Gum disease is not a particularly standout health topic. Compared to heart disease or cancer, or even anxiety or depression, you rarely hear people talk about their swollen gums bleeding when they brush or floss their teeth. Not exactly sexy.
Yet, considering the wealth of emerging science linking poor health in our gums to a laundry list of dreaded diseases from Alzheimer's to stroke, it's time to heed our dentists' warnings that bad gums are a blinking red light on our body's dashboard that we should never ignore.
Recent studies have estimated that from one in five to half of adults across the globe have inflamed and infected gums. Blood in the sink repeatedly when you brush or floss is a sign of it. Bleeding may happen sporadically or just when you bite. Other signs are redness or swelling in the gums, sudden tooth sensitivity to cold or heat, and loosening or drifting of the teeth.
In moderate to advanced stages, the gums begin to pull away from the teeth. You might notice that you look a little "long in the tooth," and your dentist will be able to measure "pockets" or gaps between your teeth that weren't there in the past.1
The US Centers for Disease Control and Prevention estimates that nearly half of American adults over 30—roughly 70 million people—have gum infection that has advanced beyond early, mild stages of gingivitis. By age 65, more than 70 percent of the population is affected.2
In the United Kingdom, where dental care is presumed to have greatly improved, it turns out that more adults suffer from severe gum disease, which can dissolve the jaw bones that support teeth, than they did in the Roman era.
Scientists from King's College London recently examined more than 300 skulls from a Roman cemetery in Dorset, England, belonging to people who lived around 200-400 AD. The researchers found that only about five percent of the skulls showed evidence of gum disease in adults, compared to 15 to 30 percent of adults with chronic gum disease in the UK today.3
Bad gums, bad body, bad brain
The numbers indicate that gum disease is common, and people may think 'common' means 'nonthreatening,' but considering the mounting evidence that inflamed gums are an almost sure-fire signal of inflammation elsewhere in the body, gum disease should be considered a red flag for poor health.
Inflammation is the current watchword of disease. An immune system fixed in chronic rapid-fire assault mode has now been implicated in everything from rampant type 2 diabetes and obesity to a host of devastating autoimmune diseases like rheumatoid arthritis and inflammatory bowel disease, dementia, heart attacks and even cancer.
Doctors have recognized the relationship between cardiovascular and gum disease for decades. Many studies have also linked periodontitis to cognitive decline—most recently, researchers at the University of Illinois said it could be playing a role in the development of Alzheimer's disease too.
The effects of the bacteria that form plaque in the mouth that leads to gum disease almost exactly mirror the brain inflammation seen in Alzheimer's patients, who develop 'senile' plaques in their brains along with their distressing array of symptoms.4
Other recent studies have linked gum inflammation to rheumatoid arthritis. A 2018 study by German researchers, for example, found an interplay between three types of bacteria linked to bone loss in gum disease and their role in the onset and progression of rheumatoid arthritis in mice.5
The bacteria in the mouth have been linked to numerous other conditions including:
• Difficulty conceiving. An Australian study of 3,737 pregnant women discovered that those with gum disease took an average of seven months to conceive, two months longer than women with healthy gums, and non-white women with gum disease in particular were more than twice as likely to take over a year to conceive.6
• ADHD in children. A study comparing 31 children with attention deficit hyperactivity disorder (ADHD) to 31 controls without ADHD found that the hyperactive children had significantly more areas of gingival bleeding and worse oral hygiene habits.7
• Cancers, including oral, lung, colorectal and pancreatic cancer. Researchers at the Johns Hopkins Bloomberg School of Public Health recently reported that people with infected gums were 24 percent more likely to develop cancer overall. They tracked 7,466 people for more than 12 years, during which time 1,648 of them developed cancer. Those with severe gum inflammation had more than double the risk of developing lung cancer compared to those with mild, or no, periodontal disease.8
• Preterm delivery 9
• Obesity 10
• Respiratory disease 11
• Respiratory allergies 12
• Osteoporosis 13
• Depression 14
• Inflammatory bowel disease 15
• Type 2 diabetes. 16
Mirror of health
Occasional bleeding or tenderness of the gums is okay. It's part of the normal function of the mouth, which is a constant border guard, defending us against a wide range of foreign pathogens, microbes, nutrients and everything passing by the gums.
