Life Extension Magazine®

Aloe vera plant that contain compounds for oral health

Oral Health Prevents Systemic Disease

Recent research has confirmed that poor oral health can result in diseases ranging from stroke and pancreatic cancer to obesity. Brushing alone is not always sufficient. A novel toothpaste provides targeted nutrients to help keep teeth and gums in optimal health.

Scientifically reviewed by Dr. Gary Gonzalez, MD, in August 2023. Written by: Michael Downey, Health & Wellness Author.

We often overlook the health of our teeth and gums as a strategy to protect against a wide range of diseases.1

Studies published in 2015 and 2016 confirm that poor oral health can result in disorders ranging from stroke and pancreatic cancer to obesity.2-7

Brushing alone is not always sufficient to keep your mouth free of disease.

Researchers have identified natural compounds that can be used as topical oral agents (inside the mouth) to support dental and whole-body health.8-14

These compounds help safeguard against periodontal disease—which affects about 70% of adult Americans aged 65 years and older.15 By using toothpaste and other oral products that contain these ingredients, risks of diseases originating in the mouth should be lowered.

Oral Health Affects the Whole Body

Common diseases can be worsened by poor oral health. Taking care of your mouth is an important part of a longevity program.

Gingivitis is an inflammatory response that affects the gums. When gums and bones that support the teeth are affected, it is called periodontitis.

Chronic oral inflammation is now linked to numerous systemic disorders:5,6,16-25



In 2016, researchers published an investigation into tooth-brushing and body-size, involving 15,666 individuals. They reported that the risk of obesity, abdominal obesity, and high percentage of body fat was higher in individuals with a lower daily frequency of tooth brushing and usage of secondary oral products.6

This supports an earlier study finding significant correlations between body composition and periodontal disease which concluded that “…periodontal disease and certain obesity-related systemic illnesses are related…26

Periodontitis, the disease of the gums and bones, induces inflammatory cytokines and may contribute to obesity by elevating C-reactive protein,27-29 which in turn causes fat cells (adipocytes) to store more fat and burn less energy.


A study released November 2016 in the International Journal of Cancer suggested that periodontal disease is a risk factor for non-Hodgkin lymphoma.30 Also in 2016, three other studies found that periodontal disease increased the risk of developing colorectal,31 lung,32 and pancreatic cancer.2

This pancreatic cancer link mirrors a number of previous studies. For example, Harvard researchers found a history of periodontal disease increased pancreatic cancer risk.4 And an 18-year study on over 48,000 men found significant associations between oral health status and pancreatic cancer, as well as lung, kidney, and blood cancers.5

This latter study also found a link between periodontal disease and greater overall risk of cancer—even in those who’ve never smoked.5

Heart Disease and Stroke

Two 2016 studies found an association between diagnosed periodontitis and the risk of ischemic stroke3 and of mortality from all causes including cardiovascular-disease.33

A 26-year study published in 2015 concluded that gingival inflammation is associated with stroke risk and that “results emphasize the role of oral health personnel in prevention (of stroke).”7

An earlier review concluded that periodontal disease among older people correlates with increased risk of systemic diseases—including heart attack, stroke, and diabetes mellitus.34

Individuals with periodontal disease have elevated blood levels of C-reactive protein, an inflammatory marker linked to increased risk for cardiovascular disease.35 Research has shown that efforts to reduce the severity of periodontitis help lower systemic inflammation,36 which may reduce the risk of inflammation-linked cardiovascular events.37

A frontline defense against systemic inflammation is excellent oral health.
What You Need to Know

Preventing Systemic Diseases Via Better Oral Health

  • Excellent oral health is on the frontline of the body’s defense against systemic inflammation.
  • Poor dental and gum health has been linked to a wide range of life-threatening diseases, including diabetes, cancer, rheumatoid arthritis, atherosclerosis, heart disease, and obesity.
  • Scientists have demonstrated that adding certain natural compounds to toothpaste can strongly protect oral health, helping to prevent both periodontal disease and numerous systemic diseases.

