Husband and wife brushing teeth for good oral health

Oral Health

Oral Health

Last Section Update: 04/2024

Contributor(s): Shayna Sandhaus, PhD

1 Overview

Summary and Quick Facts for Oral Health

  • Oral health problems like cavities and gum disease are very common. You may not realize that poor oral health is linked to other health problems like heart disease, diabetes and cancer.
  • This protocol will teach you about the different kinds of oral health problems and their causes. You will also learn how keeping your mouth healthy can help keep your entire body healthy.
  • Supplementation with a specialized oral probiotic has been shown to improve several measures of oral health, in clinical trials.

Oral health disorders, including cavities and periodontal disease, are among the most common health problems in US adults. Periodontal disease includes gingivitis (inflammation of the gums) and periodontitis, which can eventually lead to tooth loss. Over 20% of people 65 and older have untreated tooth decay, and approximately half of US adults aged 30 and older have periodontitis.

Omega-3 fatty acids, coenzyme Q10 and probiotics can support oral health and combat bad bacteria and inflammation in the mouth.

Oral Health and Systemic Diseases

Advanced periodontal disease is linked to both an increased risk of death and many chronic diseases, including:

  • Cardiovascular disease
  • Type 2 diabetes
  • Cognitive decline and Alzheimer’s disease
  • Cancer

Causes and Risk Factors

  • Dysbiosis in the mouth (ie, an imbalance of good and bad bacteria in the mouth) is thought to be an important cause of periodontal disease
  • Risk factors for periodontal disease include smoking, older age (especially 65 or older), and female gender

Signs and Symptoms

  • Hot and cold sensitivity and tooth pain may signal the presence of a cavity
  • Gum redness, swelling, sensitivity, and bleeding during brushing and flossing may occur in periodontal disease. There may also be gum recession, deepening pockets between teeth and gums, and bleeding on probing.


A dental exam, X-rays, and a periodontal probe to measure pocket depth are used to diagnose cavities and periodontal disease

Conventional Treatment

  • Cavities are removed and replaced with a filling. A root canal may be performed in an attempt to save the tooth.
  • Gingivitis can frequently be managed with home dental hygiene and regular cleanings
  • Periodontitis treatment can involve several strategies, including:
    • Scaling and root planning
    • Antibiotics
    • Surgery

Novel and Emerging Strategies

  • Using remineralization techniques in mild cavities
  • Measuring biomolecules and bacterial and human DNA in the saliva to gauge inflammation and genetic susceptibility to periodontal disease
  • Using lasers, photodynamic therapy, or topical metformin to improve efficacy of traditional periodontal treatments

Diet and Lifestyle Considerations

Along with regular brushing and flossing:

  • A diet low in sugar, processed starches, and sodas and high in vegetables and fruits decreases risk of cavities
  • Increased whole grains, calcium from dairy products, and exercise may lower risk of periodontal disease

Integrative Interventions

  • Probiotic lozenges: In a clinical study, adults with periodontal disease were treated with either probiotic lozenges providing the S. salivarius strain M18 bacteria or no lozenges. The M18 probiotic group were found to have less plaque, better gum health, and less bleeding on probing than the no-lozenge group.
  • Xylitol: Xylitol has been found to decrease salivary acidity; reduce levels of plaque, harmful bacteria, and inflammation of the gums; and prevent dry mouth and enamel erosion.
  • Coenzyme Q10 (CoQ10): A randomized controlled trial of CoQ10 in patients with periodontal disease who underwent root planing and scaling found a significant reduction in gum inflammation in the CoQ10 group compared with placebo.
  • Fish oil: Findings from several studies suggest people with periodontal disease have lower intake of anti-inflammatory omega-3 fats. Fish oil has been shown to benefit many of the chronic diseases that periodontal disease is associated with (including cardiovascular disease, type 2 diabetes, and autoimmune diseases).
  • Lycopene: Clinical trials in participants with gingivitis or periodontal disease found that lycopene taken orally was more effective than placebo as an adjunct to dental treatment.

2 Introduction

Oral health disorders are among the most common health problems in US adults. Chief among these are dental caries (cavities), caused by tooth decay, and periodontal disease. Periodontal disease encompasses gingivitis (inflammation of the gums) and periodontitis, a potentially aggressive condition that can eventually lead to tooth loss. About 20% of people 65 and older have untreated tooth decay, and approximately half of US adults aged 30 and older have periodontitis (AAP 2015; Kim 2010; Thornton-Evans 2013).

You may be unaware that neglecting oral hygiene harms more than your smile. Poor oral health is linked to heart disease, diabetes, autoimmune diseases, chronic kidney disease, Alzheimer’s disease, and osteoporosis (Hajishengallis 2015; Gulati 2013; Schenkein 2013; Watts 2008; Fisher 2010). Periodontal disease is also associated with a significantly increased risk of death from any cause (Chen 2015; Ricardo 2015). These concerning associations are linked to systemic inflammation, which can be triggered by periodontal disease (Artese 2015; Winning 2015; Craig 2009).

But there is good news. Periodontal disease treatment has been associated with improvements in overall health such as reduced systemic inflammation, endothelial dysfunction, blood pressure, and early atherosclerosis; and some evidence suggests that treatment of periodontal disease may help improve blood sugar control among diabetics (Griffiths 2010; Tonetti 2013; Lockhart 2012; Vergnes 2015; Teeuw 2010). Periodontal treatment has even been proposed as a strategy for reducing the risk of dying from heart disease (Yao 2009).

Given the potentially deadly consequences of poor oral health, preventing periodontal disease should be a major concern for aging individuals. Harmful bacteria in the mouth contribute to plaque buildup and destruction of periodontal tissue (Aruni 2015; Edwards 2010; Mayo Clinic 2014a). Dietary sugars and processed starches feed these bacteria and speed up tooth decay and periodontal disease (Mayo Clinic 2014a). But reducing sugar and processed starch intake and supplementing with an oral probiotic lozenge containing Streptococcus salivarius M18 to displace the bad bacteria in the mouth has been demonstrated to preserve periodontal health (Scariya 2015). Proper at-home dental hygiene, regular dentist visits, and a healthy diet are also essential for preventing periodontal disease (Mayo Clinic 2014a).

In this protocol, you will learn about the many health problems that poor oral health can cause, and how insufficient dental hygiene can promote systemic inflammation and disease. You will read about a unique oral probiotic that fights bad bacteria in the mouth and helps preserve healthy teeth and gums. You will also learn about emerging dental techniques such as laser therapy and photodynamic therapy. This protocol also reviews several integrative interventions that support oral health, such as omega-3 fatty acids and coenzyme Q10 to combat inflammation and support healthy gums.