Gums that are chronically inflamed pull away from the teeth and weaken the ligaments and jawbone holding teeth in place. In the worst-case scenario, the bone will be eaten away, and the teeth will fall out. In the United States, more than two-thirds of people have lost at least one permanent tooth by the time they're 44, and 26 percent of 65 to 74-year-olds have lost all their teeth.17
The bug factor
Although doctors have long puzzled about the connection between cardiovascular disease and gum health, the reasons are now emerging. The first of these is the rise, especially in the past decade, of our understanding of the importance of the microbiome—all of the bacteria, viruses and other microbes inhabiting the human body, especially the gastrointestinal tract—which has the mouth as its starting point.
There are hundreds of different species living in your mouth, competing for the food you eat, digesting it and producing byproducts that influence your immune system.
You swallow about 900 times a day. "Every time you swallow, thousands of bacteria are sent through your digestive tract," explains New South Wales dentist Steven Lin, author of The Dental Diet (Hay House, 2018). "So, when the microbiome in your mouth is out of balance, as it is when you have gum disease, the effects are felt all over your body."
'Bad' bacteria in the mouth can easily pass through a damaged or leaky gut and enter the bloodstream, where they may invade any site in the body. Endocarditis, for example, is an infection around the heart valves that can result from an invasion of mouth bacteria.
Understanding that inflammatory chronic diseases have been linked to trouble in the gut, particularly in the balance of the gut microbiome, explains why trouble in the mouth may be related to trouble throughout the body.
The second overlooked factor in mouth health is calcium. Although people generally get a lot of calcium in their diet and calcium is critical to dental health, dentist Lin believes that dental calculus—the hard tartar of bacterial plaque that gradually builds on the gumline and causes gum infection—is a sign that calcium is not being managed properly by the body.
Several years ago, Lin stumbled on a book written in 1940 by a Cleveland dentist named Weston Price. Price had noticed the rapid decline of his patients' dental health with the adoption of the modern grain-based processed diet, and he set out across the globe, visiting Inuit, Swedes, Gaelic Scots, South Americans and more in search of the diets that promoted optimal dental and physical health.
His book, Nutrition and Physical Degeneration: A Comparison of Primitive and Modern Diets and Their Effects (reprinted by the Price-Pottenger Nutrition Foundation, 2008) identified three fat-soluble vitamins (A, D and E) that Price found saturated the diets of the most extremely healthy people he found on his travels. These vitamins and another mystery substance he called "Activator X," Price concluded, were essential to a beautiful mouth and a healthy body.
Lin explains how Price's Activator X has now been identified as vitamin K2, which is critical for calcium metabolism. It acts like a foreman on a jobsite overseeing where calcium gets deposited, lifting it out of blood vessels, for example, and depositing it in bones and teeth.
Each of these fat-soluble vitamins—A, D, E and K—is essential to proper calcium metabolism, and each of them has been found to be rendered in short supply by our modern diet and lifestyle.
Cigarette smoking is recognized as the most important environmental risk factor in gum disease. According to a review of the subject, smoking can impair immune responses and damage the healing mechanisms of gum tissue.
Smokers shouldn't be fooled because their gums don't bleed so often. That may be just because the nicotine in cigarettes constricts the blood vessels of the gums and makes them tough. Nonetheless, smokers consistently have deeper gum pockets than nonsmokers, and more eroded jawbones.18
Stressed out gums
It's well-established that psychological stress can dampen our immune responses to infection and thus make it easier for our mouths to be overwhelmed by bacteria we can normally stave off. Systemic diseases associated with gum disease such as diabetes, cardiovascular disease and depression may share emotional stress as a common underlying risk factor.19
Armed with these insights into its causes, people with gum disease have a lot more in their toolbox nowadays to combat infection in their mouths—and lower their risk of severe illness in their bodies. Here are a few strategies that can help.
It's not enough to simply ditch the sugars, as dentistry has been claiming for decades, Lin advises. Aside from a low-carb diet, we have to get enough of the fat-soluble vitamins and other nutrients that our body needs to foster healthy calcium metabolism, and we need to encourage a balance of a variety of microbes to thrive.
The ADEK combo
Vitamin D. A 2018 review paper from Lithuanian dental researchers confirms Weston Price's findings on the importance of fat-soluble vitamin D and how "sufficient intake of vitamin D can decrease the risk of gingivitis and chronic periodontitis, as it has been shown to have immunomodulatory, anti-inflammatory, antiproliferative effects and initiates cell apoptosis [death]." 20 Vitamin D is also important for bone metabolism, rebuilding bone and preventing tooth loss.
Suggested daily dosage: At least 30 minutes of unblocked sunshine daily when possible. Otherwise, supplement with 5,000 IU of vitamin D3 daily. Check blood levels to ensure they reach optimum levels (60 to 80 ng/mL or 120 to 150 nmol/L)
Vitamin K. Lin advises consuming high-vitamin butter oil or emu oil daily to obtain vitamin K from food, or supplementing with 200 mg of the MK7 form of vitamin K2 daily. Seek out medical advice before taking vitamin K if you are taking warfarin or another blood thinning drug.
