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From The December 1999 Issue of Nutrition Science News
Features
Oral Health
by Marilyn Sterling, R.D., M.P.H.
Most dentists are happy if their patients pass a toothbrush over their teeth and run a string of floss between them before rushing out the door. Oral care is often considered a chore and gets as little attention as possible. But spending a few more minutes optimizing the mouth's complex environment—which includes concentrating on proper nutrition—may pay off in healthier gums and, in the long run, a healthier body.
The visible tooth is simply an enamel coating that covers a softer tissue underneath called dentin. The middle of the tooth is a pulp cavity containing nerve endings and blood vessels. Under the gum line, the dentin is covered with cementum, a substance similar to bone. The part of the jaw that contains tooth sockets is called the alveolar bone; teeth are anchored here with ligaments. The inside of the mouth as well as the gums are made up of epithelial tissue. Saliva bathes the mouth in an alkaline solution that buffers acidity, remineralizes teeth, washes away food, begins the digestion process and contains potent immunoglobulins—one part of the body's complex immune system.
Many dental problems result from the acidic environment created when bacteria feed on food remnants in the teeth. These bacteria, along with acid, carbohydrates and bacterial waste, form a sticky plaque that adheres to the teeth and tongue and holds the acid close to the tooth where it may eat away enamel. Bacteria thrive on sugar but are less likely to cause a problem if sugary foods are followed with less-sweet items. Some foods help prevent cavities; for example, tea and chocolate contain tannins that decrease the solubility of enamel, and aged cheeses increase saliva and promote remineralization.1
Despite its acidity, citrus fruit reduces cavities by stimulating saliva. Over time, saliva helps build enamel, making cavities a rarity after early adulthood. As gum lines retract with age, however, tooth roots unprotected by enamel are exposed to the decay-causing environment and may develop cavities. In addition, minerals in saliva eventually harden around bacteria corpses, forming a barnacle-like tartar. Although most people have some tartar, those practicing good oral hygiene generally have little.
What is Gum Disease?
Periodontal, or gum, disease takes two forms. Nearly half the U.S. adult population has simple gum inflammation with bacteria present, also called gingivitis.2 If the oral environment is fairly healthy, gingivitis can persist in a stable state without progressing to a more serious disease. Emotional stress often increases the severity of gingivitis. One study of 52 medical students found that of 26 students who had just completed a major exam, six had severe gum bleeding, which the authors attributed to stress.3
A more severe gum infection, called periodontitis, can lead to tooth loss. Periodontitis destroys both the connective tissue attaching teeth to the alveolar bone and the bone itself. Such bone loss is frequently the first sign of osteoporosis; calcium is first lost from trabucular bone, the type that comprises alveolar bone.4 As the infection burrows deeper into gum tissue where there is little oxygen, only progressively more pathogenic bacteria can survive. Toxic byproducts from these bacteria destroy the ligaments attaching teeth to bone. These bacteria and their toxins may also penetrate into the body, causing premature labor, strokes, ulcers and heart disease (see sidebar).
Preventing Infections
A strong immune system, healthy gums and bones, and bacterial control may help prevent periodontitis. Regular dentist visits are a must, but so is regular oral hygiene.
Claning the Mouth:
The first step in prevention is mechanically removing bacteria and plaque after meals and before bedtime, when reduced saliva production can lead to increased plaque formation. Although toothbrushes are quintessentially American, people in the Middle East use a meswak (Salvadora persica) chewing stick with comparable results.5 It's important to clean between teeth using floss, interdental brushes or a water irrigator, and to stimulate the gums as well as clean the teeth. Cleaning the tongue with a brush or a tongue scraper completes mouth cleaning. Although good hygiene may help prevent periodontitis in the first place, once the infection is established more aggressive dental procedures are required.6
Using Natural Dental Products: The next step to protect gums is using products that soothe them and create an inhospitable environment for harmful microorganisms. Research shows that herbal mouth rinses and toothpastes are as effective at reducing plaque and oral bacteria as more mainstream products, even potent prescription chemicals like Peridex.7 When used on their own, the following traditional antimicrobial herbs also may fight oral bacteria. Research supports their antibacterial properties, although few studies have specifically looked at how effectively these herbs fight the bacteria that cause gingivitis or periodontitis.
- Bloodroot
(Sanguinaria canadensis) is an effective periodontal protector that prevents bacteria from sticking to newly formed plaque, and thus reduces inflammation.8 Bloodroot is dangerous if swallowed and should be avoided by children and by women who are pregnant or breast-feeding.
- Calendula
(Calendula officinalis), an anti-inflammatory, may soothe swollen gums, according to a test tube study that isolated triterpenoids, the anti-inflammatory components of the flower.9
- Goldenseal
(Hydrastis canadensis), long used in dental preparations, contains the antibiotic berberine that prevents the growth of pathogenic oral microbes in test tube and animal studies.10
- Myrrh
(Commiphora molmol) is a traditional ingredient in herbal preparations for oral health, but no studies support its effectiveness.