3 Background

Tooth decay and periodontal disease begin with plaque buildup. Plaque is an oral biofilm composed of microorganisms and a slimy matrix they produce. This biofilm adheres to the teeth and gums (Aruni 2015). Acidic byproducts of bacterial activity cause tooth decay and eventual formation of cavities (Edwards 2010; Mayo Clinic 2014a). An imbalance in the oral microbial community undermines healthy immunity throughout the body and triggers an inflammatory response in the structures that support the teeth. Over the long term, this causes local tissue destruction that can ultimately lead to tooth loss. Systemic inflammation driven by periodontal disease contributes to the link between poor oral health and whole-body health problems (Fernandez-Solari 2015; Hajishengallis 2015; Mayo Clinic 2014b).

According to the American Dental Association, the tooth surface may be considered sound (no decay), or have initial, moderate, or advanced decay (Young 2015). Root cavities are the most common type of dental cavity in older adults. They occur on tooth root surfaces that become exposed when the gums are inflamed or receding (Mayo Clinic 2014a; Bignozzi 2014; Edwards 2010; Gluzman 2013; Ritter 2010).

Periodontal disease is generally classified according to the degree of tissue involvement (Loesche 1996).

  • Gingivitis, which is inflammation affecting primarily the gingiva (gums), is the milder form of periodontal disease. It is usually caused by plaque (Kawar 2011; Page 1986; Peedikayil 2015).
  • Periodontitis is more serious than gingivitis because it affects the gums, periodontal ligament, and bone, can lead to tooth loss, and is associated with systemic diseases (Hajishengallis 2015). It can be chronic, characterized in part by slow to moderate progression, though periods of rapidly progressive tissue destruction may occur; or it can be aggressive, with rapid tissue destruction. In either case, periodontitis may be localized to a specific region of the mouth or may be widespread (Highfield 2009). Periodontitis is also associated with certain diseases (eg, diabetes) and medications (eg, some asthma medications, oral contraceptives) (Kawar 2011; Shashikiran 2007; Heasman 2014).

Large pockets of infection known as abscesses may arise as a result of periodontitis, and may be acute or chronic (Patel 2011). Necrotizing periodontal disease is a particularly severe form in which there may be sudden and rapid destruction of periodontal tissue (Highfield 2009; Herrera 2014).

4 Oral Health and Systemic Diseases

A link between advanced periodontal disease and increased risk of death from all causes was reported in 1998 (Garcia 1998). Since then, the body of research suggesting periodontal disease may be a risk factor for a range of chronic diseases has grown dramatically (Mawardi 2015).

Cardiovascular Disease

Numerous studies show that chronic periodontitis is associated with increased risk of atherosclerosis, stroke, and coronary artery disease (Kholy 2015; Carramolino-Cuellar 2014; Gulati 2013). Fortunately, treating periodontitis can reduce systemic inflammation, improve cardiovascular health, and reduce stroke risk (Piconi 2009; Tonetti 2007; Fisher 2010; Lee 2013; Jeffcoat 2014; Lockhart 2012; Tonetti 2013). In fact, a cohort study published in the European Journal of Preventive Cardiology in 2019 indicated that proper, regular oral hygiene was associated with a reduced risk of atrial fibrillation (AFib) and heart failure. After controlling for multiple factors, frequent tooth brushing (at least 3 times daily) was associated with a 10% reduced risk of AFib and a 12% reduced risk of heart failure. Getting dental cleanings was also associated with a lower risk of heart failure, while number of missing teeth was associated with an increased risk (Chang 2019). For a detailed discussion of strategies to support cardiovascular health, refer to Life Extension’s Atherosclerosis and Cardiovascular Disease protocol.

Type 2 Diabetes

Periodontal disease is one of the many complications of diabetes (Carramolino-Cuellar 2014; Gulati 2013). More severe periodontitis has been observed in individuals with poorly controlled diabetes compared with those whose diabetes is well managed (Lim 2007). Periodontal disease may also adversely affect blood glucose control and risk of diabetic complications (Negrato 2013); and treatment of periodontal disease may improve blood glucose control and hemoglobin A1C (HbA1C) in diabetics (Moeintaghavi 2012; Gulati 2013; Vergnes 2015; Teeuw 2010).

Respiratory Disease

Periodontal disease is associated with chronic obstructive pulmonary disease (COPD) (Usher 2013; Prasanna 2011; Scannapieco 2003; Martos 2011), and more severe periodontal disease is significantly associated with COPD flare-ups (Liu 2012). Some researchers have proposed that bacteria that cause periodontal disease may be inhaled into the lungs, giving rise to respiratory infections and pneumonia (Bansal, Khatri 2013).

Cognitive Decline and Alzheimer’s Disease

Periodontal disease has chronic infectious and inflammatory components, both of which have been associated with Alzheimer’s disease (Kamer 2008; Abbayya 2015; Watts 2008; Wu 2014; Shaik 2014). One study found elevated levels of antibodies to periodontal disease bacteria years before the onset of cognitive decline (Sparks Stein 2012). Tooth loss and poor oral health have been correlated with poor cognitive function (Luo 2015; Saito 2013; Listl 2014). For a more detailed discussion about cognitive function, refer to Life Extension’s Age-Related Cognitive Decline and Alzheimer’s disease protocols.

An article published in Science Advances provides intriguing evidence that Alzheimer’s disease could be caused, in part, by infection with Porphyromonas gingivalis, a keystone pathogen of chronic periodontitis which is a significant risk factor for developing amyloid beta plaques, dementia, and Alzheimer’s.

The scientists studied and compared brain tissue samples from Alzheimer’s disease patients and neurologically normal controls. Interestingly, they found a portion of the “healthy” brains were infected as well, indicating that “…brain infection with P. gingivalis is not a result of poor dental care following the onset of dementia or a consequence of late-stage disease, but is an early event that can explain the pathology found in middle-aged individuals before cognitive decline” (Dominy 2019). These findings suggest better dental care earlier in life may promote brain health later in life.

Chronic Kidney Disease

People with chronic kidney disease are more likely to have periodontal disease, and periodontal disease is associated with declining kidney function and worsening chronic kidney disease. Treatment of periodontal disease has been shown to reduce markers of systemic inflammation in people with chronic kidney disease, especially those undergoing hemodialysis (Chen 2015; Grubbs 2015; Wahid 2013). Those interested in learning more about ways to support healthy kidney function should review the Kidney Health and Chronic Kidney Disease protocols.