Vitamin A. There is nothing like the old health standby of extra virgin cod liver oil to up your vitamin A levels, says Lin.
Suggested daily dosage: Typically, 1 tsp (5 mL) cod liver oil is the recommended daily dose, but follow the instructions on the label for each product. Otherwise, take up to 6,000 IU of vitamin A in supplement form per day
Vitamin E. Vitamin E is often present with the other three fat-soluble vitamins, so you may not need to add an extra supplement.
Suggested daily dosage: 400-1,000 IU
Another crucial nutrient involved in calcium metabolism is the mineral magnesium. Magnesium has many critical roles in the body, and magnesium deficiency has long been associated with gum disease.21
But it's becoming more difficult to get sufficient magnesium from leafy greens as they are grown in depleted soil. A 2017 study by Health Canada revealed that a shocking 16 to 22 percent of adolescents in the country currently have blood magnesium levels below the recommended threshold, and 10 to 17 percent of adults age 18 to 74 are deficient.22
Suggested daily dosage: 400 mg of magnesium citrate or magnesium gluconate. It may take time for your body to replenish its supply if you are deficient
Even patients with excellent oral hygiene can have mouths that are disaster zones, because the bacterial plaque that builds up at the gumline can spread down the roots of the teeth and can protect itself within a complex structure of multiple bacterial species called a biofilm.
The biofilm is a thin layer of microbial cells that adhere to the surface of the tooth, protected beneath a durable shield of large molecules called an extracellular matrix.
"In a biofilm, harmful bacteria may become 1,000 to 1,500 times more resistant to anything you do," explains Calgary holistic dentist Craig Young. "It's like they are in a fortress for bugs protected against assaults, including antimicrobials."
It's important to brush your teeth thoroughly twice a day because biofilms build up rapidly and are really only susceptible at first to mechanical disruption—the physical act of brushing breaks the fortress apart, and a powered toothbrush is better at reducing plaque than manual toothbrushing.23
The longer the plaque has been there, the thicker it gets as it calcifies and turns into a tough tartar. Standard dental treatment for this is dental scaling or root planing to scrape the tartar away, which often only causes the gums to recede further, but the latest solution uses lasers.
'Swish, don't gargle'
There are numerous anecdotes and websites that concern swishing with coconut oil for five to 20 minutes daily to fight deep plaque buildup. Young advises his patients to swish for a few minutes with MCT oil, an extraction of medium-chain triglycerides from coconut oil high in caprylic acid that has anti-yeast as well as antibacterial properties. Young says that most biofilms contain Candida yeast species, and targeting these with MCT oil helps disrupt the biofilm.
Other dentists prefer natural antimicrobials in mouth rinses or on the gums, including essential oils like tea tree oil, eucalyptus oil, clove, myrrh and oregano, which each have some research supporting their use.
Standard antibacterial mouth rinses like chlorhexidine can act like napalm to the mouth, they say, killing good bacteria as well as bad. Various practices include putting the oils directly on the gums, onto some dental floss before flossing between the teeth, or simply brushing the gumline with them.
Oxygenate the bugs
A number of websites and testimonials advise rinsing daily with a 1 to 3 percent solution of hydrogen peroxide. A few recent studies attest to this strategy and have found that daily use of 1.7 percent hydrogen peroxide gel in a mouth tray successfully combats recalcitrant gum bacteria up to six months after root scaling.24
It's likely that the effectiveness of hydrogen peroxide lies in its ability to blast anaerobic bacteria with oxygen. The same principle lies in ozone gas and oil treatment of teeth and gums. Ozonated oil will cling to the gums for a while and seep under the gums to attack these bugs.
Advancing gums and regrowing bone
Scaling often seems to makes the problem worse, because the gums appear more receded after treatment. This, says Young, is almost always because the scaling provokes some inflammation and exposes a problem that was already there, rather than creating more problems itself.
Gums may feel more tender and appear more recessed afterwards, but it is possible for them to regenerate. However, the regeneration process is "unpredictable." The key is arresting the progression of pockets, and if your dentist doesn't take thorough gum pocket measurements at the outset as a baseline, says Young, "find another dentist."
Decayed bone in the mouth will regenerate too, if it still has 'walls' to work within and has not been completely eroded. "As long as the scaffolding is there, and as long as you have good nutrition, the bone can heal," says Young.
