The Making of a Happy, Healthy Mouth in 2018
This blog’s been quiet for a while only because I’m been busy taking a slew of continuing education courses on the making of healthy mouth and (pardon the pun) digesting all that information to put into clinical use and then, of course, to write it down for you. I had originally thought to title this post Old Dog Learns a Bunch of New Tricks. Even after being a dental hygienist for over 37 years, I still find there’s so much to learn! It’s been quite the educational autumn for me. Today’s post will concentrate on periodontal (gum) disease, with new therapy ideas and of course, more homecare tips for a healthy mouth. I have written lots about gum disease before but strap in, because I have new information for you on how to have a healthy mouth- and it’s not what you think! New research has turned even my head!
- Before I get ahead of myself, let’s step back for a moment with a little review for new readers (or old ones!):
What the Heck is Gum Disease?
Gum disease, or as we call it “Periodontal disease” is an infection of the soft tissues of your mouth (I.E. the gums) that support and hold your teeth within the jawbone. It’s the major cause of tooth loss in adults.
According to the Center for Disease Control, upwards of 50% of the population of the United States have some form of this disease by age 30 and by age 65, at least 70% of adults have this infection! Add in all the new, direct oral/systemic connections such as heart disease, rheumatoid arthritis, and so very many more and there is indeed a huge silent health crisis here in the US. As I perused other countries data, I saw the same or similar stats – Ireland, as well as world wide. Globally, most children have gingivitis which is the first stage of gum disease. In adults, while 80% have some form of gum disease, approximately 15% of those people have a severe form.
Gum disease does not hurt, at least not until the final stages, so sometimes both clients and (gasp!) professionals tend to ignore bleeding when brushing or while getting teeth cleaned. Now, just to be clear, my patients know I never slack on discussing bleeding gums, and how best to get a healthy mouth. Many professionals do encourage more brushing, flossing, and frequent recare appointments, but time and money get in the way. Sometimes we (both patients and professionals) do “kick that can down the road” in the interest of being on schedule or because insurance doesn’t cover it. Plus, as many folks tell me, they “always bleed” when they get their teeth cleaned. Yes, well, their gums have been infected for years, probably since they were children – see above stats. It’s time to stop kicking that can though, even a little blood means something is not healthy and needs to be addressed, NOW!
A Little History Lesson
Our really, really ancient forefathers didn’t have anyone telling them to brush, let alone nag at them to floss! Yet their teeth were much better than ours! Dental disease was rare. They had room for all 32 teeth, and their teeth were straight! WOW! No disease, straight teeth, and large, healthy jaws and airways. What the heck happened to us? Approximately 10,000 to 12,000 years ago, humans transitioned from hunter/gatherer – where he ate meat, nuts and vegetables- to farmer, where the diet changed to include carbohydrates and sugar. The bacteria, or as we now call it, the microbiome, changed. The bacteria loved our new diet, as did we. Unfortunately, our teeth did not. Tooth decay, gum disease, and then crooked, crowded teeth became the norm. Then, around 150 years ago, with the advent of the Industrial Revolution and food manufacturing of flour and sugar, things really went wrong for our teeth and jaw development. For those adventurous souls who want to learn more about this, take a look at the Weston Price Foundation and read Dr. Price’s book Nutrition and Physical Degeneration. I am working my way through his book, although the website is excellent and will get you up to speed quickly. Another interesting take is a book by Dr. Alvin Danenberg called Crazy Good Living. He’s a periodontist that believes dental health starts with diet.
Basically, though – yes, our dental problems started because of our “modern” diets. The thigh bone’s connected to the hip bone, as the song goes, so it’s worth looking at the potential for nutrition to help get rid of dental diseases in a more natural and complete way.
Periodontal Medicine for a Healthy Mouth
So, what does this mean, how does this connect, and what do you do?
I have long focused on nonsurgical periodontal therapy (healing your gum disease without cutting your gums back), and I am excited to now expand my healing protocols to include innovative periodontal medicine into my oral wellness/healthy mouth protocols. This means along with blood work, complete tartar removal, salivary diagnostics, and medications, I want to look at nutrition counseling, host immune response, and genetic testing. Time for 21st Century dental care!