Autoimmune Diseases

Periodontal disease is common in people with rheumatoid arthritis. And early evidence suggests treatment of periodontal disease may reduce markers of disease activity in rheumatoid arthritis (Mays 2012; Payne 2015; Kaur, Bright 2014). Similarly, treatment of periodontitis in systemic lupus erythematosus (SLE) patients has been shown to improve measures of SLE disease activity (Fabbri 2014). A more thorough discussion of these conditions can be found in Life Extension’s Rheumatoid Arthritis and Lupus protocols.

Several other autoimmune diseases also appear to be related to periodontal disease: Hashimoto’s thyroiditis (Patil, Patil, Gururaj 2011), Sjögren’s syndrome (Olate 2014), psoriasis (Nakib 2013), and scleroderma (systemic sclerosis) (Baron 2015). Dry mouth, a known contributor to tooth decay and periodontal disease, is a symptom of several autoimmune diseases and may underlie their connection with cavities and periodontal disease (Mays 2012; Mortazavi 2014). On the other hand, systemic inflammation triggered by periodontal disease may contribute to autoimmune diseases (Bansal, Rastogi 2013; Gulati 2013).


Certain cancers are more common in people with periodontal disease (Whitmore 2014). These include head and neck (Han 2014; Zeng 2013), pancreatic (Michaud 2013), gastrointestinal, uterine, and prostate cancers (Arora 2010).

Other Conditions

Other conditions that may be associated with periodontal disease include osteoporosis, erectile dysfunction, prostatitis, liver disease, and endometriosis (Gulati 2013; Kavoussi 2009; Hajishengallis 2015; Nagao 2014; Yoneda 2012). Also, periodontal disease has been associated with adverse pregnancy outcomes. Early research suggests treatment of periodontal disease in pregnant women leads to fewer pre-term deliveries and better outcomes (Parihar 2015).

5 Causes and Risk Factors


Tooth decay and cavities are largely caused by acid secreted by bacteria. This acid erodes the hard enamel on the tooth surface, eventually exposing the vulnerable interior of the tooth (Mayo Clinic 2014a). Dysbiosis is thought to be an important cause of periodontal disease. Dysbiosis occurs when disease-causing bacteria that promote inflammation and break down teeth and gums (and in severe cases, even bone) overcome the normal balance of bacteria in the mouth and in the biofilm (Hajishengallis 2015; Mayo Clinic 2014b; Zaura 2014). Examples of bacteria that can contribute to periodontal disease include Streptococcus sobrinus (S. sobrinus), S. mutans, and some Actinomyces species (Kalesinskas 2014; Fazili 2015; Sutter 1984).

Risk Factors

Caries (cavities). Risk factors for cavities in adults include high dietary sugar, poor dental hygiene, dry mouth, worn fillings, and poorly fitting dental devices. In addition, medical conditions that increase oral exposure to digestive acid, such as gastroesophageal reflux disease and bulimia nervosa, lead to enamel erosion, tooth decay, and cavities. Deeply grooved teeth are more prone to cavities, as are tooth surfaces that are hard to access for cleaning (Mayo Clinic 2014a).

Periodontal disease. Periodontal disease risk is influenced by the composition of the oral microbial community, which can increase or decrease risk. There are several other behavioral, genetic, and environmental risk factors for periodontal disease (Kawar 2011):

  • Smoking tobacco, and possibly marijuana (Thomson 2008; UMMC 2013; Gulati 2013)
  • Older age (especially 65 or older) (Hajishengallis 2014; Kawar 2011)
  • Female gender, especially during hormonal changes such as puberty and pregnancy (Gulati 2013; UMMC 2013)
  • Family history (UMMC 2013)
  • Obesity and metabolic syndrome (Bharti 2009; Kawar 2011)
  • Other systemic diseases, including autoimmune diseases and immune-deficiency diseases like leukemia and AIDS (UMMC 2013)
  • Dental problems related to wisdom teeth or poorly fitting crowns or fillings (UMMC 2013)
  • Stress, anxiety, and depression (UMMC 2013; Oppermann 2012)

6 Signs and Symptoms

Caries (Cavities)

People with tooth decay often do not experience symptoms at first, but as the decay deepens and a cavity forms, they may experience hot and cold sensitivity and tooth pain. Left untreated, a pocket of infection known as an abscess may form, resulting in tooth loss (Mayo Clinic 2014a).

Periodontal Disease

Periodontal disease typically causes minimal symptoms at first. As the condition progresses, signs and symptoms such as gum redness, swelling, sensitivity, and bleeding during brushing and flossing become more likely. A dental practitioner may see gum recession, deepening pockets between teeth and gums, and bleeding on probing during an exam. Halitosis, or bad breath, may be noted. Left untreated, gingival deterioration can progress, and affected teeth can become loose and shift position or be lost (Gurav 2012; Mayo Clinic 2014b; Kawar 2011; UMMC 2013).

7 Diagnosis

History of symptoms such as tooth or gum sensitivity, pain, or bleeding is suggestive of a dental problem and warrants further investigation. During a dental exam, a dental practitioner will look for plaque and tartar buildup, sites of tooth discoloration and softness that indicate decay, gum redness and swelling, gum recession and separation from adjacent teeth, and tooth mobility. A periodontal probe is used to measure pocket depths and check for gum bleeding. X-rays can be used to confirm cavities or assess alveolar bone loss (Mayo Clinic 2014b; Mayo Clinic 2014a; Kawar 2011; Young 2015).

8 Treatment

Caries (Cavities)

Tooth decay in its earliest stage—before the development of cavities—may be treatable with newer methods utilizing specialized dental sealants, resins, or gums, or fluoride liquid or gel applied directly to the teeth by a dental practitioner. These treatments may remineralize enamel that has been eroded by bacterial acids or seal off decayed areas from further exposure to erosive acids (Stahl 2007; Borges 2011). Once cavities have formed, a dentist will need to remove the part of the tooth affected by decay and replace it with a filling or crown. If the infection has reached the pulp at the center of the tooth, a root canal, in which the root pulp is removed and replaced with a special filling, may be performed in an attempt to save the tooth; however, severely decayed teeth sometimes cannot be repaired and need to be extracted. The options for replacing extracted teeth include bridges and implants (Mayo Clinic 2014a).