Blood Sugar Control

Diabetics who control their blood sugar have a lower risk of periodontal disease than those who do not.38

Periodontal disease can predispose individuals to diabetes or exacerbate existing diabetes.39 In patients with type II diabetes, severe periodontitis was strongly associated with an increased risk of poor blood-sugar control.40

One investigation revealed that hemoglobin A1C—a measure of long-term blood-sugar control—was higher in both people with type II diabetes and those with severe periodontal disease. This study showed that eliminating periodontal infection and reducing periodontal inflammation in diabetic patients produced significant improvements in their hemoglobin A1C levels. This suggests that optimizing dental health could help prevent the damaging consequences of diabetes.41

Respiratory Infections


A common consequence of poor oral health in older adults is an elevated risk of a particular type of pneumonia. This form of pneumonia occurs when periodontal bacteria in the secretions of the mouth and pharynx are aspirated into the lungs.42,43

One study that followed the rate of respiratory illness among a group of older adults in Japan demonstrated the importance of thorough oral hygiene as the best prevention strategy. During six months, only one in 98 aging adults who had their oral health cared for by dental hygienists came down with a respiratory infection, compared to nine out of 92 people who did not get the same dental care.44


Scientists are investigating whether treating or preventing periodontal disease may promote bone density, and therefore may help inhibit osteoporosis.16 Research so far shows a link in the opposite direction, meaning that osteoporosis is a risk factor for periodontal disease.45

This suggests that strategies for reducing osteoporosis risk, such as optimizing calcium, vitamin K and vitamin D intake, may also retard alveolar bone loss around the jawbone sockets that hold teeth roots.45

While bisphosphonate drugs used to treat osteoporosis, such as Boniva® and Fosamax®, might offer benefits for periodontal tissues, they are associated with side effects that range from stomach pain to diarrhea.

A rare but extremely serious side effect is osteonecrosis (“bone death”) of the jaw bone, which can occur if any dental work is done while taking bisphosphonate drugs.46-48 Accordingly, safer strategies are needed that support both periodontal and body-wide bone health.

Low Birth-Weight Delivery

Observational studies provide compelling evidence that periodontal infections increase the risk for preterm delivery of low birth-weight babies.49 This link might result from cascading effects of inflammation in the mouth compromising the womb environment.49,50 Whatever the connection, controlling periodontal disease has become a potential strategy for reducing preterm labor.50

Topical Compounds That Deliver Optimal Oral Health

An optimal diet and supplement regimen may help promote general and oral health from the inside. Scientists have now identified a number of compounds that protect oral health when applied topically (inside the mouth). These substances can deliver complementary defenses when included as ingredients in toothpaste.

Green Tea

A 2016 study found that green tea extract protects against dental erosion, reducing wear and roughness.51

Other studies have demonstrated that green tea catechins exert direct antibacterial activity against Streptococcus mutans, one of the key microorganisms behind tooth decay. Green tea also inhibits a bacterial enzyme involved in the process that allows bacteria to stick to teeth. Further, it inhibits production of amylase, and since bacteria use this enzyme to break down starches into sugars, this action may help protect teeth.52,53

Evidence suggests that green tea reduces the invasiveness of oral cancer and decreases the production of a protein associated with oral cancer proliferation.54,55 Researchers also found that green tea arrests the growth of—and triggers apoptosis (self-destruction) of—oral carcinoma cells in the laboratory.56

Scientists then conducted a study to validate the usefulness of green tea in the improvement of periodontal disease. They applied green tea catechins to the mouths of patients with periodontal disease, once a week for 8 weeks, using special strips with a slow-release delivery system. It was shown that the green tea catechins killed a significant proportion of the bacteria causing periodontitis in these patients.57

Coenzyme Q10

Well known for its cardioprotective actions, CoQ10 has also been shown to improve symptoms of periodontitis when applied topically.8,58,59

Scientists conducted a placebo-controlled clinical trial in men with established periodontitis, and after six weeks of topical application of CoQ10, they found “significant improvements” in periodontal status, which were not seen in control subjects.8

Results from an early study on the effectiveness of CoQ10 against periodontitis were so impressive that the authors wrote, “Healing was so excellent 5-7 days post-biopsy that the biopsy sites were difficult to locate. The healing was viewed as extraordinarily effective.”60

Aloe Vera

Long used to promote wound healing and soothe burns, topically applied aloe vera (Aloe barbadensis) has now been shown to promote wound healing and may provide soothing and healing properties to the gum tissues.9,61,62

Further, a 2015 study found that aloe vera inhibits tooth decay and periodontal pathogens.63

In a remarkable finding, a study published in the October 1, 2016, issue of the Journal of Clinical and Experimental Dentistry concluded that aloe vera “can be used as an alternative product for curing and preventing gingivitis.64



This natural sweetener inhibits oral bacteria when chewed in a gum or topically applied.

