mentioned above, will help.

Melvin Page D.D.S. author of Your Body is Your Best Doctor has done nutritional research spanning some thirty years. He has found that a blood ratio of 2.5/1 of calcium/phosphorus is one of the factors necessary for general health. Mineral imbalances in the saliva are reflections of the problems of the blood. This is why an analysis of blood can be very helpful in treating periodontal patients. Page also found that eating sugar changes the relationship of calcium to phosphorus, with the calcium rising and the phosphorus decreasing. One of the misconceptions that many people have is that just this one part of the whole picture is not in balance. The key to remember is that if one part is off, everything is off. Each mineral is dependent upon everything else. With the calcium/phosphorus levels being out of balance, the ph changes and since the blood PH must remain a constant, buffer salts are released to counteract the changes. This will throw the other minerals out and so it goes.

Normal blood PH is 7.4. If the blood is slightly acidic, the cells tend to become acidic. Since the body wants the blood to maintain its PH level, alkalizing minerals will be released to compensate for the tendency towards acidity. Such minerals include calcium, magnesium, potassium and sodium. These minerals are replaced by fruits and vegetables . Fruits and vegetables are considered alkaline foods because they are mineral donors. Organic acids from these foods are oxidized into carbon dioxide and water. These products are eliminated through the lungs and kidneys. The alkaline minerals that are left form buffer salts that help to neutralize the acid waste from cell metabolism.

One of the reasons that the detoxification diet mentioned before is so helpful is that it is low on protein. Most people eat between 80 and 120 grams of protein per day. The RDA recommends 60 grams of protein for a male and 50 grams for a female. I believe that numbers should be much lower; 20-30 grams for males and 15-20 grams for females. Excess protein can create problems:

1. It is very acid forming because of the sulfur and phosphorus that are abundant in animal protein. These metabolize into sulfuric and phosphoric acids that need to be neutralized by the body and can deplete the body of minerals needed for other processes.
2. It can change the PH of lymphatic fluids that surround the cells and impair protein synthesis inside the cells.
3. When the body is too acidic, white blood cell production is lowered. This weakens the immune system.

With a weakened immune system, and a body that is in a state of chemical imbalance, something must give. One of the earliest problems that can occur is periodontal disease.

As a Holistic practitioner, I believe that using natural healing ways to change the body's basic chemistry to a more healthy state is a much better method of therapy then either drug induced changes or surgical procedures. By helping patients to have better nutritional habits, and realizing that periodontal disease is a warning symptom, Holistic Dentistry can make inroads into reducing major problems before they occur.

		Bibliography

1. Wilson,T and Kornman K, Fundamentals of Periodontics, Quintessence books 1996, pg 17-27 IBID pgs 47-61 IBID pgs 471-484 Page M, Your Body is Your Best Doctor, Keats Pub. 1972 pas 112-115 Genco, RJ Destefano F and Kahn H. Dental disease and risk of coronary .heart disease and mortality Br Med Jr 1993 688-691 Biomedical and Clinical Aspects of Coenzyme Q 10 1977 vol 1 Biomedical and Clinical aspects of Coenzyme Q 10 1984 vol 4 Zeines V, Nutrition Eases Dental Problems Jour Nut Consult. May 1980 Wilson ,T and Kornman K, Foundamentals of Periodontics Quintessence Books 1996 pg 250 Mindell E, Herbs Simon& Schuster 1992
   Lust J, The Herb Book Bantrom Books 1974
   Burton Goldberg group, Alternative Medicine 1995 Kaim J, A Laboratory and Clinical Evualation of " The Natural Dentist Herbal Mouth and Gum Therapy ", N.Y.U. College of Dentistry Pub March 1998 Reprints on request Harper H. Review Of Physiological Chemistry 16th ed Lange 1977 pg202 IBID pg625 Champan J.B. The Biochemical Handbook Formur Inc 1976 pg27
2. Page M, Your Body is Your Best Doctor, Keats 1972 196- 199