In my last blog I presented a testimonial from a client who discussed how most dentists are no better than your regular doctor at understanding the concept of the health-disease continuum. This means they don't understand that even mild symptoms of poor oral hygiene, like gums that bleed when you floss, is an indication of periodontal disease that could be impacting your health NOW, and needs to be rectified.
Here is why even the slightest indication of periodontal disease must not be taken lightly. Consider this simple experiment.
Rub the back of your hand with a pencil eraser by applying strong pressure. If you continue to rub, your skin will become reddened and eventually will be bloody and painful. This is severe oral disease that may lead to pain, bone loss and tooth loss. As discussed previously, it may also lead to whole-body problems like heart disease, premature births, joint pain, and even Alzheimer's.
Now do the exact same thing with light pressure. The outcomes will be the same except it will take longer. However, my team has observed that the health consequences are the same. Why? Because the oral pathogens are able to travel outside of the mouth to other parts of your body and begin to multiply, causing disease. These organisms are opportunistic and they settle in places hospitable to their growth. The difference between, say, a heavy metal toxin and a bacterial toxin from the oral cavity, is that the bacteria can rapidly grow and multiply.
So many times, people I work with say "a just have a little occasional gum bleeding," or, I just have GERD or constipation occasionally. If you do, you are trending up the WRONG direction of the health-disease continuum.
If your gums bleed even just slightly or occasionally, you are actually experiencing vascular hemorrhages. Translation: your blood vessels have been weakened enough that even the mild pressure of flossing cleaves the vessel and blood escapes. This should NEVER happen.
In your mouth, you can witness this hemorrhaging. But what if this was happening in the vessels of your heart of your brain? I don't think anyone would want that. Enter the company Cortexyme. ¶
Cortexyme, Inc. (Nasdaq: CRTX), a clinical stage biopharmaceutical company pioneering a novel, disease-modifying therapeutic approach to treat what it believes to be a key underlying cause of Alzheimer's (AD) and other degenerative diseases, today announced the publication of research further documenting the ability of the pathogen Porphyromonas gingivalis to invade neurons and trigger Alzheimer's-like neuropathology. The findings are to be published in the June 2020 issue of the Journal of Alzheimer's Disease; an early online version of the paper is available now so that the important findings can be rapidly disseminated to the research community.
The market has spoken. Cortexyme is a public company with an admirable market cap. That means many people believe this company is on the right track. That is, the oral pathogen, P gingivalis, is a causal factor in Alzheimer's. And, of course, it comes from the mouth.
Just as an aside, my mentor at Harvard, Dr. Clement Trempe, spend much of his 47-year clinical career helping people understand the cause(s) of glaucoma and memory loss. In the past week, I have consulted with several people with both glaucoma and root canals, which in many cases were installed because of P. gingivalis and other oral pathogen. You see, glaucoma is Alzheimer's of the eye and Alzheimer's is glaucoma of the brain. They are caused by the exact same pathology. Sometimes we trace these diseases back to poor oral health. In other cases, it is caused by an organism like the pathogen from Lyme disease or chlamydia pneumoniae - both of which there are inexpensive tests to measure their presence and burden.
Here are some reference titles relating glaucoma and Alzheimer's
High occurrence rate of glaucoma among patients with Alzheimer's disease
Glaucoma: ocular Alzheimer's disease
Glaucoma, Alzheimer's disease, and Parkinson's disease: an 8-year population-based follow-up study
High frequency of open-angle glaucoma in Japanese patients with Alzheimer's disease
There are 115 such studies published in PubMed - the National Library of Medicine.
What can you do to treat or prevent the development or spread of oral pathogens?
Step 1 is to recognize that you may have these pathogens, even if your dentist gives you a clean bill of health and you don’t have any of the typical “late-stage” symptoms like tender bleeding gums, oral pain, or loosening teeth.
Step 2 - Enhance your level of oral care.
The oral pathogens reside in your mouth in biofilms. The tartar your hygienist scrapes from your teeth during a dental visit is a biofilm. The oral pathogens, and most pathogens in your body, “hide” within the biofilm to avoid your immune system. The biofilm is a fatty structure. Unfortunately, the dental care industry chooses to disregard biofilms and provide you with water-based treatments that do little curb the growth of these pathogen “housing projects.” Here are some specific tips:
Sanitize your toothbrush when not in use. There is no sense in re-introducing the pathogens back into your mouth every time you brush. Immerse your brush in a jar of water with a little bleach, peroxide, iodine or salt.
Brush (gently) and floss after every meal. Your kitchen is the dirtiest place in your house, not your bathroom. The same applies to your mouth. It has all the ingredients - food, water, and oxygen to allow organisms to flourish.
Use treatments that inhibit the growth or break down the biofilms. I use any of the following:
Coconut oil to either “oil pull” or brush. I have also made a paste with baking soda and/or clay.
Essential oils like tea tree oil, oregano oil, or cinnamon oil (only use the tiniest amount of this!). I put a small amount directly on my toothbrush.