In a 2015 mouse study, a topical xylitol solution was found to exert “considerable anti-irritant and anti-inflammatory properties” against induced tissue irritation.65 A clinical study in the same year found that, in individuals with poor-to-moderate oral hygiene, xylitol-containing chewing gums more effectively reduced salivary levels of Streptococcus mutans—the bacteria responsible for most tooth decay—than conventional gums.66

Another clinical trial showed that, in contrast to sorbitol- and maltitol-containing chewing gums, only xylitol-sweetened gum eliminated saliva microbes, particularly those implicated in tooth decay.67 Xylitol could thus be an essential ingredient in a targeted strategy to avert dental disease.

More recently, scientists reviewed previous xylitol studies conducted on preteen children. They concluded, in the August 3, 2016, issue of the Cochrane Database of Systematic Reviews, that “There is moderate quality evidence showing that the prophylactic administration of xylitol among healthy children…can reduce the occurrence of AOM (acute otitis media).” This is the most common bacterial infection among young American children.68

How Periodontal Disease Develops

The starches and sugars in the food you eat interact with the bacteria in your mouth to form a bacteria-harboring, sticky film of plaque on your teeth and gums. If not properly removed by brushing with a good toothpaste, plaque hardens into tartar, which clings so tightly to the teeth and under the gum line that it can only be removed through professional cleaning.

There are two different types of periodontal disease—gingivitis and periodontitis. Gingivitis is an inflammation of the soft tissue surrounding the tooth. This is a direct immune response to microbial plaque attached to the surface of the tooth. The clinical manifestations of gingivitis are redness and swelling of the gums and bleeding on soft-touching or on probing. In the early stages, gingivitis does not significantly affect deeper structures, such as the periodontal ligaments and alveolar bone. Left untreated, however, gingivitis can lead to periodontitis.

Periodontitis occurs when pathogenic, gram-negative bacteria destroy the dental supportive structures of the teeth, leading to progressive destruction of periodontal ligaments and alveolar bone. The result is tooth loss.

Increasingly, scientists have found that periodontal diseases may trigger a range of illnesses throughout the body, ranging from cancer to heart disease.1,5,6,17-25


Lactoferrin—an immune-boosting protein involved in the body’s responses to infection and injury69—has been shown to halt growth of periodontitis-causing bacteria.12 In a 2015 study, researchers found that diabetic lactoferrin-deficient mice have a greater risk of developing periodontal infection.70

Lactoferrin appears to help fight infection and tissue damage associated with periodontal disease.

Dietary Vitamin Supplements That Promote Oral Health Internally

In addition to brushing with fortified toothpaste, taking certain vitamin supplements may help promote gum health.

Vitamin C is crucial for the maintenance of healthy connective tissue, such as the gums. In fact, one of the clinical signs of scurvy—the disease associated with vitamin C deficiency—is bleeding gums.73 But vitamin C should not be applied directly to the teeth topically as ascorbic acid may erode enamel.

Taking the B vitamin folic acid promotes gingival health by reducing redness and bleeding in these delicate tissues.14

Vitamin D is also important for oral health.74 Since many people do not generate adequate levels of the “sunshine hormone,” supplementation with vitamin D may be necessary to help ensure gum health.

Hydrogen Peroxide


This well-known antiseptic can be used to fight plaque formation and to reduce gingivitis.13 Its bubbling action exposes oral bacteria that are difficult to reach with ordinary brushing and flossing—helping to lower bacteria levels and provide cleaner teeth and gums. When applied in diluted form by aerosol spray to the gums of patients with chronic periodontitis, hydrogen peroxide improved clinical periodontal status and plasma levels of inflammatory markers and “may be a promising method in periodontology.71

Folic acid

Essential for the integrity of the gingival tissues, higher dietary intake of folic acid is associated with less gingival bleeding on probing.72 Similar results occurred when added to mouthwash. In patients with gum disease, folic acid-containing mouthwash significantly reduced gingival redness and gum bleeding.14



A frontline defense against systemic inflammation is excellent oral health.

Among the numerous diseases linked to poor oral health are type II diabetes, cancer, rheumatoid arthritis, atherosclerosis, heart disease, and obesity.

Research indicates that adding specific ingredients to toothpaste powerfully supports dental health and safeguards against periodontal disease. The expected systemic benefit is reduced risks of lethal diseases that can originate in the mouth.

If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.


