Functional Medicine: Gum Disease Treatment
Chapter 1. Introduction
What does the health of your mouth and, in particular, your gums reveal about the potential state of your health?
Chapter 2. Gum Disease – What is it?
Gum disease is highly prevalent amongst adults in the UK, but what is it? And what are the signs and symptoms that you may have it?
Chapter 3. Gum Disease – What Causes it?
From being genetically predisposed, to bacterial biofilms, inappropriate diet, smoking and inflammatory lifestyles, they all can contribute.
Chapter 4. Signs & Risk Factors of Gum Disease
Do you have signs of gum disease but don’t realise it? Find out about modifiable lifestyle factors that can put you at risk.
Chapter 5. Preventing and Treating Gum Disease
Practising great dental hygiene habits, improving your diet, stopping smoking, using products like probiotics and limiting oral anti-bacterial mouthwashes to appropiate use only.
Chapter 6. Gum Disease and its Links to Other Diseases
Most chronic disease from cancer to Type 2 diabetes are diseases of increased inflammation. Gum disease increases the risk of pathogenic bacteria moving from the mouth into the body and being a causative factor in these diseases.
Chapter 7. Gum Disease and Functional Medicine Associates
Our approach is not just to help with local oral health, but to control how poor oral health can contribute to systemic chronic disease. Through testing for pathogenic oral bacteria and identifying at risk genes we can build you a programme to help.
Healthy Smile, Healthy Gums, Healthy Body
Here at Functional Medicine Associates we are trained to the highest level in understanding how all of the systems of the body can influence both health and disease at any one time. What has become increasingly apparent both in the science and through working with our patients is the importance of good oral health not only in reducing gum disease but in improving overall health. There is now plenty of scientific evidence to support the fact that ‘what happens in the mouth doesn’t stay in the mouth’ and that chronic disease management must take into account the health of the mouth.
At Functional Medicine Associates we were noticing that the majority of our patients were presenting with some form of gum disease.
This is not unusual or alarming considering that most adults in the UK have some degree of gum disease but we could no longer ignore the science, pointing to the fact that both mild and advanced gum disease may be an indication of wider excess inflammation throughout the body. To put it differently, your smile can reveal a lot more than you might think it does about the state of your health. Your smile is the gateway to your mouth and in turn, your mouth is the gateway to your gastro-intestinal tract and the rest of your body.
The mouth is home to the second most diverse microbial community in the body, harbouring over 700 species of bacteria that colonise the hard surfaces of teeth. As individuals we each harbour, on average, about 100-200 of these individual species of bacteria. Recent technological advances have meant that we have a much better understanding of this ‘oral microbiome’ and the role it plays in health and disease and we now know that it contributes not only to oral health but to general well-being. After all, your mouth is the gateway to your gastro-intestinal tract and the rest of your body.
If you are suffering from bad breath and/or bleeding gums, these could be the first signs that the bacteria in your mouth, known as the oral microbiome, is out of balance and that you are suffering from gum disease, potentially increasing your chances of developing chronic inflammatory conditions such as heart disease, diabetes and Alzheimer’s
Dr Mark Ide, Reader of Periodontology at King’s College London, writes “Research has shown that gum disease can elevate the levels of molecules in the bloodstream that are involved in the inflammatory response throughout the body” and this in turn can lead to the development and progression of a range of chronic disease conditions throughout the body.
Regular trips to the dentist are not just about avoiding tooth decay and fillings, they should be seen as an essential part of maintaining general health, equally as important as visiting the doctor, going to the gym and eating a healthy diet. If you are concerned about the state of your mouth or want to know more about the signs of gum disease, fighting and/or reversing gum disease, or if you would like to know more about gum disease and its’ associated health risks, then read on and find out what we at Functional Medicine Associates are offering our patients when it comes to improving and monitoring their oral health.
Given the high prevalence of gum disease and periodontitis (advanced gum disease) amongst our patients we have for several years now explored and tested both the bacteria in the mouth and the associated genetic risk factors for periodontal disease. Our training and the continued scientific research means In effect, at Functional Medicine Associates we are bringing the mouth back to the body.
What is Gum Disease?