Periodontal Disease

Gingivitis can frequently be managed with diligent home dental hygiene and regular cleanings performed by a dental practitioner (Kawar 2011). The recommended time between cleanings is based on the severity of the gingivitis and other individual factors (ADA 1997). Toothpastes and mouthwashes that contain antimicrobial substances such as xylitol and essential oils are frequently used to help control plaque (UMMC 2013; Sharma 2010; Vlachojannis 2013).

Treatment of periodontitis can involve several strategies, depending on the severity of disease:

  • Scaling and root planing. These are considered “deep cleaning” procedures. Scaling uses ultrasonic and manual instruments to remove calculus and plaque from tooth surfaces above and below the gum line. Root planing smoothes the root surface so plaque and calculus are less likely to accumulate. The primary purpose of these procedures is to reduce bacterial load in periodontal pockets. Scaling and root planing are generally sufficient treatment for gingivitis and mild periodontitis (Nardi 2012; Paramashivaiah 2013; Singh 2012; Kawar 2011; UMMC 2013).
  • Antibiotics. Antibiotics are sometimes used topically at the site of infection in milder cases, or orally (systemically) in more advanced cases (Kawar 2011). Prescription mouthwashes containing the antimicrobial agent chlorhexidine may be recommended for use before and after periodontal surgery. Side effects of chlorhexidine mouthwashes include temporary tooth discoloration, and rarely, severe allergic reactions (UMMC 2013; Sugano 2012). However, antibiotic use in periodontal disease has come into question since they appear to add little to the efficacy of scaling and root planing and increasing numbers of oral bacteria are becoming resistant to commonly-used antibiotics (Sugano 2012). Doxycycline, a common antibiotic, may be used orally at very low doses to slow destruction of the gums and periodontal ligament (Tariq 2012; Kawar 2011).
  • Surgery. Flap surgery, or periodontal pocket reduction, involves removing sections of the gum that are severely affected, creating access to deeper tissues and the tooth root so cleaning techniques can be more effective. Surgical options for addressing tissue degeneration include gum grafts and bone grafts (UMMC 2013; Kawar 2011).

9 Novel and Emerging Strategies


Innovative diagnostic technologies have the potential to usher in a new era in the evaluation and management of periodontal disease. Biomolecules found in saliva and in gum crevices can now be measured to gauge inflammation and bone remodeling, and guide more effective screening and treatment. This technology has the potential to allow convenient in-office analysis that can lead to individualized treatment (Taylor 2014; Ram 2015). Tests for additional biomolecules that impact periodontal disease are being investigated; these may allow a sensitive analysis of bacterial, genetic, immunological, and stress-related factors (Patil, Patil 2011). Currently available salivary tests that measure bacterial and human DNA give insight into genetic susceptibility to periodontal disease even before symptoms occur. These tests allow for earlier and more accurate diagnosis and treatment (Nabors 2010). Ongoing research continues to identify unique genetic patterns associated with increased periodontal disease risk (Shaffer 2014).


Minimally invasive dentistry. Conventional dental care often involves aggressive mechanical treatment of even minor caries, colloquially termed the “drill and fill” approach. But emerging evidence suggests this aged practice—it has permeated dental dogma for over a century—may be unnecessarily invasive in many cases. Also, dental fillings, or restorations, may deteriorate over time necessitating replacement, which entails additional drilling that further undermines the structural integrity of the tooth (Borges 2011; Stahl 2007).

It turns out that progression of mild caries can often be halted, or even reversed, through the use of remineralizing agents and protective resins and sealants. In these procedures, gentle etching of affected tooth surfaces followed by application of a remineralizing agent and sealant facilitates tooth remineralization and prevents further erosion of tooth enamel. One of the newer widely studied remineralizing agents is casein phosphopeptide-amorphous calcium phosphate, or CPP-ACP (Borges 2011; Stahl 2007).

In the modern era, invasive “drill and fill” dentistry is beginning to fall out of favor, with more preference being given to minimally invasive clinical treatments coupled with at-home use of remineralizing agents such as fluoride- and CPP-ACP-containing mouthwashes and gums along with xylitol, a sugar alcohol that helps displace pathogenic oral bacteria (Emamieh 2015; Borges 2011; Stahl 2007; Milgrom 2006).

Laser. Dental lasers, due to their antibacterial effects and ability to access hard-to-reach sites while minimizing damage to tooth surfaces, can improve the efficacy of traditional periodontal treatments (Zhao 2014). Although one literature review found laser treatment to be as effective as scaling and root planing in improving periodontal health, another review found lasers ineffective for calculus removal, suggesting the role of lasers in conventional treatment of periodontitis requires further investigation (Zhao 2014; Kamath 2014). However, emerging evidence suggests laser treatment plus conventional scaling and root planing may be more effective than scaling and root planing alone (Cheng 2015; Roncati 2014).

Photodynamic therapy. In photodynamic therapy, a special photosensitizing chemical that specifically binds to bacteria is used. A laser, or visible light of a particular wavelength, is then directed at the area to which the photosensitizer has been applied. In the presence of oxygen, the light reacts with the photosensitizer and produces reactive oxygen species that kill bacteria without damaging surrounding tissue (Vohra 2015; Mielczarek-Badora 2013). Antimicrobial photodynamic therapy may help remove biofilm in deep root pockets, increasing the efficiency of scaling and root planing and potentially avoiding post-treatment hypersensitivity (Mielczarek-Badora 2013; Mang 2012). Photodynamic therapy may also be considered as an alternative to antibiotics due to its instantaneous antibacterial effects, reduced likelihood of resistance, absence of toxicity to periodontal tissue, and no known effects in other parts of the body (Vohra 2015). Several reviews have concluded that the addition of antimicrobial photodynamic therapy to conventional scaling and planing more effectively treats periodontal disease compared with scaling and planing alone (Vohra 2015; Smiley 2015; Mielczarek-Badora 2013).

Tissue engineering. Tissue engineering is a technologically advanced method of regenerating or reconstructing healthy periodontal tissue and supporting bone that has been lost to periodontal disease. These innovative techniques may eventually help activate the body’s own restorative self-repair mechanisms, modulating immune activity, promoting new bone growth, and inhibiting loss of existing bone structure. Tissue engineering uses new specialized materials, genetic modification, stem cell therapies, or biomolecules called growth factors (Sood 2012; Rios 2011; Racz 2014). Tissue engineering is a rapidly growing field of research and has great potential to offer a new approach to chronic and aggressive periodontitis treatment; however, only some of these methods have been incorporated into current periodontal treatment (Chen 2010; Sood 2012; Rios 2011).


Metformin and atorvastatin (Lipitor) are two widely-used medications that treat diabetes and cardiovascular disease, conditions associated with periodontal disease. These drugs have shown promise for their beneficial effects on periodontal health.