  1. Glick M. Exploring our role as health care providers: the oral-medical connection. J Am Dent Assoc. 2005;136(6):716, 8, 20.
  2. Jacob JA. Study Links Periodontal Disease Bacteria to Pancreatic Cancer Risk. Jama. 2016;315(24):2653-4.
  3. Leira Y, Seoane J, Blanco M, et al. Association between periodontitis and ischemic stroke: a systematic review and meta-analysis. Eur J Epidemiol. 2016.
  4. Michaud DS, Joshipura K, Giovannucci E, et al. A prospective study of periodontal disease and pancreatic cancer in US male health professionals. J Natl Cancer Inst. 2007;99(2):171-5.
  5. Michaud DS, Liu Y, Meyer M, et al. Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study. Lancet Oncol. 2008;9(6):550-8.
  6. Park JB, Nam GE, Han K, et al. Obesity in relation to oral health behaviors: An analysis of the Korea National Health and Nutrition Examination Survey 2008-2010. Exp Ther Med. 2016;12(5):3093-100.
  7. Soder B, Meurman JH, Soder PO. Gingival Inflammation Associates with Stroke--A Role for Oral Health Personnel in Prevention: A Database Study. PLoS One. 2015;10(9):e0137142.
  8. Hanioka T, Tanaka M, Ojima M, et al. Effect of topical application of coenzyme Q10 on adult periodontitis. Mol Aspects Med. 1994;15 Suppl:s241-8.
  9. Davis RH, Leitner MG, Russo JM, et al. Anti-inflammatory activity of Aloe vera against a spectrum of irritants. J Am Podiatr Med Assoc. 1989;79(6):263-76.
  10. Lambert JD, Kwon SJ, Hong J, et al. Salivary hydrogen peroxide produced by holding or chewing green tea in the oral cavity. Free Radic Res. 2007;41(7):850-3.
  11. Lynch H, Milgrom P. Xylitol and dental caries: an overview for clinicians. J Calif Dent Assoc. 2003;31(3):205-9.
  12. Kalfas S, Andersson M, Edwardsson S, et al. Human lactoferrin binding to Porphyromonas gingivalis, Prevotella intermedia and Prevotella melaninogenica. Oral Microbiol Immunol. 1991;6(6):350-5.
  13. Rosin M, Kocher T, Kramer A. Effects of SCN-/H2O2 combinations in dentifrices on plaque and gingivitis. J Clin Periodontol. 2001;28(3):270-6.
  14. Pack AR. Folate mouthwash: effects on established gingivitis in periodontal patients. J Clin Periodontol. 1984;11(9):619-28.
  15. Available at: Accessed December 8, 2016.
  16. Kim J, Amar S. Periodontal disease and systemic conditions: a bidirectional relationship. Odontology. 2006;94(1):10-21.
  17. Mealey BL, Rose LF. Diabetes mellitus and inflammatory periodontal diseases. Curr Opin Endocrinol Diabetes Obes. 2008;15(2):135-41.
  18. Moutsopoulos NM, Madianos PN. Low-grade inflammation in chronic infectious diseases: paradigm of periodontal infections. Ann N Y Acad Sci. 2006;1088:251-64.
  19. de Pablo P, Dietrich T, McAlindon TE. Association of periodontal disease and tooth loss with rheumatoid arthritis in the US population. J Rheumatol. 2008;35(1):70-6.
  20. Demmer RT, Desvarieux M. Periodontal infections and cardiovascular disease: the heart of the matter. J Am Dent Assoc. 2006;137 Suppl:14S-20S; quiz 38S.
  21. Abou-Raya S, Abou-Raya A, Naim A, et al. Rheumatoid arthritis, periodontal disease and coronary artery disease. Clin Rheumatol. 2008;27(4):421-7.
  22. Niemiec BA. Periodontal disease. Top Companion Anim Med. 2008;23(2):72-80.
  23. Meyer MS, Joshipura K, Giovannucci E, et al. A review of the relationship between tooth loss, periodontal disease, and cancer. Cancer Causes Control. 2008;19(9):895-907.
  24. Mustapha IZ, Debrey S, Oladubu M, et al. Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: a systematic review and meta-analysis. J Periodontol. 2007;78(12):2289-302.
  25. Kuwabara M, Motoki Y, Sato H, et al. Low frequency of toothbrushing practices is an independent risk factor for diabetes mellitus in male and dyslipidemia in female: A large-scale, 5-year cohort study in Japan. J Cardiol. 2016.