Gum disease is described as swelling, soreness or infection of the tissues supporting the teeth. There are two main forms of gum disease: Gingivitis and Periodontal Disease (Periodontitis).
Most adults in the UK have gum disease to some degree but it is often overlooked in its’ early stages as it has very few symptoms. Around 1 in 2 adults has some form of periodontitis that is hard to treat. Gum disease will be expressed differently in different people and is a highly personalised disease. It not only causes tooth loss but can have an impact on the rest of the body contributing to the inflammatory conditions already mentioned such as heart disease, rheumatoid arthritis, diabetes, Alzheimer’s and certain cancers.
Meaning ‘inflammation of the gums’, gingivitis is when the gums around the teeth become very red and swollen and often bleed when they are brushed during cleaning. Bleeding during brushing as well as bad breath are signs that you may have gingivitis, the early stages of gum disease.
Long-standing Gingivitis left untreated can turn into Periodontitis of which there are a number of different types all affecting the tissues supporting the teeth. Periodontitis is caused by certain bacteria and the inflammation they trigger.
These bacteria, naturally present in the mouth, only become harmful when the conditions are right for them to increase in numbers. As the disease deteriorates the bone anchoring the teeth in the jaw is lost causing the teeth to become loose and, if left untreated, to eventually fall out. This is a gradual process that takes place over many years.
What Causes Gum Disease?
In short, gum disease is caused by a build-up of plaque (biofilm) on the teeth. Plaque is allowed to build up when good oral hygiene is lacking. We all know about plaque through our dentist/hygienist telling us that if we do not clean our teeth adequately then plaque will build up over time and harden into tartar.
Plaque is a film of bacteria, viruses and yeast which forms on the surface of teeth every day. Many of the bacteria in plaque are completely harmless and are there to protect our teeth and gum tissues and promote health not only in our mouth but in the rest of our body. There are some bacteria, however, that have been shown to be pathogenic and are the main cause of gum disease. When soft bacterial plaque is not removed through adequate tooth brushing, minerals are deposited within it over time causing tartar to form which cannot be removed using a toothbrush.
It is widely understood that there is also a genetic component involved in the development of gum disease and whilst the exact mechanisms may not be clearly understood, it is clear that for some individuals a genetic susceptibility to gum disease combined with lifestyle factors such as poor oral hygiene/health, smoking, poor diet, lack of exercise, stress etc, increases the risk of developing some form of gum disease. Lifestyle factors and the role they play in the development of gum disease are discussed in further detail in the following chapter.
Signs of Gum Disease
Gum disease is often silent, meaning that symptoms may not appear until the disease is already in its’ advanced stages. One of the first signs of gum disease is bleeding during brushing and in some cases even whilst eating. Other symptoms that may indicate there is something wrong include:
- Red swollen or tender gums
- Gums that recede or pull away from the teeth
- Loose or separating teeth
- Sores in the mouth
- Bad breath
- A change in your bite (the way your teeth fit together when you bite)
Your first port of call if you are concerned about bleeding gums and think you may have gum disease is of course your dentist.
Am I at Risk of Gum Disease?
As already discussed, poor oral hygiene puts you at risk of developing gum disease but so do a number of other things including:
Some individuals, despite having good oral hygiene habits, may be at increased risk for developing gum disease based on their genetic make-up. At Functional Medicine Associates we offer Oral DNA testing to identify whether or not individuals have genetic susceptibility to developing gum disease.
- Having Diabetes
Diabetes is one of the most common and serious chronic diseases worldwide and is becoming increasingly common in Western countries affecting at least 5% of the population and with as many as this likely to be undiagnosed. Diabetes is a condition where the body is unable to correctly regulate the amount of sugar in the blood.Much research has been carried out in order to understand the link between diabetes and periodontal disease. We know that people with Type 2 Diabetes are around 3 times more likely to develop dental problems such as periodontitis than people without diabetes. One of the mechanisms for this is high levels of sugar in the blood which can lead to higher levels of sugar in the saliva providing a breeding ground for bacteria. High blood sugar levels can also damage the blood vessels in the gums increasing their susceptibility to infection.