Metformin. Metformin is generally considered to be the first-line drug treatment for type 2 diabetes (Rena 2013). But metformin has a remarkably wide range of therapeutic indications beyond diabetes: there is strong evidence that it reduces the risk of multiple types of cancer, improves response to cancer treatment, increases likelihood of survival in some forms of cancer, and mimics some of the anti-aging benefits of caloric restriction (Zhang 2011; Lee 2012; Wang 2014; Zhang 2012; Wang 2013; Yu 2014; Kasznicki 2014; Col 2012; Song 2012; Skinner 2013; Noto 2012; Storozhuk 2013; Anisimov 2013; Stein 2012; Fontana 2004; Pryor 2015). 

Now, emerging evidence indicates metformin’s benefits may extend to periodontal disease as well. In two controlled clinical trials, topical metformin was applied directly to affected periodontal tissues in people being treated for chronic periodontitis with scaling and root planing. After six months of treatment, subjects treated with metformin had reduced periodontal pocket depth, better gingival attachment, and improvements in bony defects compared with those receiving placebo (Pradeep, Rao 2013; Pradeep 2015). Similar results were seen in a trial involving smokers with chronic periodontitis (Rao 2013).

Atorvastatin. Atorvastatin, widely used to treat high cholesterol and reduce cardiovascular risk (AHA 2014), appears to reduce periodontal inflammation as well. In one study, 71 participants with suspected or known atherosclerosis were treated with either 10 or 80 mg per day of atorvastatin. After 12 weeks, those on the higher dose had significantly reduced levels of periodontal inflammation, which was accompanied by an improvement in vascular inflammation (Subramanian 2013). In another trial, 60 subjects with periodontitis were treated with scaling and root planing plus either topical atorvastatin or placebo for nine months; subjects receiving topical atorvastatin had greater reductions in periodontal pocket depths and better gingival attachment compared with placebo (Pradeep, Kumari 2013).

10 Diet and Lifestyle Considerations


A diet high in sugar and processed starches increases the risk of tooth decay and cavities (Touger-Decker 2003). This is because microbes including Streptococcus mutans (S. mutans) digest dietary carbohydrates and produce acids that erode tooth enamel (Mayo Clinic 2014a; Struzycka 2014). Fresh fruits and vegetables increase saliva flow, which helps wash food particles from teeth (Mayo Clinic 2014a), while eating foods that leave sugar in contact with teeth for long periods of time, such as sticky and gummy sweets, is thought to increase cavity risk (Mayo Clinic 2014a; Palacios 2009). Sugary sodas bathe the teeth in both acid and sugar and are therefore strong promoters of tooth decay (Kaplowitz 2011).

On the other hand, milk and milk products contain proteins that discourage the attachment of cavity-related bacteria to tooth surfaces (Johansson 2011), as well as phosphorus and calcium compounds that appear to promote remineralization of tooth enamel (Kaplowitz 2011; Palacios 2009). Studies have shown increased intake of calcium from dairy may be associated with lower risk of periodontal disease, and low dietary calcium intake is associated with more severe periodontal disease and tooth loss (Kulkarni 2014). In addition, rinsing with water or drinking unsweetened coffee or tea can help remove sugars from tooth surfaces (Mayo Clinic 2014a).

Vegetarians had better periodontal health than non-vegetarians in one controlled clinical trial (Staufenbiel 2013). In another study, men with the highest intake of whole grains had a 23% lower risk of periodontitis compared with men with the lowest whole grain intake (Merchant 2006).

Dental Hygiene

Brushing and flossing effectively remove plaque. Combined with regular dental care, brushing and flossing are critical for preventing cavities and periodontal disease (Struzycka 2014; Mayo Clinic 2014a). Tooth brushing at least twice daily is recommended to prevent tooth decay, with soft toothbrushes that cause less mechanical trauma to gum tissue generally preferred (Carvalho Rde 2007; Zimmer 2010; Mayo Clinic 2014a). Electric toothbrushes have been shown to outperform manual toothbrushes (Stoltze 1994; Hamerlynck 2005). Dental flossing, using either traditional string floss or a water flosser (eg, Waterpik), to clean between teeth is also important (Mayo Clinic 2014a; UMMC 2013). Several studies suggest water flossers, such as those manufactured by Waterpik, are superior to string floss for plaque removal and gum protection (Goyal 2013; Lyle 2012; Magnuson 2013). Home fluoride rinses, anti-bacterial rinses, and professionally applied fluoride treatments can also contribute to cavity prevention (Gluzman 2013; Mayo Clinic 2014a). It should be noted that frequent use (≥2 times daily) of antibacterial mouthwash can disrupt the oral microbiome, potentially leading to increases in blood pressure from reduced nitric oxide. Those who regularly use antibacterial mouth rinses should consider adding an oral-health probiotic to their dental regimen (Joshipura 2020; Pignatelli 2020).


One study found that lack of physical activity is associated with poor periodontal health and increased risk of periodontal disease, while another large study found that higher levels of physical activity appear to protect against periodontal disease (Bawadi 2011; Merchant 2003). Preclinical and clinical research has shown that exercise reduces gingival oxidative stress and inflammation (Azuma 2011; Mendoza-Nunez 2014), which may contribute to improvements in periodontal health observed in older adults who engage in physical activity (Mendoza-Nunez 2014).

11 Integrative Interventions


Antibiotics and antimicrobials have long been a mainstay of periodontal disease treatment. However, there is a growing recognition that oral dysbiosis contributes to periodontal disease. Moreover, the emergence of increasing numbers of antibiotic-resistant bacterial strains may limit the value of antibiotic treatment for periodontal disease. Therefore, researchers have become increasingly interested in the potential of probiotics to promote a healthy oral microbiome. Probiotics are microorganisms that, when taken as a supplement in adequate amounts, deliver health benefits. Probiotic bacteria that can establish long-term colonies in the oral biofilm may be helpful in preventing and treating periodontal disease (Deepa 2009; Woo 2013; Krayer 2010; Scariya 2015; Sugano 2012; Hajishengallis 2015).