  26. Wood N, Johnson RB, Streckfus CF. Comparison of body composition and periodontal disease using nutritional assessment techniques: Third National Health and Nutrition Examination Survey (NHANES III). J Clin Periodontol. 2003;30(4):321-7.
  27. Pischon N, Heng N, Bernimoulin JP, et al. Obesity, inflammation, and periodontal disease. J Dent Res. 2007;86(5):400-9.
  28. Dalla Vecchia CF, Susin C, Rosing CK, et al. Overweight and obesity as risk indicators for periodontitis in adults. J Periodontol. 2005;76(10):1721-8.
  29. Genco RJ, Grossi SG, Ho A, et al. A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol. 2005;76(11 Suppl):2075-84.
  30. Bertrand KA, Shingala J, Evens A, et al. Periodontal disease and risk of non-Hodgkin lymphoma in the Health Professionals Follow-Up Study. Int J Cancer. 2016.
  31. Momen-Heravi F, Babic A, Tworoger SS, et al. Periodontal disease, tooth loss and colorectal cancer risk: Results from the Nurses’ Health Study. Int J Cancer. 2016.
  32. Zeng XT, Xia LY, Zhang YG, et al. Periodontal Disease and Incident Lung Cancer Risk: A Meta-Analysis of Cohort Studies. J Periodontol. 2016;87(10):1158-64.
  33. Hansen GM, Egeberg A, Holmstrup P, et al. Relation of Periodontitis to Risk of Cardiovascular and All-Cause Mortality (from a Danish Nationwide Cohort Study). Am J Cardiol. 2016;118(4):489-93.
  34. Boehm TK, Scannapieco FA. The epidemiology, consequences and management of periodontal disease in older adults. J Am Dent Assoc. 2007;138 Suppl:26s-33s.
  35. Noack B, Genco RJ, Trevisan M, et al. Periodontal infections contribute to elevated systemic C-reactive protein level. J Periodontol. 2001;72(9):1221-7.
  36. Blum A, Front E, Peleg A. Periodontal care may improve systemic inflammation. Clin Invest Med. 2007;30(3):E114-7.
  37. Pischon T, Mohlig M, Hoffmann K, et al. Comparison of relative and attributable risk of myocardial infarction and stroke according to C-reactive protein and low-density lipoprotein cholesterol levels. Eur J Epidemiol. 2007;22(7):429-38.
  38. Mealey BL. Periodontal disease and diabetes. A two-way street. J Am Dent Assoc. 2006;137 Suppl:26s-31s.
  39. Shlossman M, Knowler WC, Pettitt DJ, et al. Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc. 1990;121(4):532-6.
  40. Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective. Ann Periodontol. 2001;6(1):99-112.
  41. Grossi SG, Skrepcinski FB, DeCaro T, et al. Response to periodontal therapy in diabetics and smokers. J Periodontol. 1996;67(10 Suppl):1094-102.
  42. Shay K, Scannapieco FA, Terpenning MS, et al. Nosocomial pneumonia and oral health. Spec Care Dentist. 2005;25(4):179-87.
  43. Scannapieco FA. Role of oral bacteria in respiratory infection. J Periodontol. 1999;70(7):793-802.
  44. Adachi M, Ishihara K, Abe S, et al. Professional oral health care by dental hygienists reduced respiratory infections in elderly persons requiring nursing care. Int J Dent Hyg. 2007;5(2):69-74.
  45. Kaye EK. Bone health and oral health. J Am Dent Assoc. 2007;138(5):616-9.
  46. Palomo L, Liu J, Bissada NF. Skeletal bone diseases impact the periodontium: a review of bisphosphonate therapy. Expert Opin Pharmacother. 2007;8(3):309-15.
  47. Available at: Accessed December 9, 2016.
  48. Available at: Accessed December 9, 2016.
  49. Paquette DW. The periodontal infection-systemic disease link: a review of the truth or myth. J Int Acad Periodontol. 2002;4(3):101-9.
  50. Yeo BK, Lim LP, Paquette DW, et al. Periodontal disease—the emergence of a risk for systemic conditions: pre-term low birth weight. Ann Acad Med Singapore. 2005;34(1):111-6.
  51. De Moraes MD, Carneiro JR, Passos VF, et al. Effect of green tea as a protective measure against dental erosion in coronary dentine. Braz Oral Res. 2016;30.
  52. Hamilton-Miller JM. Anti-cariogenic properties of tea (Camellia sinensis). J Med Microbiol. 2001;50(4):299-302.
  53. Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr. 2006;25(2):79-99.