No-one can deny the fact that smoking is detrimental to health and is associated with a number of diseases, particularly cancer. Not everyone is aware though that smoking is also a risk factor for gum disease. People who smoke are more likely to produce bacterial plaque which leads to gum disease and smoking causes a lack of oxygen in the bloodstream meaning that the infected gums don’t heal. Some studies suggest that tobacco use may be one of the most significant risk factors in the development and progression of gum disease
The oral microbiota changes when women become pregnant and levels of periodontal pathogens increase leading to increased periodontal inflammation. Not only is the pregnant woman more at risk of developing gum problems, but the bacteria associated with gum disease are also known to increase the risk of pre-term birth, lowered birth rate and even blood infection in the placenta or the new born. Testing is available to identify these harmful bacteria and some experts recommend that all pregnant women be tested.
- A weakened immune system
This might be caused by another illness that compromises your immune system, a poor diet, lifestyle factors, stress etc. A weakened immune system
A poor diet low in nutrients can compromise the immune system and make it difficult for the body to fight infections
Whilst a direct connection between stress and gum disease is yet to be proven, there is certainly evidence to show an indirect association. Some levels of stress are normal of course and help us cope with everyday challenges in our lives. When stress levels remain high, however, this has an impact on our immune system and as we have already mentioned, a compromised immune system decreases the body’s ability to fight infection
The risk of gum disease/periodontitis is increased in individuals who or overweight or obese. The exact mechanisms to explain this relationship remain unclear but it is thought that the development of insulin resistance as a consequence of the inflammation and oxidative stress that is seen in overweight or obese individuals plays a key role.
Some prescription and over the counter medications can cause a decrease in saliva thereby giving you a dry mouth. The decrease in saliva flow caused by these medications can cause an unhealthy growth of bacteria and may put you at risk of gum disease. The reason for this is the fact that saliva itself is an important promotor of oral health, containing vital enzymes and proteins that help to maintain a balanced oral microbiome. Medications that have dry-mouth as a side effect are numerous and include those that treat allergies, asthma, blood pressure, pain, anxiety, depression, cholesterol, Alzheimer’s and Parkinson’s disease.
How to Prevent Gum Disease
So, what’s good for gum disease then and how can you stop gum disease from occurring in the first place. You may already be affected and want to know how to fight and even reverse gum disease?
Most people are aware that having good oral hygiene habits is an essential starting point in preventing or delaying the progression of gum disease. All plaque must be removed from the teeth every day by brushing and cleaning in between the teeth using interdental brushes or floss. Cleaning the tongue and having regular dental check-ups are also important in controlling dysbiosis in the mouth. Here we discuss what else you can do to improve your oral microbiome and not only prevent gum disease, fight gum disease and potentially reverse gum disease but improve your health in general as a result:
- Maintaining strong and healthy gut Bacteria
It’s a well-known fact that a healthy gut microbiome (the bacteria in our gut) plays an important role in determining our health and well-being, supporting our immune system and contributing to for example, mental health, weight control and even resistance to dementia.
- What many people may not be aware of is that a healthy gut microbiome also maintains a healthy oral microbiome. There is an approximate 45% overlap in the microbes that inhabit the mouth and the gut! An overabundance of pathogenic species of bacteria in the gut causes the immune system to become compromised and in turn the oral microbiome to become disturbed and unbalanced leading to an increased risk of inflammatory conditions including gum disease
- Eat a nutrient-rich balanced diet
A healthy diet for both the oral and gut microbiome is one based on a wide variety of vegetables and fruits, nuts and seeds, free-range and wild caught animal products. On the other hand, a diet high in simple carbohydrates, refined grains and sugar will contribute to dysbiosis in the mouth as well as in the gut. Whilst the exact role of sugar in the development of periodontal disease has not been adequately studied, what is known is that added sugar consumption promotes inflammation which in turn leads to the development of risk factors for gum disease such as insulin resistance.Processed foods containing chemicals, additives, added sugars and unhealthy/unstable fats should also be minimised or excluded from the diet as should acidic drinks such as fizzy drinks.
