Periodontitis and Cavities

Periodontitis and Cavities

1 Introduction

There are many reasons to keep your teeth and gums healthy. Healthy teeth and gums not only look better, but also promote better eating habits and nutrition. By contrast, unhealthy, inflamed gums are associated with various diseases, including coronary heart disease and an elevated risk for heart attack, while tooth loss is linked to malnutrition.

In a healthy mouth, teeth are intact and anchored in pink with firm gums that do not bleed during brushing. A regular dental care program should include flossing and brushing twice daily, as well as regular visits to the dentist for cleaning and examination.

Gum disease and tooth loss are especially common among the elderly. Some researchers believe that malnutrition in older people may be in part due to poor dentition (the type, number, and arrangement of a set of teeth). In fact, some researchers believe that the short life span of early humans was related to tooth loss that caused starvation (Goodman 1989; Story 1986).

The three most common problems in the oral cavity are dental caries (cavities) and the periodontal diseases gingivitis and periodontitis. These are caused by multiple factors, including plaque buildup, diet, oral hygiene, genetics, environment, and lifestyle factors. For more information on gingivitis, the most common dental disease, see Life Extension’s Gingivitis protocol. Dental caries and periodontitis are discussed in this chapter.

2 Cavities

Dental caries (cavities) occur when microorganisms build up in deposits of dental plaque and ferment dietary sugars. The byproduct of this fermentation, lactic acid, lowers the pH at the junction of the plaque layer and tooth enamel, and eventually the enamel is eroded (Geddes 1991).

The layer of plaque in the mouth has recently been redefined as “biofilm” (Rudney 2000). Biofilm develops in a predictable pattern, whereby oral bacteria colonize areas of the gums and teeth, then spread, and eventually link with other organisms in a cohesive film. This film can occur both above and below the gum line. If left intact, it may form a hard, mineralized mass called calculus (tartar) (Bernimoulin 2003). This is the hard, yellow substance that dentists scrape off with specialized equipment. Tartar contains masses of bacteria that produce lactic acid and promote tooth decay. Brushing and flossing alone cannot penetrate or remove the tartar.

One novel hypothesis for disrupting the creation of biofilm and preventing tartar involves oral vaccines that may protect the mouth against Streptococcus mutans (S. mutans), the bacteria most commonly responsible for dental caries. Human studies have shown encouraging results with antibodies designed to suppress colonization of S. mutans in the biofilm (Michalek 2004).

The risk of developing cavities differs for each individual, based on factors such as oral hygiene, genetics, the size and shape of the teeth, resistance to infection, retention of dental plaque, and metabolism of sugar (Boraas 1988; Conry 1993). In addition, people with pre-existing conditions such as gum disease have a greater chance of developing cavities, and smoking can accelerate the transformation of plaque into tartar (Feldman 1983). Other risk factors for dental cavities include exposure to lead (Watson 1997), polychlorinated biphenyls (PCBs) (Rogan 1988), and second-hand smoke (Aligne 2003).

Clinically, cavities appear as blemishes on the tooth surface. If not clinically visible, they can still be detected using dental x-rays. Most dentists recommend one set of dental x-rays annually.

Waiting for tooth pain as a reason to visit the dentist is a not a good strategy for preventing cavities. In many cases, cavities are not painful because they affect only the surface layers of the tooth and do not extend into the dental pulp, which is the soft tissue inside the tooth. In more advanced cases, a cavity may extend into the pulp, causing intense pain and pulp disease known as pulpitis. Early pulpitis is generally treatable. If not treated, however, it can advance to pulp death. At this point, the tooth may stop hurting because the nerve has died. By the time a cavity has reached this stage, the tooth will most likely require extraction. Modern preventive dentistry is designed to prevent tooth decay from reaching such advanced stages.

Fluoride: Effective Against Cavities

Fluoride's role in preventing cavities has been extensively documented (Klein 1972). Teeth with adequate fluoride are resistant to acid, and studies have shown a 30 to 50% reduction in decay following the fluoridation of drinking water (Neenan 2004).

