the truth about gum disease

Gum disease can be the first notable sign of underlying conditions such as cardiovascular disease, diabetes and other inflammatory diseases

periodontal probe

Gum disease, also known as periodontal disease or just periodontitis affects almost half of American adults. It starts as a reversable inflammation of the gums known as gingivitis. That tiny space between the tooth and gum where sometimes popcorn kernels get stuck is called the sulcus. Chronic inflammation causes the gums to detach from the tooth making the sulcus deepen into what is known as a pocket. You may have noticed that your dentist and hygienist routinely measure the space with a periodontal probe to make sure you don’t have pockets. As the pocket deepens, the bone surrounding the tooth is destroyed. Over time, the bone loss can become severe enough that the tooth can loosen. When too much bone is lost, there is nothing modern dentistry can do and the tooth needs to be removed. The symptoms of gum disease are relatively minor considering how destructive the process is. Typically, bleeding and redness are the only symptoms, generally accompanied by unpleasant breath. In late stage gum disease, the teeth can loosen and become uncomfortable to chew on.

plaque and gingivitis

It is widely held that gum disease occurs due to plaque accumulation. This is why we are supposed to brush and floss daily, and have a dental cleaning every six months. I believe that this explanation is over simplified and misleading. Plaque can directly inflame the gums under certain conditions, so you should be brushing, flossing and going to the dentist, these habits are necessary, just like bathing, shampooing and combing your hair.

Prehistoric skulls contain plaque that can be analyzed to determine the varieties of bacteria contained within it. Researchers at the University of Adelaide have found that there were two major changes in the bacterial composition of our plaque over time. The first occurred when we became farmers and started consuming larger quantities of grains. The second change happened during the industrial revolution when we added more refined carbohydrates and sugar to our diets. In both instances, they found that the germs that cause tooth decay increased. The surprising finding is that we have always had the germs that cause gum disease in our plaque, even though our paleolithic ancestors had neither tooth decay nor gum disease.(1) Something is not adding up; If gum disease is caused by germs, shouldn’t our stone age relatives have had it since they possessed the germs that caused it? Furthermore, gum disease is not communicable from person to person as normally happens in infections.

fossilized plaque

More evidence that plaque alone does not cause gum disease comes from a 2009 study that split subjects into two groups. Both were told not to brush or floss for one month. The first group ate as they normally would, and the second ate a paleolithic diet devoid of processed carbohydrates. The first group suffered worsening gum disease while the latter group was found to have less periodontal disease at the end of the month, thus proving that plaque alone does not cause periodontal disease.(2)

If plaque alone does not cause gum disease, then what does? There is a unifying theory of inflammation behind much of our modern chronic diseases including diabetes, heart disease, obesity, and gum disease to name a few. It is a bit complicated, so I will try to simplify it for you. It all begins with concentrated fermentable carbohydrates.

processed carbs and fat

First, a little background history. Weston A. Price, Thomas L. Cleave and John Yudkin were forgotten pioneers who studied human dietary practices, demonstrating that when processed carbohydrates were added to the diet, tooth decay and gum disease appeared almost immediately, followed by the other chronic systemic diseases including obesity, heart disease, tooth decay, cancer etc. In a remarkable paper from 2012, Ian Spreadbury presents a convincing argument that dense acellular carbohydrates promote an inflammatory change in our innate bacterial colonies in our GI tracts, and may be the primary dietary cause of increased systemic inflammation.(3) Researchers believe that prior to farming, the carbohydrates that we consumed were locked up in plant cells, making them less dense and harder to digest. When grains are processed for consumption, they are ground up and the resultant flour is devoid of any remaining plant matter, concentrating the carbohydrate into an easily digestible form. As the researchers in Adelaide found, our plaque composition changed and became more virulent due to the introduction of dense carbohydrates into our diets. The same changes occur in the germs that inhabit our gut. The present hypothesis suggests that in parallel with the bacterial effects of sugars on dental and periodontal health, flours, sugars, and processed foods produce an inflammatory bacterial colony via the upper gastrointestinal tract, with fat able to effect a “double hit” by increasing systemic absorption of endotoxins.(3) Click the link at the end of this post to watch Ian Spreadbury’s presentation if you want more information.

Let’s break this down a little. The germs that normally colonize our GI tracts including our mouth, change their composition and behavior due to the presence of processed carbohydrates. The altered germ colony increases production of molecules called lipopolysaccharides or LPS for short, which are better known as endotoxins. The name endotoxin alone says it all-it is bad and increases inflammation. The presence of dietary fat increases the amount of toxins entering into our bloodstream. Unfortunately western diets contain both of these elements in high quantities.

The next part of the story is that the LPS acts on the nerves of the GI tract, making them less sensitive to the hormone Leptin which makes us feel full and stop eating. The result is overeating and weight gain. Fat tissue secretes numerous substances that further promote inflammation. These substances are known as inflammatory cytokines, further promoting the development of coronary artery disease, gut inflammation, and many other common diseases.(4) A 2009 study found a connection between periodontal disease and obesity. This strengthened arguments that periodontal disease and certain obesity‐related systemic illnesses are related, with abnormal fat metabolism possibly being an important factor.(5) Remarkably, another study found that the presence of one endotoxin producing oral bacteria was a greater than 98% predictor of obesity. (6)

So there you have it, processed carbs plus normal germs equate to increasing amounts of imflammation. Gum disease is just one type of inflamation promoted by the ingestion of processed fermentable carbohydrates. With the consumption of processed carbs, we can expect all diseases with a basis in inflammation to increase, whether it is gum disease, obesity, or heart disease. This is why the American Heart Association has taken the position that curing gum disease will not decrease the risk of heart disease, since it is the diet that is at the root of the problem.

Two more studies are worth taking a look at. They both confirm the assumption that taking processed carbohydrates out of your diet can reduce inflammation and improve several aspects of health. The first study looked at diabetics on a paleolithic diet that showed notable improvements in weight, triglycerides, waist circumference, hemoglobin A1c, blood pressure and blood sugar.(7) The next study compared the Mediterranean diet to the paleo diet in cardiac patients. Leptin decreased by 31% in the Paleolithic group and only by 18% in the Mediterranean group. Weight and waist circumference improved more in the Paleolithic group but not in the Mediterranean group.(7)

We can improve our overall health and lose weight by adapting a diet with little to no processed carbohydrates. As a practitioner of functional medicine and dentistry, I believe that the best way to decrease the risk factors for most of the diseases of chronic inflammation is to get rid of processed carbs from our diets. It is what I call my recipe for a happy, healthy vibrant human being.