One of the most promising of these bacteria is Streptococcus salivarius (S. salivarius) strain M18. In a clinical study, adults with moderate and severe gingivitis and moderate periodontitis were treated with either probiotic lozenges providing the S. salivarius strain M18 bacteria or no lozenges for 30 days (Scariya 2015). They were examined twice during the treatment period, and 15 and 30 days after the end of treatment. Subjects in the probiotic group were found to have less plaque, better gingival health, and less bleeding on probing than the no-probiotic group; specifically:

  • The plaque index score decreased 44% by day 30
  • The gingival index score decreased 42% by day 30
  • The sulcular bleeding index score decreased 53% by day 30
  • The probing pocket depth decreased 20% by day 30

Intriguingly, subjects who received the S. salivarius M18 probiotic lozenges exhibited superior scores on these indices even 30 days after they stopped using the lozenges. This study demonstrated the ability of the probiotic lozenge to significantly improve all four of these commonly used assessments of periodontal health. S. salivarius M18’s ability to colonize the oral cavity contributed to the sustained benefits seen even after the supplementation period ended. A separate randomized controlled trial corroborated the antigingivitic and antiplaque effects of S. salivarius M18. In this trial, 57 participants were randomized and instructed to consume a placebo or probiotic lozenge containing 500 million colony forming units (CFUs) of S. salivarius M18 once daily in the evening after toothbrushing for four weeks. Treatment with the probiotic resulted in a significant decrease in gingival index and Turesky modification of the Quigley and Hein Plaque Index (TQHPI) scores, whereas placebo showed no improvement. The improvement in gingival index score was maintained up to four weeks following the intervention period (eight weeks from baseline) (Babina 2023).

In children, a randomized controlled trial demonstrated supplementation with S. salivarius strain M18 reduced plaque buildup. In addition, salivary bacterial cultures showed children with greater numbers of S. salivarius M18 after treatment also had reduced numbers of cavity-associated S. mutans, which suggests supplementing with this probiotic may prevent cavities (Burton 2013). S. salivarius M18 has also been shown to improve bad breath (halitosis) (Burton 2006). A separate study in children aged 3–6 years found that supplementation with S. salivarius M18 once daily for seven days, compared with placebo, significantly inhibited Streptococcus mutans growth, a bacteria associated with tooth decay (Salim 2023).

S. salivarius M18 promotes oral health via several mechanisms. It produces enzymes that break down plaque. The probiotic also helps maintain healthy oral cavity pH, in part through competitive inhibition of other bacterial growth, which is important because imbalanced pH in the mouth can lead to tooth demineralization (Salim 2023). S. salivarius M18 produces powerful antimicrobial compounds called bacteriocin-like inhibitory substances (BLIS) or lantibiotics as well. These lantibiotics then destroy disease-causing bacteria in the mouth (Burton 2013; Loesche 1996; Heng 2011; Wescombe 2011; Burton 2010).


Xylitol is a small carbohydrate sometimes used in the food industry as a sugarless sweetener. It has been widely studied over the past four decades for its anti-plaque and anti-cavity effects, and has been found to decrease salivary acidity; reduce levels of plaque, harmful bacteria, and gingival inflammation; prevent dry mouth and enamel erosion; and improve salivary flow (Chattopadhyay 2014; NCBI 2015; Nayak 2014). One trial showed xylitol consumption reduced levels of cavity-causing S. mutans bacteria immediately after use, and this effect continued after the subjects stopped using xylitol (Fraga 2010).

Supported by a growing body of evidence demonstrating its beneficial effects, xylitol is now available in therapeutic anti-cavity toothpastes, candies, chewing gums, syrups, and mouthwashes (Lif Holgerson 2006; Nayak 2014; Yuen 2012).

Coenzyme Q10

Evidence for a deficiency of coenzyme Q10 (CoQ10) in gum tissue of patients with periodontal disease, and for a beneficial effect of CoQ10 supplementation in these patients, has existed for decades (Iwamoto 1975; Littarru 1971; Nakamura 1974). The mechanisms behind this relationship lie in CoQ10’s important role in controlling inflammation and regulating oxidative stress (Prakash 2010).

A randomized controlled trial of 120 mg of CoQ10 in 30 patients who underwent root planing and scaling found a significant reduction in inflammation of the gums in the CoQ10 group after one and three months compared with placebo (Manthena 2015). In preclinical and clinical studies using topical oral applications of CoQ10 to diseased periodontal tissue, CoQ10 therapy improved periodontal health and inflammation, including as an adjunct to scaling and root planing (Hanioka 1994; Hans 2012; Sale 2014; Yoneda 2013; Chatterjee, Kandwal 2012). An animal study showed CoQ10 moderated the negative effects of omega-6 fatty acids on periodontal-related bone loss (Varela-Lopez 2015).

Fish Oil

Fish oil and its omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have shown benefit in a variety of inflammation-related conditions, including cardiovascular disease, diabetes, and autoimmune diseases (Kremer 1995; Calder 2013; Ellulu 2015; Tabbaa 2013). Interestingly, periodontal disease is bidirectionally associated with these conditions (Koutsochristou 2015; Flemmig 1991; Mays 2012; Ogrendik 2013; Patil, Patil, Gururaj 2011; Mayer 2013; Hollan 2013; Altamash 2015). Findings from several studies suggest people with periodontal disease have lower intake of anti-inflammatory omega-3 fats (Iwasaki 2010; Naqvi 2010) and a relatively greater intake of pro-inflammatory omega-6 fatty acids (Iwasaki 2011; Tabbaa 2013). In one study, 80 patients being treated for periodontitis with scaling and root planing were given either 900 mg EPA plus DHA and 81 mg aspirin daily or placebo. After six months, those receiving the omega-3 supplements and aspirin had more improvement in pocket depths and better gingival health (El-Sharkawy 2010).


Lycopene is a red plant pigment found in foods including tomatoes, watermelon, papaya, and pink grapefruit. Lycopene is in the family of plant compounds known as carotenoids and, like other carotenoids, has well-established anti-inflammatory activity (Gupta 2015). A randomized controlled trial in 20 healthy participants with signs of gingivitis found that 8 mg per day of lycopene taken orally was significantly more effective than placebo as an adjunct to regular dental care in the treatment of gingivitis (Chandra 2007). Similarly, another clinical trial in 42 patients with chronic periodontitis already being treated with scaling and root planing found that 8 mg of lycopene per day resulted in greater improvement in indices of periodontal health compared with placebo (Arora 2013). In a randomized trial, patients with both periodontitis and diabetes were treated with scaling and root planing alone or in combination with 8 mg of lycopene per day. Those taking lycopene had greater reductions in periodontal pocket depths as well as improvements in blood glucose control (Reddy 2015).