The use of fluoride, however, is not without its side effects. The most common side effect is fluorosis. This permanent alteration causes small, barely visible white flecks on adult teeth (Dean 1934). It occurs early during tooth development, when adult teeth are just coming in (Den Besten 1999). To help prevent it, experts recommend:

  1. Use of low-fluoride water in infant formulas
  2. Adult supervision of children during brushing
  3. Rigid application standards when administering fluoride supplements to children (Fomon 2000).
There is, however, little question that fluoride works to prevent cavities. When children between the ages of 5 and 6 years were treated with a 1.2 percent fluoride gel versus a placebo gel twice daily, the fluoride group showed a 40% decrease in cavities compared to the placebo group after a two-year follow-up (Klein 1972).

3 Periodontitis

Periodontal diseases, including gingivitis and periodontitis, are inflammatory diseases affecting the supporting structures that anchor teeth in place (periodontium). Gingivitis and periodontitis are related conditions; if left untreated, gingivitis (inflammation of the gingival tissue [gums]) can progress to periodontitis, a more serious condition. Gingivitis is treatable and reversible, while periodontitis is irreversible and can lead to tooth loss.

Risk factors for periodontitis include smoking, stress, depression (Grossi 2000), and alcohol consumption (Tezal 2004). Tobacco use is an important risk factor for periodontitis (Albandar 2000; Bergstrom 2000a,b; Tomar 2000). For more specific information on risk factors for gingivitis, the most common form of gum disease, see Life Extension’s Gingivitis protocol.

During periodontitis, healthy gum tissue is transformed from pink and firm, with knife-edge margins between the soft tissue and the tooth, to inflamed and red. Eventually, tissue pulls away from the tooth, allowing pockets to form. These pockets can be measured with a special probe during a standard dental check-up. Any pocket over 3 millimeters (mm) in depth signifies gingivitis; a pocket over 5 mm usually signifies periodontitis.

Periodontal infections frequently involve bacteria that discharge hydrogen sulfide, ammonia, amines, toxins, and inflammatory-causing enzymes that can cause tissue and tooth loss (Haffajee 2000). Bleeding gums, bad breath, and pain also occur (Haffajee 2000). Clinically, periodontitis is characterized by inflamed, red gums and deepening pockets between the tooth root and gum tissue, as well as loss of bone in the jaw. Advanced periodontal disease can be diagnosed by changes in appearance of the teeth and gums, including:

  1. noticeable loosening of teeth
  2. gum recession with tooth root exposed
  3. new spaces forming between teeth
  4. food being trapped between teeth and where gums have receded
  5. constant bad taste in the mouth

Periodontal disease is usually painless until late in the disease process, when teeth are so loose that pain occurs while chewing. Retention of food in a pocket site may provoke a sudden burst of bacterial growth, resulting in a painful abscess (Loesche 2001). At other times, front teeth may become so loose that they separate.

Conventional therapy for periodontal disease consists of mechanical scaling and root planing, surgical treatment, and use of various antimicrobial regimens (Loesche 2001). The goal is to reduce the number of bacteria on the surface of teeth by reducing the amount of plaque. If pocket depths in the gums are 5 mm or greater, large numbers of bacteria can accumulate that cannot be reached by normal oral hygiene. Periodontal surgery may then be recommended to reduce the pocket depths to 1 to 2 mm (Loesche 2001).

Antibiotic therapy is sometimes needed when bacterial count continues to climb. In open clinical trials, tetracycline has been used successfully to treat aggressive periodontitis, either as an oral tetracycline/surgery combination (Lindhe 1984; Mandell 1986, 1988) or alone for 3 to 8 weeks (Christersson 1993; Slots 1983). Tetracycline can deplete calcium, magnesium, and iron; therefore, people on tetracycline should take a multivitamin (Pelton 2001).

There are several ways to release medications directly into the periodontal pocket, including the use of long-lasting gels. These methods reduce the dose of medicine needed and deliver the antibiotic in a highly targeted fashion (Loesche 2001). Devices that deliver localized antibiotics are about as effective as systemic agents in their ability to target harmful bacteria; also, people do not have to remember to take medicine, thus improving patient adherence (Loesche 1993, 1999). These devices include Atridox®, PerioChip®, and Arestin® (Paper 2004).