- Tea Tree
(Melaleuca alternifolia) oil is often used in toothpastes and mouth rinses because of its ability to kill bacteria resistant to other antimicrobials. According to one test tube study, several of the eight components of tea tree oil were effective against Candida albicans, Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa.11
Feeding the Immune System:
Overall nutritional status determines the integrity of oral tissue and the effectiveness of the immune system. Dietary zinc helps to optimize immunity, but the immune system also needs protein and antioxidants, including selenium and the vitamins A, C, E and beta-carotene. Vitamin B6 deficiencies can also inhibit immunity. Some researchers theorize that periodontal tissues need a higher supply of nutrients than the rest of the body.12
Nourishing the Gums: Mouth and gum cell tissues are replaced weekly, so nutritional deficiencies appear quickly as mouth inflammation or bleeding. Oral tissues prevent toxic materials and microorganisms from entering the body. Once these are damaged, pathogens have free access to deep gum and tooth attachment tissues.
Vitamin C is necessary for proper collagen formation, and even a minor deficiency causes gum swelling and bleeding, while folic acid is needed on a daily basis to build new cells. A placebo study of 60 adults with gingivitis given folate-fortified mouthwash demonstrated that after four weeks, those using folic acid had less gum bleeding and color changes than those using the placebo mouthwash.13 Although there is a great deal of research on the effect of Co-Q10 on gum health, the research is generally poor, so it is difficult to draw any conclusions. Zinc deficiency increases the permeability of oral tissue and is positively associated with periodontal disease severity.14 Animal studies show vitamin E helps heal gum and bone destruction caused by stress.15
Protecting the Alveolar Bone: Dissolution of the alveolar bone contributes to tooth loss, so the nutrients that prevent osteoporosis (bone loss and fragility) are especially important.3 Adequate calcium and vitamin D are critical. Without enough dietary calcium, the body mobilizes calcium from trabecular bone, which comprises the alveolar bone. Vitamin K, protein, boron and magnesium are other key nutrients to help maintain adequate bone tissue.
Nowhere does proper self-care pay off more than in the mouth. People who practice meticulous oral hygiene and eat a nutritious diet have a better chance of keeping their teeth intact for life.
Sidebars:
Oral Signs of Nutrient Deficiencies
Marilyn Sterling, R.D., M.P.H., is a consultant to the natural products industry and a contributing editor to Nutrition Science News. She works part-time as a clinical nutritionist in Arcata, Calif.
References
1. Jensen ME, et al. Evaluation of the acidogenic and antacid properties of cheeses by tememtric recording of dental plaque. In: Hefferren JJ, et al. Editors. Foods, nutrition and dental health. Park Forest South (IL): Amer Dental Assn;1984.
2. Albandar JM, Kingman A. Gingival recession, gingival bleeding and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999;70(1):30-43.
3. Deinzer R. Increase in gingival inflammation under academic stress. J Clin Periodontol 1998;25(5):431-3.
4. Krall EA, Dawson-Hughes B. Tooth loss and skeletal bone density in healthy postmenopausal women. Osteoporos Int 1994 Mar;4(2):104-9.
5. Gazi M. Meswak chewing stick versus conventional toothbrush as an oral hygiene aid. Clin Prev Dent 1990;12(4):19-23.
6. Westfelt E, et al. The effect of supragingival plaque control on the progression of advanced periodontal disease. J Clin Periodontol 1998; 25(7):536-41.
7. Gultz J, et al. From the New York University College of Dentistry, Antimicrobial activity of an herbal mouthrinse, unpublished.
8. Harkrader RJ, Reinhart PC. Antimicrobial action of sanguinarine Sanguiaria extract from bloodroot Sanguinaria. J Clin Dent 1989 Spring;1(4):96-101.
9. Della Loggia R, Tubaro A. The role of triterpenoids in the topical anti-inflammatory activity of Calendula officinalis flowers. Planta Med 1994 Dec;60(6):516-20.
10. Su RY. The effect of berberine in sterilizing infective root canal of deciduous teeth. Chung Hua Kou Chiang Hsueh Tsa Chih. 1992 Sep;27(5):302-5, 319.
11. Carson CF, Riley TV. Antimicrobial activity of the major components of the essential oil of Melaleuca alternifolia. J Appl Bacteriol 1995 Mar;78(3):264-9.
12. Depaula, D. Nutrition in relation to dental medicine. In: Shiles, M. Modern nutrition in health and disease. 9th ed. Baltimore (MD) Williams and Wilkins; 1999. p 1099-121.
13. Pack ARC. Folate mouthwash: effects on established gingivitis in periodontal patients. J Clin Periodontol 1984;11:619-28.
14. J Freeland, et al. Relationship of mineral status and intake to periodontal disease. Am J Clin Nutr 29 1976;745-9.
15. Cohen ME, Meyer DM. Effect of dietary vitamin E supplementation and rotational stress on alveolar bone loss in rice rats. Arch Oral Biol 1993:54:305-58.
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