WHAT IS GUM DISEASE?
Gum disease, or periodontal disease as it is more correctly known, starts as gingivitis, an inflammation of the gums around the teeth, often characterised by tenderness, redness and bleeding during brushing. If untreated, it may develop into pyorrhoea, which is a chronic, degenerative disease of the gums, characterised by further gum inflammation, bad breath, discharge of pus and loosening of the teeth. As inflammation progresses, the gums recede from the teeth allowing deeper tissues -the collagen, ligaments and bone supporting the teeth to become affected. This is periodontitis.
As it becomes more advanced, deep pockets form between the teeth and the surrounding tissue, abscesses develop under the roots of the teeth, bone loss continues and teeth may fall out. In adults over the age of thirty, more teeth are lost from periodontal disease than from tooth decay.
In addition to causing pain, general malaise, fatigue and bad breath, periodontal disease is associated with a higher risk of heart disease, respiratory disease and nutritional deficiencies.
The care of a periodontal specialist, combined with good oral hygiene and plaque control measures, is essential in treating gum disease. A periodontist will use techniques such as scaling to remove plaque deposits above and below the gumline, root planing to smooth rough root surfaces so that the gum can heal, and oral irrigation to flush out bacteria and toxins. If very deep pockets have formed around teeth and bone has been lost, periodontal surgery may be recommended to remove gum flaps, so that the roots of the teeth are accessible for cleaning. Recently, techniques for regenerating lost periodontal attachment have been developed. A gel containing the protein amelogenin has been used with some success as an adjunct to surgery, to reawaken the growth of periodontal tissue.
NUTRITIONAL THERAPY FOR GUM DISEASE
In general terms, the diet that provides for good gum health is no different from that which provides for optimal health of the whole body.
It should be nutrient-rich and based on fresh natural foods, whole grains, vegetables, fruit, fish, beans and seeds. It should be low in sugar, refined carbohydrates, salt and alcohol and should avoid damaged fats, artificial additives and allergenic foods. Foods that are high in bioflavonoids, such as blue-black fruits, onions, citrus pith and hawthorn berries should be included as these compounds are important in maintaining healthy collagen structure. A diet that is high in fibre may protect against gum disease by promoting the secretion of saliva.
Specific nutritional supplements have been used with success in the treatment of periodontal disease.
The following daily supplement programme is likely to be helpful…
Coenzyme Q10 (50 to 150 mg)
Coenzyme Q10 (Co Q10) is chemically similar to vitamin E and is involved in electron transfer in the mitochondria. Early work suggested that people with periodontal disease may be deficient in Co Q10.(14) In double blind trials, 50mg a day of Co Q10, given for three weeks, led to a significant reduction in the symptoms of gingivitis.(15) More recent studies have shown that the topical application of Co Q10 may also improve periodontitis (16), although the conclusions of this research have been questioned.(17)
Vitamin C (2 to 4g)
Vitamin C supplementation can improve the symptoms of periodontitis in people who have a low intake of the vitamin (below 35 mg daily) (18), although there is less evidence that it benefits people who already consume adequate amounts in their diet. (19) However, vitamin C is necessary to maintain a healthy immune system, to combat free radical damage and to promote healing. A daily supplement would seem sensible.
Bioflavonoids (500mg to 1g)
The bioflavonoids that often accompany vitamin C in foods, which are important for collagen structure, can reduce gum inflammation when taken as a supplement. (20)
Vitamin A is necessary for collagen synthesis and wound healing, maintaining the integrity of periodontal tissues and enhancing immune function. Beta-carotene may be the best form of vitamin A to take, due to its affinity with gum tissue, potent antioxidant activity and safety at high dosages. (21)
Zinc functions synergistically with vitamin A, inhibits plaque growth and helps to stabilise membranes in the periodontal tissues. (22) Citrate or picolinate are the best forms to take.
Vitamin E (200 to 400 i.u)
Vitamin E has been shown to be of benefit in severe periodontal disease, due to its antioxidant and wound healing properties.
Selenium and vitamin E act synergistically as antioxidants.
Folic acid (2mg)
Double blind studies have shown that folic acid can significantly reduce gum inflammation. (23) This is a particularly important supplement for women who are on the contraceptive pill or are pregnant.
A diet that is high in fibre may protect against gum disease by promoting the secretion of saliva
TOPICAL TREATMENTS AND HERBAL MOUTHWASHES
Co Q10, folic acid and zinc have shown to be beneficial when used topically for gum disease. A mouthwash containing copper citrate is claimed to be effective in preventing plaque bacteria from sticking to the teeth below the gumline. A herbal mouthwash containing chamomile, echinacea, myrrh, peppermint, clove, caraway and sage has been used successfully to treat gingivitis. White oak bark, tea tree, goldenseal, grapefruit seed extract and aloe vera may also be helpful, due to their immune boosting, bactericidal or anti-inflammatory properties.