4 Gum Disease, Inflammation, and Chronic Disease

Gum disease is clearly associated with heart disease and other health-related problems. This is not necessarily due to bacterial spread from the mouth into the bloodstream, as many people think. In fact, “bacteria showers” in the bloodstream are relatively common and occur in response to brushing teeth, bowel movements, and other normal activities. These are rarely dangerous for people with healthy immune systems. Rather, the link between gum disease and other systemic diseases appears to be due to an increased inflammatory response occurring throughout the body and is triggered by inflammation in the gums. The following diseases have been associated with gum disease.

Infective Endocarditis. Infective endocarditis is a serious, potentially fatal bacterial infection of the heart, its valves or inner lining. It occurs when bacteria in the bloodstream are embedded on abnormal heart valves or damaged heart tissue. Dental procedures and diseases are associated with endocarditis in people with underlying congenital heart disease and in those with prosthetic heart valves or who have had other forms of heart surgery (Drangsholt 1998; Lacassin 1995; Van der Meer 1992). About 8% of cases in the United States have been associated with periodontitis or other dental diseases without an associated dental procedure. Chances of infective endocarditis following dental procedures in people with pre-existing heart conditions ranged from 1 per 3000 to 1 per 5000 procedures (Drangsholt 1998). To prevent this condition, some heart patients are advised to take antibiotics during dental procedures.

Cardiovascular Disease. Studies have shown an association between periodontitis and cardiovascular disease (Beck 1999; Loesche 1988; Mattila 1988), and suggest that periodontitis is a risk factor for cardiovascular disease (Loos 2000; Arbes 1999; Beck 1998). Periodontitis is linked to heart disease by inflammation. According to the latest research, large amounts of bacteria in the gums trigger a systemic inflammatory response, with elevated levels of pro-inflammatory chemicals such as COX (cyclooxygenase) products, arachidonic acid, and others. These pro-inflammatory chemicals may contribute to atherosclerosis, which is now understood to be an inflammatory disease that affects the inner linings of arterial walls (the endothelium). Numerous studies have thus linked inflammatory gum disease to cardiovascular events such as stroke, atherosclerosis, and thickening of calcifications in the carotid artery (Dorfer 2004; Grau 2004; Wu 2000; Ravon 2003; Beck 2001).

Obesity. Obesity, a significant risk factor for numerous diseases, has been associated with periodontitis, gingivitis, and dental cavities (Wood 2003). Other conditions associated with obesity such as metabolic syndrome or Syndrome X (a clustering of dyslipidemia, insulin resistance, hypertension, and type 2 diabetes) can worsen periodontitis (Grossi 1998).

Diabetes. Periodontitis is twice as prevalent in diabetics as non-diabetics (Loe 1993). Experimentally produced periodontitis increased blood glucose levels in uncontrolled diabetic animals. Studies have linked glycation and inflammation in diabetics to worsening periodontitis. Alternatively, studies have linked the inflammatory response triggered by worsening periodontitis to amplified glycation, a damaging process that links proteins to glucose molecules and has been implicated in hardening of the arteries and other diseases (Grossi 1998).

Osteoporosis. Significant relationships exist between periodontitis and osteoporosis (Jeffcoat 1996,1998; von Wowern 1994; Streckfus 1997; Ronderos 2000; Tezal 2000; Krook 1972) as well as tooth loss and osteoporosis (Krall 1994, 1996; Tagushi 1999; Grossi 2000).

Pregnancy-Related Issues. Oral infections can increase the risk of low birth weight in newborns (March of Dimes 2000). Pregnant women with periodontitis were found to be 7.5 times more likely to have a pre-term, low-birth-weight infant than pregnant women without periodontitis (Offenbacher 1996). Pregnancy can increase the frequency, severity, and degree of gingivitis (Hugoson 1970; Loe 1965).

