TV has never been the most reliable source of health news and information – a fact underscored by a recent Today Show segment pooh-poohing one of the most widely accepted manifestations of the oral-systemic connection: the link between periodontal and heart health.
The “evidence” given to “prove” that link a “myth”? A superficial reference to an American Heart Association statement released this past spring, which was found to be problematic by mainstream and biological dentists alike. As the American Academy for Oral Systemic Health put it in their position paper,
We agree in substance with statements made by the American Academy of Periodontology that “the lack of causal evidence should not diminish concern about the impact of periodontal status on cardiovascular health.” We believe the preponderance of extant literature is sufficient to warrant continued interest in and research about the associations between periodontal disease and vascular disease. Indeed, we agree with the conclusions inside the AHA Scientific Statement and the clarifying comments made following its publication by two of its co-authors that periodontal disease is associated with vascular disease “independent of known confounders”, which means that common risk factors do not completely explain this relationship and that periodontal disease contributes independently to risk for atherosclerotic vascular disease.
Additionally, as stated within the abstract itself, the authors of this study declare that the literature to date “support an association between PD and ASVD”, and that “periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction.
Such particulars and nuances were nowhere to be found in last week’s Today segment.
In light of renewed attention on the perio-systemic link, here’s a slightly abridged version of one of Dr. Verigin’s earlier articles about it:
The Relationship Between Gum Health & Systemic Health
By Gary M. Verigin, DDS, CTN
A research team at a prestigious university hospital was conducting an experiment: how does a bullfrog react to a handclap? They set the frog on a table and clapped their hands. The frog jumped. Then they severed the frog’s right front leg. Again, the handclap; again, the frog jumped. They cut off the left front leg. Again, the handclap; again, the frog jumped. They cut off the back left leg. Again, the handclap; again – though weakly – the frog jumped. Finally, they cut off the back right leg. When they clapped their hands, the frog didn’t move. The research team thus concluded that if you cut off all the legs from a frog, it will go deaf.
This joke reminds me of how each conventional medical specialty – dentistry included – views health and disease states in isolation, each according to its own biases and premises. Each treats the symptoms of toxicity in its own narrow area of expertise. They’re like the 12 blind men who touch 12 different parts of an elephant and each identify a completely different animal. For instance, conventional Western medicine has different specialists diagnosing eczema, psoriasis, arthritis, teething, muscle trigger points, tooth decay, gum disease, inflammatory bowel disease, migraine headaches, asthma, angina, coronary vessel spasm and chronic fatigue. Yet every one of these states reflects a single condition: uncontrolled inflammation.
Oral health and systemic health are intimately linked – a fact that continues to be confirmed by research published in a wide variety of scientific journals, including the prestigious Nature. For instance, autopsy studies have revealed a specific strain of bacteria in bodies diagnosed with Alzheimer’s disease. This bacteria was found only in the depths of the periodontal pockets around the teeth.
Such findings remind us that dentists are truly “Oral Medicine Care Providers,” and that there is much more at stake than just teeth, bone and gums.
The oral cavity is home to hundreds of microorganisms. In fact, several hundred bacterial, fungal and viral forms live there. Some are helpful, while others are harmful. The main bacteria that cause decay or caries (cavities) are of the Streptococcus family, the genes of which let them cling to teeth, fillings and crowns – especially when the biofilm (plaque) hasn’t been thoroughly and often disturbed. Because they don’t need oxygen to survive, they live very easily below the gum line. If these colonies of anaerobic bacteria aren’t broken up by flossing, brushing, irrigation and the like, they multiply. And when they do, they produce metabolic waste materials. These toxins and enzymes destroy the oral tissues, causing inflammation and breakdown of the tissue lining. This is why such gums bleed when slightly scraped with a cleaning device. When there is chronic inflammation around the teeth, the inflammation can penetrate the underlying bone and enter the bloodstream.
The ability to resist this process depends on one’s biochemical and bioelectrical status, immune system condition and constitutional weakness.