Soap! Yes, I use a high-quality natural lye soap by wetting my brush with water and then rubbing it on the soap bar. It has very little taste and creates no irritation. The soap will capture the fat soluble “slime” that is the first state of the building of the biofilm
Biocidin toothpaste. This expensive but well-studied dentifrice, is a prepared mixture of biofilm busting herbs and is available on our Fullscript account.
Povidone iodine: Iodine (the brown substance), not iodide (the white “salt”) is a non-polar potent antiseptic. Therefore, it can penetrate and break down biofilms. I apply a drop of povidone solution to my toothbrush and also use a diluted solution of the 10% povidone to sanitize my brush.
Here is an article on the use of “molecular iodine.” You don’t have to use a fancy and expensive product. Iodine (povidone solution) is dirt cheap at most supermarkets and drugstores.
Step 3 - Work the gum lines and below.
I recommend getting a high-quality water flossing device. I’ve been very dissatisfied with the Water Pik and other lesser brands. I now use a “Hydro flosser.” I use this device nightly with Lukewarm water. At least twice/week I add any of the following: povidone iodine, salt (dissolve first), or peroxide. Don’t swallow any of the water to the extent possible. I don’t have an exact formula for the mixture of water and 10% povidone. Instead I add enough to make the water in the flosser reservoir a dark brown. I know I have too much iodine when the solution froths in my mouth. With the peroxide, I do a 3 to 1 dilution with 3% peroxide.
The key is to point the stream of water right at the gum line, forcing some of the water below the line where most of the pathogens are hiding.
Step 4 - Testing for oral pathogens on the health-disease continuum
If you are not testing, you are guessing. We offer “oralDNA” testing for the presence of oral pathogens (https://www.oraldna.com/). If you have obvious oral problems you may say, “why do I need this testing?” I recommend the testing not to prove you have oral pathogens. Instead, I recommend this testing to PROVE TO YOUR DENTIST that you have oral pathogens. Additionally, there is no sense in testing unless it leads to a treatment plan. The oralDNA test results comes with a detailed treatment plan, if you have organisms. Your dentist can execute the plan that they otherwise would not have done. I have yet to hear that a dentist would not carry out the recommended plan - because the data is so clear about the pathogen burden and the plan is within your dentist’s scope of work.
The following article brings important context to the oral hygiene conundrum. It is published in Nature, one of the top journals in science and medicine.
Title: Advancing antimicrobial strategies for managing oral biofilm infections
Here is an excerpt from the paper - worth reading:
Biofilm-related infections pose a major problem in the society from both an economical and health perspective. Biofilms are defined as “aggregates of micro-organisms in which the associated cells are frequently embedded in a self-produced matrix of extracellular polymeric substances (EPS) that are adherent to each other and/or a surface.” The EPS matrix not only provides microorganisms with a multilayered scaffold in which most cells experience cell-to-cell contact, either in flocs or in surface-attached biofilms, but also creates a microenvironment that is different from other sites in terms of key environmental inputs known to affect microbial behaviors, including pH, redox, and nutrient availability. Compared with planktonic microorganisms, the microorganisms in mature biofilm show increased tolerance to antimicrobial agents. It is estimated that biofilms contain multiple microbial species that weigh as high as 108–1011 cells g−1 wet weight. The classical biofilm lifecycle may be described as a multi-stage process involving microbial attachment, biofilm maturation, and biofilm dispersal. Strategies that can disrupt any stage of biofilm formation are considered potentially valuable in controlling biofilm-related infections.
The warm, moist, and nutritious oral environment provides an ideal hatchery for microbial growth and proliferation. The complex dynamic interactions among microorganisms, host and diet result in microbial colonization and the subsequent formation of pathogenic biofilms. Biofilms formation on either tooth or dental material surfaces, known as oral biofilms, have been clearly recognized as a virulence factor in many oral infectious diseases, including dental caries, periodontitis and endodontic infections Restorations, non-surgical or surgical periodontal therapies, root canal therapy, and dental implants are well-accepted therapeutic regimens, but secondary biofilm infections cannot be completely eliminated. Because of the increased drug tolerance, the complexity of the oral cavity and the rapid clearance of saliva, topical application of antimicrobial agents cannot be maintained at an effective concentration at the site of interest for a long enough period.
The consequences of these infections depend on the location of biofilms and features of dental materials. Acid production by biofilms at the tooth-restoration margin causes secondary caries, which is a main reason for restoration failures. Pulp infections have also been clinically observed after dental restorations. Persisting biofilms inside the root canal system after root canal therapy may result in re-infections and persistent apical periodontitis. Biofilms on periodontal tissues and dental implants may cause periodontitis and peri-implantitis. The long-term clinical success of oral rehabilitation procedures depends on the capacity of dental materials to incorporate specific antimicrobial strategies for controlling and/or eradicating these infections. The present review encompasses a critical appraisal of recently published, innovative antimicrobial strategies for controlling oral biofilm-related infections.
My next blogs will be a continuation of this topic and will include:
Focal Infections - Not of Oral Origins
To find out where you are on the oral health continuum, consider taking this test...
The "MyPerioPath" analyzes for 11 oral pathogens
The "Alert 2" does the same MyPerioPath test but also tests for inflammation by why of the biomarker interleukin-6.
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