Let’s talk WHY. Have you had deep cleaning or gum surgery only to “need it again” a few years later? You are not alone! Let’s work toward ending that cycle for you.
Blood & Some Basics
Blood work at the dental office may be a new concept to the dental world but really, it shouldn’t be. Gum disease is an infection and inflammation not just in the mouth but in the entire body. It just so happens to be located in your mouth. Any other disease and your doctor does all sorts of testing, for good reason! Why wouldn’t we do that for gum infections as well? Blood work, genetic testing, pathogen testing, as well as some basics like checking/monitoring blood pressure and blood oxygen saturation.
With the information from these results, we can create a treatment plan that’s more specific to you. Changes and shifts within your body cause this overgrowth of pathogenic bacteria. Your genes may make you more or less susceptible to these bacteria. More and more medical science is looking to genetics, especially since they have unraveled the DNA code. Gum infections are no longer considered to be “just” a bacterial infection, so while it’s vital to remove the bacterial niche (tartar) on the tooth surface, and to get the biofilm out of there, it’s also important to prevent or halt the bone loss and improve the immune system, or the disease will return or continue. It’s critical to look for the cause of your gum infection. Test, treat, re-test. Dentistry can and should be incorporating all these, but especially genetic testing into their treatment protocols. Your gum infection could well be due to your genetics! We still need to address the plaque biofilm and the pathogens, but that’s only the tip of the proverbial iceberg, because….
The (Dental) Chicken and The Egg
According to new research from Drs. Bartold and Van Dyke, plaque accounts for only 20% of the risk for developing periodontal disease. This article and that statistic rocked my dental hygiene world! Plaque and tartar removal is the center of “dental hygiene” care! Now, it does not negate the fact we need to get that plaque out of your mouth BUT! it certainly means we need to also address the other 80% of the cause!! Thus, the “periodontal medicine” angle.
This explains why some people can get away with never brushing or flossing their teeth yet have no bone loss or infection. On the other hand, there are those meticulous brushers, flossers, and pickers that have aggressive bone loss. I hear and see this a lot and had no real answers until my trip to meet up with Judy Carroll, and learn perioscopy. Then I read the Bartold paper. As I work my way through this research, it challenges my previous thought processes. All my learning had focused on bad bacteria elimination. In actuality, it may well be a person’s own immune system and genetics reacting to stress, smoking, diet, social determinants, and general health which then determine our reaction to and creation of either periodontal disease or periodontal health.
So, which came first? Did the bad bacteria cause the infection or did the host immune response and genetics allow the bacteria to proliferate and then cause red, bleeding infected gums? Interesting thinking about this, especially in lieu of the fact that plaque and bacteria may not be the bad guys we so vehemently blamed after all. We will still need to address the oral flora and treat the pathogens, but maybe in a much different way.
New Paradigms on Gum Therapy
In early December I drove out to Sequim, Washington to again meet up with Judy Carroll RDH, Director of Regenerative Periodontal Endoscopy. I’d been to watch Judy perform her perio magic about two years ago and made a pact with myself to learn endoscopy from her. Fast forward two years! I am now blessed to work with fabulous biological dentists that encourage my training and out of the box thinking. One such dentist is Dr. Rebecca Taylor. I started working with Dr. Taylor this summer and unbeknownst to me, she was Judy’s niece. What a small world. Dr. Taylor had already taken Judy’s training and encouraged me to do so as well. So, I brought a very lovely and understanding patient with me and we traveled out to Sequim. I learned how to use a tiny dental camera on her, called a dental endoscope or, as it’s referred to, “perioscopy” to see the tartar underneath the gum line. This tartar is a cement-hard bacterial niche, sort of like a concrete hotel for the bacteria and pathogens to hide within and continue the inflammatory process under the gum line. (Check out It’s All About the Plaque (No Tartar!) to read an old post about what plaque and tartar are.)