Lung Disease. Poor oral hygiene provides an ideal growth environment for anaerobic bacteria, which can cause severe pneumonia, especially in people with impaired swallowing (Shreiner 1979; Komiyama 1985; Costerton 1995; Mergran 1986; Toews 1986; Fiddian-Green 1991; Levison 1994; Moore 2000; Appelbaum 1978; Pratter 1980; Scannapieco 1999).

5 Are Teeth Whiteners Safe?

Over the past decade, sales of at-home teeth-whitening products have exploded in the United States. These products generally contain either hydrogen peroxide or carbamide peroxide, and are usually painted or brushed on, or applied in strips directly to the teeth. They are milder versions of whiteners that are used in the dentist's office, which may contain up to 35% active ingredients.

While studies have shown that these products do whiten teeth, there is some lingering concern about their safety. For example, studies have shown that peroxide from at-home whitening products penetrates the tooth enamel into the pulpy interior of the teeth (Gokay 2005). In studies of human molars, these products have also been shown to adversely affect the hardness of enamel (Leonard 2005; Basting 2005).

So far, however, no systemic adverse effects have been demonstrated with the use of teeth whiteners containing 10% carbamide peroxide (Li 2003). The most common side effects are moderate tooth sensitivity and mild gum irritation that usually discontinues when the product is no longer being used (Li 2003).

Because stronger at-home solutions containing up to 18% carbamide peroxide have not yet been extensively tested in humans, it may be advisable to use a milder at-home tooth-whitening product under a dentist's supervision.

6 Tooth Loss, Nutrition, and Diet


Approximately 60% of United States adults are missing at least one tooth, and 10% have no teeth at all (Marcus 1996). Besides the aesthetic value of a nice smile, there are harmful health repercussions to lacking functional teeth, including a greater risk of malnutrition (ADA 2003). People missing their teeth have about 20% of the chewing capacity of people with teeth, and tend to avoid eating fruits, vegetables, and whole grains (Moynihan 2001). This can quickly lead to malnutrition as well as serious vitamin and mineral deficiencies.

Nutrition for a Healthy Mouth

Good oral hygiene, regular tooth brushing and flossing, tongue cleaning, regular dental check-ups, and use of high-quality oral care products can prevent or reduce the risk of cavities. At the same time, because of the risk of a dangerous inflammatory response, it is important that people with gum disease protect themselves with powerful anti-inflammatories. The following nutrients support healthy gums and reduce inflammation.

Coenzyme Q10. In one study, topical application of coenzyme Q10 (CoQ10) to periodontal pockets significantly reduced gingivitis, bleeding gums, and pocket depths after 5 to 7 days of treatment (Hanioka 1994). In another study, symptoms of gingivitis and periodontitis improved 3 weeks after beginning CoQ10 treatment (Wilkinson 1975). Topical application of CoQ10 improved adult periodontitis alone and in combination with non-surgical periodontal therapy (Hanioka 1994).

Hydrogen peroxide. Hydrogen peroxide, which is included in many brands of toothpaste, is valuable for its ability to reach bacteria hiding among gingival folds and gaps. Hydrogen peroxide is also added to some mouthwashes to reduce gingivitis and whiten teeth (Hasturk 2004). Hydrogen peroxide has been used effectively for years in dentistry.

Essential Oils. Mouth rinses containing essential oils such as eucalyptus oil and menthol significantly reduced both gingival inflammation and bleeding when used in conjunction with fluoride toothpaste (Beiswanger 1997). Tea tree oil (Melaleuca alternifolia) is an antiseptic, fungicide, and bactericide that is effective against oral bacteria (Vasquez 2002; Carson 2001).

Tea tree oil, used as an oral rinse, has been proven to kill bacteria (Kulik 2000). In fact, research has shown that a tea tree oil concentration of 0.6% inhibited 14 of 15 oral types of bacteria. In one study, 49 subjects age 18 to 60 years with severe, chronic gingivitis were divided into groups, one of which was given a gel containing tea tree oil to apply with a toothbrush twice daily. The tea tree oil group had improved gingival index and papillary bleeding index scores attributed to the herb’s anti-inflammatory properties (Soukoulis 2004).