Vitamin E

Vitamin E, particularly gamma-tocopherol, may favorably influence periodontal disease, while in animals, alpha-tocopherol has improved gingival healing, prevented bone loss, and decreased local inflammation. Lower blood vitamin E levels have been associated with more severe periodontal disease (Zong 2015). One study found lower blood and saliva levels of superoxide dismutase (SOD), an important enzyme that quenches oxygen free radicals, in 38 subjects with chronic periodontitis compared to 22 people without periodontal disease. The periodontitis subjects were then treated with scaling and root planing alone or with the addition of 200 mg (300 IU) of vitamin E every other day. After three months the vitamin E group had greater improvements in periodontal health. In addition, SOD levels increased in those receiving vitamin E (Singh 2014).


Curcumin, a polyphenolic phytonutrient from the culinary spice turmeric, is a well-known anti-inflammatory agent (Nagpal 2013). It has also shown anti-microbial activity against bacteria implicated in gingivitis and periodontitis (Shahzad 2015). Several studies have demonstrated that curcumin, applied directly to the gums, demonstrates effectiveness comparable to conventional antimicrobials and is a useful adjunct to scaling and root planing for gingivitis and chronic periodontitis (Muglikar 2013; Behal 2011; Jaswal 2014; Anuradha 2015). In laboratory studies, curcumin has inhibited periodontal disease bacteria and biofilm (Izui 2015; Shahzad 2015).

Rodent studies have shown that supplemental curcumin can reduce periodontal disease-related inflammation in the mouth by inhibiting the expression of inflammatory cytokines and reducing activation of the inflammatory mediator nuclear factor-kappaB in gum tissue, resulting in noticeably lower signs of inflammation (Guimaraes 2012; Guimaraes 2011). These studies used the equivalent of 386 ‒ 1287 mg of curcumin per day for a 175 lb person. In a randomized controlled trial, a highly bioavailable form of curcumin was found to deliver up to seven times more bioactive curcumin to the blood than previous curcumin preparations (Antony 2008).


Lactoferrin, an iron-binding protein with anti-microbial and immune-modulating properties, is found in saliva and other body fluids (Berlutti 2011). In the mouth, lactoferrin has been shown to help control the growth of colonies of plaque-related bacteria that contribute to both tooth decay and periodontal disease. It inhibits formation of pathogenic biofilm and can help reduce established biofilm. In a clinical study, treatment with a liposomal lactoferrin tablet providing 180 mg lactoferrin daily in five adults with periodontal disease improved periodontal pocket depths after just four weeks (Ishikado 2010). In another clinical study, oral lactoferrin reduced levels of disease-causing bacteria under the gums of chronic periodontitis patients, favorably influencing the biofilm (Wakabayashi 2010). A preclinical study concluded that orally administered lactoferrin may be a powerful treatment and preventive therapy for periodontal inflammation (Kawazoe 2013), while two other laboratory studies demonstrated that lactoferrin can inhibit the growth and biofilm formation of periodontal disease-associated bacteria (Wakabayashi 2009; Dashper 2012).

Periodontal Tissue Support

Calcium and vitamin D. Calcium and vitamin D deficiencies are associated with osteoporosis, periodontal bone loss, and tooth loss, and adequate intakes are necessary for dental and periodontal health (Miley 2009; Garcia 2011; Stewart 2012). In addition to enhancing calcium uptake and metabolism, vitamin D has anti-inflammatory and immune-modulating properties, both critically important for the maintenance of periodontal health (Stein 2014; Dietrich 2005). Vitamin D also helps prevent other chronic inflammatory conditions including cardiovascular disease and diabetes (Stein 2014).

Supplementation with calcium plus vitamin D may be beneficial for people with periodontal disease. In a preliminary study, subjects who took at least 400 IU vitamin D and 1000 mg calcium daily had less severe periodontal disease compared with subjects who did not take these supplements (Miley 2009). These same subjects were followed for one year, and those who took vitamin D and calcium supplements improved more rapidly, with the greatest difference seen after 6 months of treatment (Garcia 2011). Another study in patients being treated for chronic periodontitis found supplementation with 250 IU vitamin D and 500 mg calcium per day for three months led to markedly better measures of periodontal disease compared with no supplemental calcium and vitamin D (Perayil 2015).

A large study that incorporated findings from a food survey, blood tests, and dental exams concluded that low calcium intake results in more severe periodontal disease (Nishida 2000). In another study, women with the highest calcium intake were 47% less likely to have periodontal disease than women with the lowest intake (Tanaka 2014). Similarly, individuals with low vitamin D status have been found to be more likely to have periodontal disease (Antonoglou 2015; Dietrich 2005), and higher vitamin D intake may protect against periodontal disease progression (Alshouibi 2013).

B vitamin complex. B vitamins are necessary for cell growth and metabolism (Kulkarni 2014). A study in 30 subjects with periodontitis, treated with flap surgery, examined the effects of a vitamin B complex supplement. (In flap surgery, severely infected sections of the gum are removed, creating access to deeper tissues and tooth root.) After surgery, participants received either placebo or a supplement providing 50 mg each of B1 (thiamine), B2 (riboflavin), B3 (niacinamide), B5 (pantothenic acid), and B6 (pyridoxine); 50 mcg each of vitamin B12 (cobalamin) and biotin; and 400 mcg of folic acid per day for 30 days. These subjects were then followed up for 180 days. Those treated with vitamin B complex after surgery had more improvement in gingival attachment at the end of the study (Neiva 2005).

Folate. Folate is critical for normal cell division and tissue repair. It has a special role in maintaining periodontal health, and folate deficiency is linked to oral health problems including infections and degeneration and destruction of the gingiva, periodontal ligament, and alveolar bone (George 2013). Individuals with periodontitis have been found to have lower folate levels compared with those without periodontal disease, and a mouthwash with 5 mg folate per 5 mL (1 tsp) has been shown to improve periodontal health in people with periodontal disease (Pack 1984; Yu 2007).

Smoking depletes folate (Vardavas 2008; Gabriel 2006), which may help explain the co-occurrence of smoking and periodontal disease (George 2013). The association between smoking and folate depletion has led some researchers to recommend folate supplementation for smokers with periodontal disease (Erdemir, Bergstrom 2006; George 2013).

Magnesium. Magnesium is necessary for a wide range of cellular functions. Low magnesium intake has been linked to periodontitis (Staudte 2012). In one study, people with the highest magnesium intake had a 36% lower risk of tooth loss compared to people with the lowest intake (Tanaka 2006), and several studies have observed lower levels of magnesium in the blood of individuals with periodontal disease (Meisel 2005; Pushparani 2014). Smoking and diabetes may worsen the magnesium deficit seen in people with periodontitis (Kolte 2012; Pushparani 2014). Individuals with periodontal disease, and particularly smokers (Erdemir, Erdemir 2006), may fare better if they maintain higher blood magnesium levels.