  54. Ho YC, Yang SF, Peng CY, et al. Epigallocatechin-3-gallate inhibits the invasion of human oral cancer cells and decreases the productions of matrix metalloproteinases and urokinase-plasminogen activator. J Oral Pathol Med. 2007;36(10):588-93.
  55. Ko SY, Chang KW, Lin SC, et al. The repressive effect of green tea ingredients on amyloid precursor protein (APP) expression in oral carcinoma cells in vitro and in vivo. Cancer Lett. 2007;245 (1-2):81-9.
  56. Hsu S, Farrey K, Wataha J, et al. Role of p21WAF1 in green tea polyphenol-induced growth arrest and apoptosis of oral carcinoma cells. Anticancer Res. 2005;25(1a):63-7.
  57. Hirasawa M, Takada K, Makimura M, et al. Improvement of periodontal status by green tea catechin using a local delivery system: a clinical pilot study. J Periodontal Res. 2002;37(6):433-8.
  58. Matsumura T, Saji S, Nakamura R, et al. Evidence for enhanced treatment of periodontal disease by therapy with coenzyme Q. Int J Vitam Nutr Res. 1973;43(4):537-48.
  59. Wilkinson EG, Arnold RM, Folkers K. Bioenergetics in clinical medicine. VI. adjunctive treatment of periodontal disease with coenzyme Q10. Res Commun Chem Pathol Pharmacol. 1976;14(4):715-9.
  60. Wilkinson EG, Arnold RM, Folkers K, et al. Bioenergetics in clinical medicine. II. Adjunctive treatment with coenzyme Q in periodontal therapy. Res Commun Chem Pathol Pharmacol. 1975;12(1):111-23.
  61. Vazquez B, Avila G, Segura D, et al. Antiinflammatory activity of extracts from Aloe vera gel. J Ethnopharmacol. 1996;55(1):69-75.
  62. Davis RH, Donato JJ, Hartman GM, et al. Anti-inflammatory and wound healing activity of a growth substance in Aloe vera. J Am Podiatr Med Assoc. 1994;84(2):77-81.
  63. Chandra Shekar BR, Nagarajappa R, Suma S, et al. Herbal extracts in oral health care - A review of the current scenario and its future needs. Pharmacogn Rev. 2015;9(18):87-92.
  64. Vangipuram S, Jha A, Bhashyam M. Comparative efficacy of aloe vera mouthwash and chlorhexidine on periodontal health: A randomized controlled trial. J Clin Exp Dent. 2016;8(4):e442-e7.
  65. Szel E, Polyanka H, Szabo K, et al. Anti-irritant and anti-inflammatory effects of glycerol and xylitol in sodium lauryl sulphate-induced acute irritation. J Eur Acad Dermatol Venereol. 2015;29(12):2333-41.
  66. Haghgoo R, Afshari E, Ghanaat T, et al. Comparing the efficacy of xylitol-containing and conventional chewing gums in reducing salivary counts of Streptococcus mutans: An in vivo study. J Int Soc Prev Community Dent. 2015;5(Suppl 2):S112-7.
  67. Holgerson PL, Sjostrom I, Stecksen-Blicks C, et al. Dental plaque formation and salivary mutans streptococci in schoolchildren after use of xylitol-containing chewing gum. Int J Paediatr Dent. 2007;17(2):79-85.
  68. Azarpazhooh A, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2016(8):Cd007095.
  69. Kruzel ML, Actor JK, Boldogh I, et al. Lactoferrin in health and disease. Postepy Hig Med Dosw (Online). 2007;61:261-7.
  70. Alabdulmohsen W, Rozario SD, Markowitz K, et al. Diabetic Lactoferrin Deficient Mice Demonstrates Greater Susceptibility to Experimental Periodontal Disease. J Oral Biol (Northborough). 2015;2(2).
  71. Zekonis G, Zekonis J, Gleiznys A, et al. Effect of Supragingival Irrigation with Aerosolized 0.5% Hydrogen Peroxide on Clinical Periodontal Parameters, Markers of Systemic Inflammation, and Morphology of Gingival Tissues in Patients with Periodontitis. Med Sci Monit. 2016;22:3713-21.
  72. Esaki M, Morita M, Akhter R, et al. Relationship between folic acid intake and gingival health in non-smoking adults in Japan. Oral Dis. 2010;16(1):96-101.
  73. Dakovic D, Ljuskovic B, Mileusnic I, et al. Changes in the oral caused by scurvy. Vojnosanit Pregl. 2003;60(6):753-6.
  74. Dietrich T, Nunn M, Dawson-Hughes B, et al. Association between serum concentrations of 25-hydroxyvitamin D and gingival inflammation. Am J Clin Nutr. 2005;82(3):575-80.