Folic Acid. Mouthwash containing folic acid is effective in treating gingivitis and its accompanying inflammation. Among pregnant women, who are prone to gingivitis, folate mouthwash has proven superior to oral folate supplementation in preventing gingivitis (Pack 1980, 1984; Thompson 1982).

Green Tea. Green tea extract is rich in a class of antioxidants called catechins. Two in particular, epigallocatechin gallate (EGCG) and epicatechin gallate (ECG), combat oral plaque and bacteria (Horiba 1991; Otake 1991; Rasheed 1998). These green tea polyphenols work as anti-plaque agents by suppressing glucosyl transferase, which oral bacteria use to feed on sugar. Other research has demonstrated that green tea extract can kill oral bacteria and inhibit collagenase activity. Collagenase, a natural enzyme that becomes overactive in the presence of bacterial overgrowth, can destroy healthy collagen in gum tissue.

Green tea extract applied topically inhibits S. mutans bacteria in the laboratory. These bacteria have been implicated in the development of dental cavities. The scientists suggested that certain green tea extracts might be especially helpful in preventing tooth decay by inhibiting the development of bacterial plaque (Hattori 1990). In a Chinese study, green tea extract was used to rinse and brush teeth. The study demonstrated that S. mutans could be inhibited completely after contact with green tea extract for 5 minutes. There was no drug resistance after repeat cultures, and researchers concluded that green tea extract is effective in reducing the risk of developing cavities (You 1993). Other studies have found that the catechins in green tea remain at active levels in saliva for up to 1 hour following application (Tsuchiya 1997).

Additional studies confirm the benefits of green tea in fighting gum disease, especially when combined with conventional treatments. In a pilot study, hydroxypropylcellulose strips containing green tea catechins as a slow-release local delivery system were applied to the pockets in periodontal patients once a week for 8 weeks. The green tea catechins inhibited the bacteria P. gingivalis and Prevotella spp., and a reduction in pocket depth was observed (Hirasawa 2002).

Hyperimmune egg extract. Agricultural scientists discovered long ago that they could immunize hens against germs that threaten humans. This immunity was then passed on by the hen to the egg (Dias da Silva 2010; Dean 2000; Cama 1991). Scientists have now been able to customize eggs to provide different types of immunity. At least 24 different organisms have been used to immunize a single hen, which then lays eggs that offer passive immunity to all of the organisms (Dean 2000).

Hyperimmune egg extract has been shown to reduce the volume of dental plaque, which in turn cuts down on the total load of inflammation in the mouth (Hatta 1997). Animals supplemented with hyperimmune egg against the leading bacterial cause of dental caries developed significantly lower dental caries scores than control animals (Otake 1991; Mitoma 2002). Oral hyperimmune egg rinses have also been used successfully in humans to reduce disease-causing bacteria; the extracts remain active and present in the mouth at least overnight, offering long-standing protection (Carlander 2002; Wang 2003; Zhou 2003).

Pomegranate. Researchers are finding important applications for pomegranate in the field of dental health. Clinical studies have shown that this popular antioxidant vigorously attacks the causes of tooth decay at the biochemical level (Vasconcelos 2006; Sastravaha 2005; Menezes 2006; Sastravaha 2003; Taguri 2004). Pomegranate attacks bacteria where they live. Research shows that by interfering with production of chemicals the bacteria use as “glue”, pomegranate extract suppresses bacteria’s ability to adhere to the surface of the tooth (Vasconcelos 2006) (Li 2005).

A study conducted in 2007 examined the effects of a mouthwash containing pomegranate extract on the risk of gingivitis (DiSilvestro 2007). Investigators noted that pomegranate’s active components, including polyphenolic flavonoids (eg, punicalagins and ellagic acid), are believed to prevent gingivitis through a number of mechanisms including reduction of oxidative stress in the oral cavity, direct antioxidant activity (Seeram 2005; Chidambra 2002; Battino 1999), anti-inflammatory effects, antibacterial activity (Madianos 2005; Aggarwal 2004), and direct removal of plaque from teeth (Menezes 2006). Saliva samples were evaluated for a variety of indicators related to gingivitis and periodontitis. Subjects rinsing with pomegranate solution experienced a reduction in saliva total protein content (DiSilvestro 2007), which is normally higher among people with gingivitis (Narhi 1994) and may correlate with plaque-forming bacterial content (Rudney 1993).