There is also ample evidence that magnesium deficiency is associated with cardiovascular disease, and is commonly seen in people with other chronic inflammatory conditions including metabolic syndrome and diabetes (Nielsen 2014).

Vitamin C. Vitamin C plays a critical role in connective tissue repair processes and regulation of the immune response throughout the body, making it an important factor in the health of the periodontium (Gokhale 2013). In fact, swelling and bleeding of the gingiva is a hallmark of vitamin C deficiency (Ben-Zvi 2012; Alagl 2015; Rubinoff 1989). Vitamin C may also help maintain alveolar bone and help control the balance of oral bacteria (Alagl 2015).

In a randomized controlled trial, 120 participants were divided into four groups of 30. The first group had no periodontal disease, the second had chronic gingivitis, the third had chronic periodontitis, and the fourth had chronic periodontitis and type 2 diabetes. Subjects with periodontal disease were treated with scaling and root planing, half of whom were randomized to receive 450 mg per day chewable vitamin C or placebo for three weeks. Vitamin C administration resulted in significantly greater reductions in gingival bleeding compared with placebo in the chronic gingivitis and the diabetes plus chronic periodontitis groups (Gokhale 2013).

Zinc. Zinc reduces dental plaque and is effective against bad breath. It also has wound healing, immune-supportive, and antibacterial properties that can all contribute to periodontal health (Kulkarni 2014). In one study, zinc deficiency was associated with an increased number of cavities and poorer gingival health in children (Atasoy 2012). Low zinc levels have also been noted in people with both diabetes and periodontitis (Pushparani 2014).

Additional Support

Green tea. Green tea leaves are a rich source of polyphenols called catechins, which are well known for their ability to reduce oxidative stress and inflammation (Nugala 2012; Babu 2008). Epigallocatechin gallate (EGCG) is the most abundant and most studied of green tea’s catechins (Hamilton-Miller 2001; Anita 2014; Wolfram 2007). Researchers have found that green tea catechins have antibacterial activity against cavity-causing bacteria such as S. mutans and bacteria implicated in periodontal disease such as Porphyromonas gingivalis (Hirasawa 2002). Green tea catechins may also promote oral health by preventing plaque formation (Hamilton-Miller 2001), inhibiting enzymes involved in tissue breakdown (Chatterjee, Saluja 2012; Nugala 2012), and preventing alveolar bone loss (Chatterjee, Saluja 2012; Nugala 2012).

A survey in Japanese men found that green tea intake was associated with better oral health. For each cup of tea consumed per day, there was a measurable benefit observed in the form of decreased average pocket depth, improved gingival attachment, and reduced gingival bleeding (Kushiyama 2009). Drinking green tea has been recommended as a strategy for maintaining periodontal health in patients with periodontitis (Ramasamy 2015).

Green tea catechin extracts have been used as an ingredient in mouthwash or applied directly to tissues with periodontal disease. This method has demonstrated efficacy comparable to conventional antimicrobial mouthwash in reducing plaque, and can enhance the effectiveness of scaling and root planing to treat chronic periodontitis (Kaur, Jain 2014; Kudva 2011; Hattarki 2013; Chava 2013).

Pomegranate. Pomegranates are high in a wide array of beneficial polyphenol phytonutrients demonstrated to prevent cancer, cardiovascular disease, diabetes and other conditions. Pomegranate polyphenols are potent defenders against oxidative stress and inflammation (Basu 2013; Prasad 2014; Jurenka 2008). A mouthwash that contained pomegranate extract, added to scaling and root planing, performed comparably to a conventional antimicrobial chemical, and other localized applications of pomegranate have shown benefit in treatment of periodontal disease (Batista 2014; Sastravaha 2005; DiSilvestro 2009).

Essential oils. Essential oils are aromatic plant extracts rich in compounds called monoterpenes. Mouthwashes and toothpastes with essential oils and monoterpenes from plants such as peppermint and clove have long been in use, and scientists now recognize that the antimicrobial effects of these compounds may explain much of their benefit for oral health (Zomorodian 2015; Allaker 2009). For example, Listerine mouthwashes contain three monoterpenes: menthol, thymol, and eucalyptol (Allaker 2009). Numerous studies have shown that Listerine use is associated with decreased levels of harmful oral bacteria, plaque, and gingival inflammation (Goutham 2013; Charles 2014; Cortelli 2013; Cosyn 2013). A randomized controlled trial in chronic periodontitis patients found that an essential oil mouthwash significantly reduced populations of two types of pathogenic bacteria, and concluded that an essential oil rinse may be an effective adjunct to standard treatment for reducing bacterial counts in gum pockets (Morozumi 2013).

A study involving a mouthwash made with the essential oil from the Ayurvedic herb Ocimum sanctum, also known as holy basil or tulsi (Cohen 2014), found positive periodontal effects (Gupta 2014). In another study, 49 participants with gingivitis were treated with topical 2.5% tea tree oil gel, 0.2% chlorhexidine gel, or placebo gel applied with a toothbrush twice daily for eight weeks. The major monoterpenes in tea tree oil are cineole and terpineol. The greatest improvements in gingival health were seen in the tea tree oil group (Soukoulis 2004).


  • Apr: Replaced section on probiotics in Integrative Interventions and updated section on cognitive decline and Alzheimer’s disease in Oral Health and Systemic Diseases


  • Mar: Updated section on cardiovascular disease in Oral Health and Systemic Diseases


  • Dec: Comprehensive update & review

Disclaimer and Safety Information

This information (and any accompanying material) is not intended to replace the attention or advice of a physician or other qualified health care professional. Anyone who wishes to embark on any dietary, drug, exercise, or other lifestyle change intended to prevent or treat a specific disease or condition should first consult with and seek clearance from a physician or other qualified health care professional. Pregnant women in particular should seek the advice of a physician before using any protocol listed on this website. The protocols described on this website are for adults only, unless otherwise specified. Product labels may contain important safety information and the most recent product information provided by the product manufacturers should be carefully reviewed prior to use to verify the dose, administration, and contraindications. National, state, and local laws may vary regarding the use and application of many of the therapies discussed. The reader assumes the risk of any injuries. The authors and publishers, their affiliates and assigns are not liable for any injury and/or damage to persons arising from this protocol and expressly disclaim responsibility for any adverse effects resulting from the use of the information contained herein.

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