A new light on gum disease
Forward-thinking gum specialists, or periodontists, are now turning to low-level light therapy (LLLT) using light wavelengths that don't emit heat, which affect cells similar to the way plants photosynthesize energy from the sun—triggering an array of inflammatory, antibacterial and antioxidant effects at the cellular level (see our December 2018 issue for more on LLLT).
The cool lasers can penetrate deeper into gum pockets for effective cleaning and root planing, but with a lot less resultant pain and inflammation in the gums, a smaller risk of recurrence and a better healing response.
A 2015 review of 10 studies on the use of light laser diodes to treat gum disease concluded that patients with chronic moderate periodontitis who had light therapy in addition to scaling and root planing (SRP) fared significantly better than those who had SRP alone.1
An 2018 Italian study of patients with severe gum disease found that light therapy as an adjunct to SRP results in significantly fewer markers of gum disease after a year, and patients reported less pain.2
Researchers at the University of Buffalo's Department of Oral and Maxillofacial Surgery treated biofilms of two bacteria commonly implicated in gum disease—Porphyromonas gingivalis and Treponema denticola—with varying doses of light. Both low and high light doses resulted in "complete bacterial kill throughout the entirety of the biofilm."3
In addition to obliterating bacteria and infection, light therapy has been found to actually stimulate bone regeneration,4 suggesting that light is light-years ahead of traditional gum cleaning and surgery alone.
The best toothpaste for gum disease
Gum disease and tooth decay are dependent on acidity, thinks Refugio, Texas, dentist Tim Rainey, a practitioner of minimally invasive preventative dentistry. Foods like sugar and carbs feed the bacteria and leave the mouth open to takeover, but if you raise the pH of the mouth to neutral (7.0) or basic, pathogenic bacteria can't flourish.
"Almost all toothpastes and mouthwashes are acidic, with Listerine a major offender at around a pH of 3.2, somewhere in the neighborhood of battery acid," says Rainey.
Calgary dentist Craig Young also cautions that popular brands like Colgate Total still contain chemicals like triclosan—a verified hormone disruptor and carcinogen so toxic it was banned from use in soaps by the FDA two years ago, yet still allowed in this and other mouth and skin products (see page 72 for more on triclosan).
Rainey developed his own toothpaste alternative, Common Sense Teeth Cleaning Powder, to counter the trend. It has a basic pH to neutralize acid and contains minerals so the saliva can provide the ingredients for the teeth and bones to remineralize.
The main ingredient on his list is plain old, cheap baking soda, which is "one of the most plentiful products on the planet," he says. He adds in some calcium and sodium phosphate as well as xylitol sweetener, which has been shown to favorably alter the mouth microbiome, for flavor.
For a DIY version, use an aluminum-free baking powder (which contains baking soda and some calcium and phosphate) and a sprinkle of pure powdered xylitol to clean the teeth, alkalize the mouth and give it the ingredients to self-repair.
A revolution in toothbrushing?
Since childhood, we've been taught to "brush in circles" twice a day for at least two minutes, but all this toothbrush coaching has not put a dent in adult tooth loss, mostly related to gum disease.
In the 1960s, Joseph Phillips, a little-known periodontist, thought the solution might lie in the way we brush our teeth. Phillips considered traditional brushing "primarily a cosmetic exercise" that really only sweeps plaque under the gums—like a broom sweeping debris under the edge of a rug.
Looking at the habits of people from tribes in Africa like the Masai, who only chew on twigs of the mustard tree to clean their beautiful strong teeth, Phillips devised a revolutionary toothbrush. The Phillips brush looks like a regular toothbrush, but each of its bristles is a hollow filament that acts like a miniature straw, drawing plaque inside its tube.
"Through capillary action, the plaque is drawn out and not just disturbed as it is by brushing and swept under the gum," he explains in a demonstrative video on YouTube.
Rather than brushing in the traditional way, which leaves much of the plaque in the mouth, Phillips' 'blotting technique' involves gently tapping along the gumlines to draw plaque up and away from the teeth like a microscopic vacuum cleaner. This removes far more plaque than a toothbrush, Phillips and advocates of his method insist, and consequently it results in a dramatic reduction in gum disease and decay, fresher breath and a brighter smile.
Phillips' idea of sucking the plaque out of the toothbrush and swallowing sets some people gagging, but rinsing and tapping the bristles in a sink is just as effective.
Phillips' blotting brushes are available from the Price-Pottenger Nutrition Foundation in the US (price-pottenger.org/store/blotting-brush) and in the UK from ToothWizards (www.toothwizards.com).