Cranberry. Cranberries may offer important benefits for healthy teeth and gums. The berries contain a special chemical that may inhibit and even reverse the formation of dental plaque deposits that often lead to tooth decay (Weiss 1998). Cranberry constituents may also help reduce inflammation in gingival or gum tissues, which could offer protection against periodontitis (Bodet 2008). These promising findings suggest that cranberry may soon find a place in dental health care regimens.

Xylitol. Pure xylitol, a white crystalline substance that resembles and tastes like sugar, is found naturally in fruits such as plums, strawberries, and raspberries. Xylitol is used commercially to sweeten sugarless gum and candies. Xylitol has also been shown to inhibit the formation of plaque. In a double-blind and controlled study, Swedish researchers had 128 children chew gum containing either xylitol or the sweeteners sorbitol and maltitol, 3 times daily for 4 weeks. While both were effective against the buildup of dental plaque, only the xylitol-sweetened gum eliminated microbes found in saliva, particularly a strain of bacteria implicated in tooth decay (Holgerson 2007). Xylitol could thus be an essential ingredient in a targeted strategy to avert dental disease.

A double-blind, placebo-controlled study of 2,630 children compared a standard fluoride toothpaste with 1 containing 10% xylitol. Over a 3-year period, children given the xylitol-enriched toothpaste developed notably fewer cavities than those using the fluoride-only toothpaste (Sintes 1995).

Probiotics. Probiotics have been defined as “living microorganisms which upon ingestion in certain numbers exert health benefits beyond inherent general nutrition” (Gorbach 2002). Scientists have been interested in the makeup of microbes that live in the mouth (oral flora) for decades, seeking to identify factors that promote growth of healthy organisms and reduce growth of those implicated in disease and inflammation (Li 1999; Marsh 1991; Marsh 1994; Marsh 2006).

Probiotics improve oral health and can help change the stubborn composition of dental biofilm and plaque (Marsh 2006; Kornman 2008). Reducing plaque through teeth brushing is always a desirable goal; however, complete elimination is not possible. Therefore, changing the actual composition of plaque from an inflammatory cytokine-rich environment to a more benign environment (dominated by neutral or even helpful organisms) can contribute to overall systemic health (Kamma 2009; Compend 2008; Pasquantonio 2008).

In laboratory studies, the probiotic S. salivarius helped inhibit formation of the sticky biofilm that can contribute to oral disease (Tamura 2009). Building on these results, an animal study showed that the S. salivarius probiotic helped displace biofilm from teeth, displacing cavity-causing bacteria and inhibiting tooth decay (Tanzer 1985). Another experiment demonstrated how effectively a second oral probiotic protects oral health (Ganeden 2009). In this experiment, a form of Bacillus coagulans (GanedenBC30™) was shown to competitively inhibit the cariogenic (cavity-inducing) bacterium Streptococcus mutans, which contributes to significant tooth decay.

Lactoferrin. Lactoferrin, a naturally occurring antimicrobial agent, is found in saliva and gingival fluid, breast milk, tears, and other bodily fluids.

This protein is a well-known immune system booster involved in the body’s responses to infection, trauma, and injury (Kruzel 2007). Lactoferrin may bind to and slow the growth of periodontitis-associated bacteria (Kalfas 1991). In an animal study, locally applied lactoferrin powder appeared to support the healing of oral lesions (Addie 2003).

Aloe Vera. Aloe vera gel packings are sometimes used by dentists after tooth extraction to reduce the incidence of infection and dry socket (Poor 2002). They have also been shown to reduce the risk of developing ulcers in the mouth (Garnick 1998).

