Gum Disease: Meet the Bugs!

Do you want to be healthy?  Really healthy??  Let's get serious about getting rid of gum disease.  It's time for the dreaded gum disease talk, no floss lectures though ;).   The Queen of Dental Hygiene has discussed gum disease a little- now it's time to really offer up something different.  We are going to war against it!  In warfare, you have to know your enemy- his strengths, his weaknesses, and how to defeat him.  And, then you need the biggest gun!  Bring out the Bazooka!  Let's win this war, and get healthy, finally!  Here's why and then next week is how.

Meet the Bugs  - the Enemy

In periodontal disease there are 11 bad bacteria- we call them "pathogens".   Since I use a phase contrast microscope right here in my operatory (the room where I see patients is called an operatory), my patients can see them squiggling around on my video monitor like real live (microscopic) bugs.  I think "bugs" an appropriate term.  The bacteria are alive and well, living quite happily under your gums, on your tongue and even in your tonsils.  Your mouth is a warm, cozy place with plenty of "food" for the bacteria, so they multiply and invade your gums.
These bugs are crafty, resilient and hardy.
(And, for the record, I have not seen Listerine kill them.  I did my own little experiment with my microscope: plaque samples and slides, using Listerine on a slide instead of saline solution.  No dead bacteria on either the control slide or the Listerine slide. So forgetaboutit!)

Bad Mama Jama's taking over your tooth biofilm

We'll come back to the bacterial weaknesses in a moment.

Dentistry has divided up the bugs into three categories: high, moderate and low risk.  (Clever, I know!)

The high risk group has some very bad mama jama bugs.  Here are the baddest of the bad:

Treponema Denticola  (also called Spirochetes)
Porphyromonas Gingivalis  (also called Pg.)
Tannerella Forsythia  (also called Tf)
Aggregatibacter actinomycetemcomitans (also called Aa- and for good reason!  Don't even ask me to pronounce this one! I stumble every time.)

The Moderate risk group is only marginally less bad.

Fusobacterium nucleatum  (Fn)
Eubacterium nodatum (En)
Peptostrepococcus  (Pm)
Eikenella corrodens (Ec)
Prevotella intermedia
Campylobacter rectus

Low Risk

Capnocytophaga species

Then there're viruses!
Epstein Barr (EBV)
Cytomegalovirus  (CMV)
Human Papilloma Virus (HPV)

and the Fungus amongus
Candida albicans


There's no pop quiz afterwards, but I do want you to know a little about some of these guys, and why they matter.  You'll want to wipe them out once you hear what they do to your body, not to mention your mouth.

The Enemy's Strengths 

Health- that's the goal here, that's why you read this, correct?  So, in order to be truly healthy, you really have to have a healthy mouth.  Heart disease, stroke, and oral health are on the news lots lately.  Here's what you may not know!
The above bad guys pry open your mouth to invade all parts of your body.  Between being swallowed, hitchhiking your blood stream, being inhaled or even just squirreling into nerves, they are a sneaky, invading army.

Tooth Decay + Gum Disease

The oral bacteria are connected to many more serious diseases and Pg is the keystone pathogen!  He's the linchpin- even in small doses he is the key that opens the door for the other bad bacteria to enter the body.  And, he's present in gingivitis and shallow pockets- more on this important fact shortly.  Pg manipulates, changes, and enters white blood cells (WBC), which then transport it throughout the body!  This is huge!  Your white blood cells are suppose to be your attack and healing cells.  Instead, Pg changes the WBC and impairs its ability to kill Pg.  Pg hijacks your immune system!  Pg inhibits wound healing.  Try as you might to get healthy, until you reduce and remove Pg your wounded gums won't heal.  Pg thrives on the fluid around the teeth and under the gumline, which is called the crevicular fluid.  The crevicular fluid makes cortisol, especially when you're stressed, and this cortisol increases the bacterial growth.  Bacteria love cortisol!   And then they get a free ride to other parts of your body, creating havoc along the way:

•  Pg and Oral Squamous Cell carcinoma -starting with cancer in the mouth. 
•  Pg and Esophageal Cancer in a new study released February 2016-  Pg was found in 61 percent of patients with esophageal squamous cell carcinoma.
•  Pg, and  Rheumatoid Arthritis  - periodontitis may be more frequent and severe in  people with Rheumatoid arthritis.  Research published May 2014 connects periodontal disease and RA.    Relatedly: Pg, Pi, and Fn in a study released in 2014 have been found in the synovial fluid of joints, failed joints as well as in the dental plaque biofilm of the mouth. 
• Pg and Atherosclerosis research from 2015 shows that Pg causes changes in gene expression that boosts inflammation and atherosclerosis in aortic smooth muscle cells.
•  Pg and Cardiovascular Disease - Research from 2013 supports the heart disease/stroke connection to gum disease.
•  Pg, Spirochetes and Dementia- yes, even Alzheimer's disease is connected to inflamed gums.   This deserves it's own blog post in the near future. It's pretty scary.

Then there's the other bacteria too.

•  Fn and stillbirth or low birth weight babies - gum disease bacteria can and do cross the  placenta.  Fn is present in GINGIVITIS!  Fn and Pg work in concert.

More new research:

•  Gum disease and breast cancer connection!  Research published in 2015 connected breast cancer,  former cigarette smokers and gum disease.