Most of the microorganisms that live in the oral cavity are not pathogenic (harmful). Yet those that are can affect the tongue, oral mucous membranes, salivary glands and tonsils. Not only do such infections have disruptive effects on the oral tissues, they can have a profound impact on overall health and seed infections throughout the body.
Periodontal tissues begin with the alveolar bone. This is what houses your teeth. Thousands of tiny ligaments – called the periodontal ligament or membrane – connect your teeth to this bone. The gingival tissues – your gums – are attached to both the bone and your teeth. They are united in what’s called the epithelial attachment. When we chart periodontal conditions, we slip a probe between each tooth and the gum, into the sulcus and measure this attachment. Healthy tissues measure from one to three millimeters. Larger measurements denote pockets, which mark the onset of periodontal disease.
Two conditions are of special concern: gingivitis and periodontitis. Both are infectious, inflammatory processes. Both are generally chronic. But gingivitis is limited to the gums. Periodontitis results in the destruction of the periodontal ligament, alveolar bone and gingival tissues. Early on, it seldom causes much pain or discomfort. In fact, at this point, the changes aren’t even observable in x-rays.
These disease states result from exposure to more than 400 bacterial species. When pathogenic, subgingival microbes release their various toxic products, the bacteria colonize in the pockets. Left undisturbed for just one or two days – untouched by cleaning tools – the toxins begin to destroy the periodontal tissues. Even after cleaning, as sure as death and taxes, the microbes that make up the biofilm start another cycle of colonization.
After a few days of undisturbed colonization, ulcers grow in the gums. This allows intact microbial cells and their byproducts – including lipopolysaccharides, peptidoglycan fragments and hydrolytic enzymes – into systemic circulation. One’s immune system and host response to these infections result in the local production of cytokines and biological mediators such as serum antibodies, prostaglandins and interleukins.
In light of the many kinds of microbial biofilms and plaques associated with periodontal infections, and in light of the chronic nature of these diseases and local and systemic response to the microbial assault, it’s reasonable to hypothesize that these infections may influence overall health and the course of quite a few systemic diseases.
So why don’t all those with marginal or poor cleaning practices have outright periodontal disease?
Nutrigenomics points to one answer. This field considers the effect of diet – and bioactive molecules in the diet – on specific genes. It looks at how diet may alter the risk of common chronic diseases. It tells us that we are not hotwired to get any particular disease. Rather, we participate in its development.
Disease risks are related to lifestyle. This includes everything affecting your body, mind and spirit. Every cell in your body is connected to the others. It’s as if every cell has the address, phone, fax number and e-mail address of every other cell in your body. Or think about the last time you were barefoot and stubbed your toe on the edge of a piece of furniture. Though only your toe was injured, you felt the impact from head to toe. For this, you can thank the chemical and energetic connections among your cells.
Premised on the notion that the influence of diet on health is related to one’s genetic makeup, Nutrigenomics opens up the best route for treating periodontal and other systemic diseases. Simply, your diet uniquely influences how you function because of how the “information” in your food affects genetic expression. Yes, food is more than just calories and simple nutrients. It provides a dietary signature that presents molecules as information, influencing gene expression and various metabolic functions. As noted biochemist Jeffrey Bland has remarked, “The paradigm shift is to the concept of ‘food is information,’ whether it is protein, carbohydrate, fat, vitamins, minerals, accessory nutrients or the health-promoting phytonutrients found in plant foods.” (Emphasis added)
Says Dr. Steven Green, author of Eclectic Dentistry: Demystifying Medicine, “Other than defined mutation or unknown toxicity, disease is due to harmful addictive behavior arising from diminished self esteem or a perverted reward system. We can broaden dentistry’s range of services into the primary-care arena abandoned by the orthodoxy of the medical profession. Nutritional pharmacology could be a uniquely dental approach, especially in treating that transitional area between vibrant health and disease diagnosis codes. The technology of the emerging age is coming full circle, rediscovering old truths and thus giving doctors the power to become healers again.”