Propolis. A 20% ethanol propolis extract was compared to antifungal agents such as nystatin, clotrimazole, econazole, and fluconazole in a study designed to assess the susceptibility of Candida albicans, an oral bacteria. The researchers concluded that the propolis extract could be an alternative medicine in treating candidiasis, but further studies were needed (Martins 2002)

For More Information…

Additional chapters that may be of interest include:

The Value of Vitamin C, Vitamin D, and Calcium

Vitamin C has long been known for its ability to prevent gum disease and tooth loss. In fact, the use of vitamin C in dental disease is one of the earliest recorded uses of nutrient therapy in Western medicine. In 1747, a British Naval physician named James Lind noticed that lime juice, which is rich in vitamin C, helped prevent scurvy, which causes tooth loss. As a result, British sailors bottled lime juice for gum disease prevention. Incidentally, this practice later gave rise to the term “Limey.”

Modern studies have confirmed the value of vitamin C, in conjunction with other antioxidants, in promoting good oral health. In one controlled, double-blind study of patients with periodontitis, a multivitamin combined with regular brushing resulted in significant improvements in gum health and a reduction in pockets after 60 days (Munoz 2001). Clinical studies of people with vitamin C deficiencies show that gingival inflammation is directly related to ascorbic acid status, suggesting that ascorbic acid may influence the early stages of gingivitis, particularly bleeding (Leggott 1986).

Researchers have also examined the value of vitamin D and calcium, which are typically used to reduce the risk of osteoporosis. Supplementation with these two nutrients reduces the rate of bone and tooth loss in postmenopausal women and men. Calcium intake of 800 mg or more daily reduced the risk of periodontitis in females (Nishida 2000).

Reducing Gum-Related Inflammation

Because of the association between gum disease and systemic inflammation, researchers have begun looking at anti-inflammatory nutrients in the context of gum disease. In one study, 30 adults with gum disease were given a variety of polyunsaturated fatty acids, including omega-3 fatty acids from fish oil (up to 3000 mg daily) and omega-6 fatty acids from borage oil (up to 3000 mg daily). At the end of the study, clinically significant improvements were measured in both gingival inflammation and depth of gum pockets (Rosenstein 2003). Another preliminary human study found that omega-3 fatty acids tended to reduce inflammation, but called for more thorough research (Campan 1997). However, in light of the established connection between omega-3 and omega-6 fatty acids and inflammation, along with their lack of side effects, it is reasonable for people with gum disease to consider using these supplements. Other anti-inflammatory supplements include ginger and curcumin, although neither of these has been studied in the context of inflammatory gum disease.


Good oral health begins with a disciplined program of flossing, twice-daily brushing, and tongue cleaning with a tongue scraper to remove plaque and bacteria colonies on the tongue before they become incorporated in the biofilm. It is also important to visit a dentist for professional cleanings at least twice a year, and perhaps even more often. Because of the radiation associated with x-rays, Life Extension does not recommend annual dental x-rays, although occasional dental x-rays are necessary.

Avoid behaviors that contribute to gum disease and tooth decay, especially tobacco use and consumption of refined sugar. Instead, focus on consuming a diet rich in fruits and vegetables that provide important phytochemicals and nutrients. In addition, patients with gum disease and existing heart disease should monitor their levels of inflammation. C-reactive protein and homocysteine are both indicators of inflammation, which can be determined by blood tests. For more information on comprehensive blood testing, call 1-800-226-2370.

Your choice of toothpaste is also important. Today, the market is flooded with very strong toothpastes that contain high levels of hydrogen peroxide. A toothpaste is now available that has been fortified with coenzyme Q10, folic acid, and other nutrients that are directly delivered to the gums each time one brushes. This novel toothpaste also contains a mild solution of 0.2% hydrogen peroxide.

A mouthwash containing pomegranate, peppermint oil,  aloe and other soothing nutrients may also be helpful.

Patients with mouth sores (ulcers) should consider using aloe vera gel packs.

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.

The protocols raise many issues that are subject to change as new data emerge. None of our suggested protocol regimens can guarantee health benefits. Life Extension has not performed independent verification of the data contained in the referenced materials, and expressly disclaims responsibility for any error in the literature.


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