•  Candida albicans and denture wearing while sleeping increases the risk of pneumonia

•  Gum disease, kidney infections and heart attacks- new research published March 2015   connects improved oral heath to decreased heart attacks in those with kidney infection. 

• Gum disease byproducts called metabolic small chain fatty acids have been found to wake up HIV in dormant T cells and cause the virus to start up again.  January 2015

There are many more oral-systemic connections. I've just reported some of  the latest research.  For more information  - if you're curious - click here.  There are definitely good bacteria in your mouth as well as these bad boys.  When the system gets out of whack the bad bacteria take over and crowd out all the good bacteria.

Enemy's weaknesses- know whom you are dealing with!

So, now you've met the enemy.  Unfortunately, gum disease DOES NOT HURT so how on earth do you find out if you have it, or if you are hosting these pathogens?

#1.  Know the signs of gum disease- bleeding gums (even a little bit on your toothbrush), red swollen gums, bad breath, loose teeth, shifting teeth, pus (that should go without saying), dentures not fitting correctly, and of course, pain in your mouth.

#2.  Dental examination - your dentist really is your friend, and your dental hygienist is your life guard!  Ask for their help in spotting problems before they grow.  Even better- PREVENTION!  The dental hygienist is your prevention specialist.  We roam the toothbrush isle looking at and for new products, we visit dental conventions for the same reason.  I want to know what's available and how best to use it.  Everything I recommend, from techniques, tools, rinses, pastes, and procedures- know I've done it, tasted it, tried it and figured out what is best for my patients.  My goal is to keep it super simple so it can work for you!
Spend a little extra, get more professional care more often.  There's NO research that says you can keep your mouth healthy with twice yearly hygiene "cleanings".   FYI- those bacteria start repopulating within 24 hours and are right back to the levels they were by the next day.  Twice a year is not enough!  Your homecare really matters- get that plaque off- it's where the pathogens live.

***More on some homecare treatment ideas in next week's post! ***

#3. Testing- yes it costs money.  The tests we recommend run under $400 US.   However, take a second look at that list above.  Cancer, Alzheimer's, and all those other debilitating diseases will cost you much more in the well-being of your family, not to mention possibly your life.  Cancer's a nasty, nasty disease. I urge and implore you to spend the time, effort, and money to prevent gum disease, it will keep you much healthier in the long run.

So, you ask what tests will tell if you have these bacteria?  Great question!

• #1.  Phase contrast microscopy- I use a chairside microscope to tell me a lot about what's going on under the gumline.  You and I can see spirochetes right away! Plus there are Gram-negative rods and spores. My microscope is important to me. I can't work without one.  That'd be like your doctor saying you have strep throat without testing, you don't know what you're up against without testing! 

OralDNA testing  sample

• #2. My other "can't live without" test is a saliva test by OralDNA .  There are other companies that also do microbial testing.  I am most familiar with OralDNA since I use their services.  They have a simple saliva test.  You swish with their saline solution for 30 seconds, spit it back in the test tube and mail it off to the laboratory.  They email your dentist the results.  The test looks at all the above bacteria, and for an additional fee can even test for many of the viruses I have listed as well.  The test also tells us what antibiotics will kill the specific bacteria you have.  Using antibiotics may be an option, I consider it one of my Bazookas! (I save it for last though.)

• #3. Oral DNA also does another very important test- it looks at your genetics.  There are people genetically prone to being what we term hyper-responders.  That means they are much more sensitive to these pathogens than other people, and react much more aggressively to pathogens in that they get more aggressive gum disease.  Did your mom or dad lose their teeth by age 40?  How about grandma or great granddad?   Folks that are hyper-responders in the mouth are also hyper-responders in their arteries - i.e. more susceptible to heart attack and stroke.  

People who are hyper-responders are at increased risk of cardiovascular episodes- actually this puts them at the same risk as if they were a smoker.  Wouldn't it be good to know at age 20 if you found you were at increased risk for gum disease, heart disease and stroke, and  then could monitor your bacterial levels?  Talk about prevention!!   You'd only need to do the genetic test once, although they are adding new tests all the time so down the road you may elect to test further.  Personally I'd love to test each and every patient so we know where we are starting and can further customize preventive care, rather than waiting for disease to show up!

Gingivitis - not so benign 

What does "a little bleeding" really mean?  It really means you have an infection.  Period.  In order to find out what you're dealing with, you would benefit from additional testing.  It's really not a benign infection- ask the mom who lost her baby at 36 weeks due to "just gingivitis".   The bacteria in this case is Fusobacterium Nucleatum, and new research also implicates it in preventing your body from fighting cancer cells.   

Gingivitis is not something to be ignored, and ignored, and ignored until you have bone loss and your dental insurance "will finally pay" for treatment!  This infection is totally reversible, but when it settles into the jawbone, yikes! so much harder to address!!!  And it's contagious!

  Please attack this infection as if your life depends on it, because it DOES!



So, hopefully, you're inspired to eliminate gum disease.  The next post will be the nuts and bolts of fighting gum disease at home with  new tools!  I'll bring the bazooka!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~






Smile! Why? Because it makes you more attractive, it changes your mood, it relieves stress, and it helps you stay positive!

til next time, 

Barbara