Winning the battle, losing the war against gum disease

Kathryn contacted me for a second opinion. Her problems are not unusual. She told me what she had gone through so far.

It started when her dentist told her that she had a gum infection, caused by the bacteria living under her gum tissues. This dentist suggested to her that if she killed the bacteria, that would cure her disease.

Alvin Danenberg, DDS.

So, her dentist prescribed an antimicrobial mouth gel to place around her teeth to kill these bacteria. After several weeks, the gum bleeding was gone. Kathryn thought her disease was cured.

Then, several months went by, and she returned to her dentist for a dental cleaning. The hygienist asked her if she knew that she had active gum disease? The dentist came into the room and confirmed that she had active infection. He recommended another round of antimicrobial gel.

Kathryn realized something didn't seem right, so she contacted me for a second opinion.

"It sounds like you won the battle but not the war," I told her.

The battle and the war

The battle Kathryn won was to end the acute infection in her gum tissues. Killing the bacteria stopped her gums from bleeding. Yet, she lost the war.

The war she lost was to identify the various causes of her gum disease and to treat the hidden sources of her infection.

The causes of periodontal disease are multifold. They relate to dysbiosis in the gut, chronic systemic inflammation, and a significant decrease in the immune response. Stopping gum infection by killing oral bacteria is not a cure. It is not an effective means to restore overall health.

It may be the first step for an acute infection, but there is more to it. Indiscriminate killing of microbes is detrimental to the balance of bacteria throughout the mouth and the body. Indiscriminate killing of microbes can cause serious systemic problems.

To win the war, acute infection in the mouth needs to be treated first. In addition, all other factors need to be discovered and dealt with effectively and in a timely manner.

Most people don't understand the importance of the gut and its relationship to disease. The gut needs to be treated and the resulting spread of chronic disease needs to be addressed.

2 nidi of infection

I explained to Kathryn that she has two separate nidi of infection -- one nidus in her mouth and one in her gut. A nidus is a place where bacteria have multiplied or may multiply.

Her original nidus of infection started in her gut, which she is completely unaware of because she has no obvious gut symptoms. However, her gut problems created chronic systemic inflammation, which led to various chronic diseases. Periodontal disease is just one manifestation of chronic disease.

Once she developed periodontal disease, which is an imbalance in the overall oral microbiome, the infection established itself deep under the gum tissues. This became Kathryn's second nidus of infection. The infection and inflammation around her teeth could spread through capillaries under the gum and eventually enter the blood system. As they course through her circulation, they could affect other organs.

To treat this complicated disease, both the mouth and the gut must be treated to regain health. If only the mouth were treated, then out-of-balance bacteria in the gut would continue to be the culprit for further bouts of active periodontal disease and more.

Action steps

After I explained my opinion of what was going on, I made specific recommendations and provided action steps for Kathryn to consider:

• Do what is necessary to stop acute infection.
• The dentist or the hygienist needs to do a deep cleaning under the gum tissues to remove tartar, which is irritating and acts like a splinter.
• The dentist needs to treat decay, repair any broken or irritating tooth fillings, remove any toxic dental fillings or restorations, and extract any nontreatable teeth.
• The dentist or the hygienist needs to demonstrate efficient tooth brushing, interdental cleaning, and tongue scraping.
• She needs to repair her gut by taking spore-based probiotics and specific prebiotics.
• She needs to change her diet to include nutritious foods that are anti-inflammatory and to remove foods that are inflammatory.

I look forward to reporting back on her progress.

Alvin Danenberg, DDS, practices at the Bluffton Center for Dentistry in Bluffton, SC. He is also on the faculty of the College of Integrative Medicine and created its integrative periodontal teaching module. He also spent two years as chief of periodontics at Charleston Air Force Base earlier in his career. His website is drdanenberg.com.

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