Judy’s protocol is very different from everything I’d learned up to now. While she tests for the bacteria and pathogens with the use of salivary diagnostics from Oral DNA, she also is interested in the patient genetic risk connections, as well as reviewing their blood work. All of that! She treats the disease from a different angle than the rest of the dental world. AND! She is gets healthy results for those people who have bone loss and are in danger of losing teeth. Look up Judy and travel to see her. It’s well worth your time and money. (I’m still in the learning stages and do not have Judy’s proficiency, yet, but my plan is to be proficient soon! )
What makes her process different is her approach to treating periodontal disease with a medical model. She removes the tartar by visually seeing it with that teeny tiny camera on the screen, and using a piezo scaler to remove it- she calls this “perioscopy clean”. Then she places a natural regenerative protein which then stimulates the patient’s own stem cells to regenerate bone. She looks at this as a breakdown of the host’s (that’s you) immune system response due to genetics (parents have perio?), other systemic illnesses (diabetes, high blood pressure, metabolic syndrome?), as well as nutrition (got a lot of sugar? low on vitamins?), while she meanwhile stops bone loss with pharmaceuticals (more on this in a moment) and stem cells. Wow! That’s so different than what dentistry has been doing.
BUT! with the knowledge that only 20% of gum disease is caused by plaque bacteria, what the heck is causing the rest of the breakdown?!? It’s genes and host response. Now it makes sense. Does this mean I never have to give the floss lecture again? Well, maybe, but don’t stop yet.
Better Living through Pharmocotherapies
I greatly appreciate that, if need be, we can slow down or stop bone loss with medication. Sometimes a body just needs a little help to have a healthy mouth.
Periostat has been around for the last 18 years. It’s a sub-antibiotic dose of doxycycline so it does NOT kill bacteria. Instead, Periostat stops the breakdown of the jaw bones by inhibiting the collagen breakdown. If you want more information on how and why, then click here. Yes, it’s a medicine and I understand some people’s reluctance to commit to meds, but sometimes you need a little help to halt bone degeneration. It’s not forever, but since it can stop bone loss, firm teeth up in the jawbones and counteract the host response to the bacteria and other pathogens why say no? Isn’t it great that we have options like this in treatment?!
Host Modulation Therapy and Controlling Your “Host Response”
So we’ve reached the new crux, here: Periodontal disease is the result of the body reacting, or even overreacting, to a stimuli. Using all the tools at our disposal, we need to find that stimuli- what’s causing that reaction- and, also as important, see what havoc this disease may well be creating in other body parts far removed from the mouth! Did you know gum disease and rheumatoid arthritis are connected? There are many such connections. Thus, the reason for blood work. It is doing detective work for us. Your genes are contributing to how your body reacts to this stimuli. We call this the “host response”. You are “the host,” and as such, it’s your genetics that are controlling your health, in many ways. Knowing your genetic response allows us to then know your risk level for inflammation not only in your mouth but also your entire body which helps direct your therapy. The inflammation in your mouth is literally the tip of the iceberg and tells us of potentially big problems within the rest of your body.
Luckily, your genes are not your destiny! The ability to override your code is called epigenetics. You can change your genes by eating poorly, smoking, lack of exercise, and the like. Just as you can do the reverse, and improve your outcome with better nutrition, proper breathing, proper treatment, and generally healthier living!
Like I said earlier: we test, treat, and re-test. And we do that until you’re healthy.
Gum disease is not just about plaque, tartar and “poor” oral hygiene. Nor is it about lack of flossing. It truly is connected to the entire body and must be treated not just by the dental team but with a true medical mindset. Let’s heal our mouths so we can finally, truly have a healthy mouth and body. It’s a long to-do list but better than a reoccurring chronic infection.
Blue Print for “How to Achieve 21st Century Mouth Health”:
- 1. Work with both your dental and your medical teams. Tell your medical provider you have a gum infection.
- 2. Blood work – tells us a lot, maybe even the source(s) of your infection-there’s lots of good information to be sleuthed out there!
- 3. Time for diagnostic images – both a CT Scan as well as a full set of great quality radiographs (x-rays). Refusing diagnostic imaging, but expecting the best care from dental team? Not possible. My eyes can’t see below the gumline and I have no idea what’s happening underneath. Superman I am not. Would you refuse your heart surgeon’s request for diagnostic images?
Additionally, make sure your team looks for pathology on the root tips of any root canal teeth. This is a (sometimes ignored) source of infection not only for your mouth, but for your heart and body as well.