- Proper Airway space
Your dentist should be trained to evaluate your bite and the proper function of your tongue position for breathing and swallowing. Nasal breathing should be encouraged
- Efficient Oral Hygiene
As discussed, a good oral hygiene routine is an essential part of staving off gum disease and keeping your oral microbiome in balance. Brushing and flossing are key here, as is eliminating the use of antibacterial mouth washes (which wipe out microbial diversity).
- Not smoking or Quitting smoking
We have already discussed the impact of smoking on risk of gum disease. Smoking cessation is a step in the right direction in the fight against gum disease.
- Using Probiotics
There is now evidence to support the use of probiotics in the treatment of both early gum disease (gingivitis) and advanced gum disease (periodontitis). At Functional Medicine Associates we recommend the use of Oral Probiotic powders, probiotic mouth swishes and natural anti-microbial products to patients.
- Use anti-bacterial mouthwash only when needed
As we have already discussed, many of the bacteria in our mouth are there to protect our teeth and gums and promote overall health. Overuse of antibacterial mouthwash can reduce both the good and bad bacteria possibly leading to dysbiosis in the mouth. It is important to note that there are times when the use of an antibacterial mouthwash is recommended by your dentist, for example following surgery, and it is important to follow the advice of your dentist and use the mouthwash as directed.
Gum Disease and it’s Links to Other Diseases
Countless studies now link oral health with overall health. Some 5 years ago, It was our discovery of this scientific link that led us to start looking into this area in the first place. The influence of the health of the mouth on the rest of the body is so important, that testing this area is one of our starting tests with many of our patients. By testing the mouth we can identify some of the contributing “root causes” to a patients chronic disease state.
We know that certain bacteria present in plaque (also called a biofilm) in combination with an individual’s genetic inflammatory response can result in bad breath, painful, bleeding gums, loss of bone and eventually tooth loss. However, the consequence of these bacteria being present in the mouth for years, even decades, is a significant increase in the risk of a number of life-threatening diseases beyond the mouth.
For example, there is evidence indicating that having gum disease may increase the risk of cardiovascular disease, rheumatoid arthritis, diabetes, some forms of cancer, Alzheimer’s and inflammatory bowel disease. The link between our oral health and the rest of the body is known as the ‘Oral-systemic Connection’
Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, explains
“The link between oral health and overall body health is well documented and backed by robust scientific evidence. Despite this, only 1 in 6 people realises that people with gum disease may have an increased risk of stroke or diabetes. And only 1 in 3 is aware of the heart disease link.”
Gum Disease and Functional Medicine Associates
The team at Functional Medicine Associates uses a Functional Medicine approach when treating patients. This approach is one which looks at chronic disease through a different lens than traditional models of medicine. In effect we not only treat the symptoms that our patients display, we aim to treat the root causes for these symptoms being there in the first place. In the case of gum disease for example, not only would we recommend better oral hygiene practices and regular dental check-ups, we may also recommend some probiotics to improve the gut microbiome, suggest improvements in diet and lifestyle such as reducing stress and stopping smoking. In addition to this we offer, as part of our routine testing programme, a specific tests to identify levels of pathogenic bacteria in the mouth and, on occasion, we will also test for the genes that are associated with increased risk of periodontal disease.
Test result examples:
Through our work with patients experiencing Cardiovascular Disease (CVD), Cognitive Decline, pain associated conditions and auto-immunity, we became aware of the links between specific bacteria and an increased risk of these diseases. It is now routine for us to ask about and investigate a patient’s oral health at the beginning of working with them. This association between oral health and overall health has significantly expanded our view on disease and its’ treatment. We have now adopted interventions to improve oral health and we use these in conjunction with all the other traditional lifestyle interventions. Same disease but a new “lens” to look through which opens new and exciting ways to treat. Our work has interested dental professionals in the UK and further afield. We will be presenting some of our thoughts and examples in an up and coming Dental Conference in London on June 22 -23rd 2019
How can we help you?
Are you concerned about your oral health? You may have noticed sensitive or bleeding gums or been told by your dentist that you have some form of gum disease. Perhaps your dentist isn’t aware of the links between oral pathogens and certain diseases. Perhaps you think you may be genetically susceptible? We can help you. Testing is very simple to perform and we can provide an oral hygiene programme to help.
Please contact firstname.lastname@example.org for more information.
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