- Salivary diagnostics – know what pathogens we are dealing with to directly address any “bad bacteria, fungus, viruses or parasites”! Everyone should request a salivary diagnostic test. Know what you have, and treat accordingly. Even if you do not have “deep pockets” you may still harbor bad pathogens, and be at risk for systemic connections. You can not tell just by looking if someone has these bacteria, fungi or other bugs. Test, treat, retest. Know for certain you are healthy.
If there are no bad bugs, but there’s still bleeding and inflammation, then we know the cause is more genetic or systemic. You do not have to have pathogens to have bone loss. Another fun fact that rocked my hygiene world.
- Genetic testing- see if you have the genes markers that indicate a relationship to a hyper-inflammatory response. Hyper-responders to periodontal disease bacteria are also hyper-responders in other areas of the body. Gene testing tells us your periodontal risk level.
Review medications to see if they may be contributing to inflammation or bone loss.
- Have a thorough removal of all your tartar done with the aid of a dental endoscope (Seeing is believing), and place a protein matrix on these cleaned root surfaces and regenerate bone.
Address proper breathing- vital to total body health. Can’t breathe through your nose? See someone, and get it fixed once and for all. And, (I’m biased, I admit) see an orofacial myofunctional therapist. Just about everyone has some orofacial myofunctional disorders.
Proper breathing includes correcting sleep disordered breathing. Sound, healthy sleep is important to a healthy body and thus a healthy mouth. You heal when you sleep.
- Stop bone loss with medicine- Periostat stops the collagen break down in the gum tissues.
Eat good, healthy, nutritious food. Skip the processed, boxed foods, anything white, and definitely watch those carbs! Improve your diet. Incorporate eating clean (getting rid of sugar, nutrients and ingredients you can’t pronounce, carbohydrates, processed foods and other unhealthy foods.), and read Dr. Danenberg’s book (the one I mentioned above). Another book worth reading, when it comes out sometime in January 2018, is Dr. Steven Lin’s book on The Dental Diet.
While you’re looking at your diet, make sure you get proper vitamins and nutrients such as:
Homecare Tips and Tidbits for a Healthy Mouth
So, with all this talk about genes causing your gum infections, does that mean you can skip the nightly brushing? Well, nooo, sorry. Perio bacteria are not entirely off the hook. Until such time as I read differently, I still want to reduce and eliminate as many of those nasty buggers as possible. What I consider the basic basics: brush, clean in-between and all around your teeth, and scrape your tongue!
I have just tested out and fell in love with a new gentle, but thorough, electric tooth brush. It’s called the Triple Bristle Brush. It makes brushing foolproof by putting the brush bristles at the correct angle into the gumline for you. It’s almost like your personal dental hygienist guiding your hand as you brush and, it cleans three surfaces at one time! How efficient. Clean your teeth better, faster and more thoroughly. The price is reasonable for both the brush and the refill heads. Try it out and let me know what you think. Click here and order one today! Tell’m I sent you!
Yes, please clean in between your teeth, but how ’bout with little brushes called piksters instead of floss. Easy peasy, no mess and no cutting up your gums or fingers. They are reusable, at least until the wire looks like a spaghetti noodle. Just wash between uses. If you wanna get wild and crazy, dip them in ozone oil or baking soda before working them between your teeth. Healthy mouth, here you come!
Yup, water power to flush out under the gumline and medicate, raise the pH and get things even healthier. I prefer either the Hydro Flosser or, for those that might use something in the shower, how about the Water pik cordless. Throw some baking soda in with the water, irrigate three times around the mouth, rinse the container with fresh water and you are good to go! Yeah for a healthy mouth!
Clean your tongue twice daily with a Tongue Sweeper. In addition to a healthier mouth, you’ll also have better breath, and maybe even little-to-no morning breath. Your spouse will thank me, and you’re welcome.
Make 2018 the year you commit to mouth health as part of your total body wellness plan. Join me on this journey as I learn more and change how I treat gum disease. Here’s your blueprint to oral wellness. Come see me and let’s get you perioscopy clean and help you have a healthy mouth and healthy body!
Happy New Year and keep smiling my friends,