Their review of these studies showed that improvements in clinical measures were common in all studies but were scientifically significant in two that used a combination of fish oil and aspirin. Although this is not conclusive evidence, intake of fish oil is recommended for health benefits
beyond the teeth.

“I would recommend that people ensure they have a sufficient intake of long chain omega-3 fatty acids in their diet for general health,” said Coates. “In Australia, these types of fatty acids are considered to be essential with ~500 mg recommended as the suggested dietary target. This
equates to approximately 2 fatty fish meals per week.”

There are no serious dangers to consuming fish oil. At high levels of fish oil above the GRAS limit, people may experience a delayed clotting time and at very high doses potential gastric upset. If people are taking blood thinning medication, then they should consult with a doctor.

The group reports that the evidence for fish oil being effective in reducing periodontal symptoms is building but there is a need for more well designed studies that evaluate the supplement both alone and in combination with aspirin to be able to tease out whether fish oil by itself is
effective. It is important that compliance to treatment is considered and that the dose and length of supplementation is appropriate. A clinical trial is underway in Australia that is investigating the effects of fish oil as adjunct therapy for periodontitis.
 

Periodontal plastic surgery is a very useful technique that will treat and prevent unsightly gum recession, and can reduce or eliminate sensitivity caused by tooth roots that are exposed in the mouth. Dr Korwin has been applying similar periodontal plastic surgery techniques such as the ones taught by Dr. Kohner for many years for patients with gum problems.

These new techniques are many times more successful than older methods, and are more comfortable for the patient.

The good news is that daily flossing, smoking cessation, along with regular professional cleanings protects health and prevents gum disease.

Periodontal disease is a chronic inflammatory disease that affects the gum tissue and other structures supporting the teeth. According to Dr. Pamela McClain, President of the American Academy of Periodontology and a practicing periodontist in Aurora, Colorado, “If left untreated, periodontal disease can lead to tooth loss and may also interfere with other systems of the body. Several research studies have indicated that one’s periodontal health may be related to overall health. Therefore, it is crucial that you do everything you can to establish good periodontal health.”

According to the AAP, the following tips may help sustain healthy teeth and gums while also helping you live an overall healthy lifestyle:

Eat and drink up.  It is well known that eating a balanced diet leads to proper nutrition and helps keep the body running effectively. Studies published in the Journal of Periodontology (JOP) have also shown that certain foods can promote teeth and gum health. Foods containing omega-3, calcium, vitamin D and even honey have all been shown to reduce the incidence or severity of periodontal disease.

Hit the gym. Frequent exercise is a recognized way to avoid being overweight, and it may ultimately reduce your risk of periodontal disease. In a study published in the Journal of Periodontology, researchers found that subjects who maintained a healthy weight and had high levels of physical fitness had a lower incidence of severe periodontitis than those that did not exercise.

Stress less. Stress can lead to a variety of health complications, including periodontal disease. Research published in the JOP showed a relationship between stress and periodontal disease. Increased levels of cortisol, which the body releases when experiencing stress, can intensify the destruction of the gums and bone due to periodontal disease. In addition, another JOP study indicated that people experiencing stress are more likely to neglect their oral hygiene.

Kick the habit. Smoking is not only a leading cause of respiratory and cardiovascular disease in the United States, it is also a major risk factor for periodontal disease. Several research studies have shown that smoking not only increases the chance of developing periodontal disease, but it can also affect the success of treatments for existing periodontal disease.

See the doctor. Regular check-ups by a physician can help with early diagnosis of several health issues, including periodontal disease. A large body of research associates gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis. Therefore, by screening for systemic disease early and receiving any needed treatment, you may also benefit your periodontal health.

Dr. McClain stresses that while these tips may contribute to healthy teeth and gums, the benefit of routine oral care cannot be discounted. “Taking good care of your periodontal health starts with daily tooth brushing and flossing. You should also expect to get a comprehensive periodontal evaluation, or CPE, every year,” she advises. A dental professional, such as a periodontist, a specialist in the diagnosis, treatment and prevention of gum disease, can conduct a comprehensive exam to assess your periodontal health.

P. Gingivalis Copyrighted by Dr. George Hajishengallis

Sherlock Holmes had his villain Moriarty. Periodontists have an unusual bacterium called Porphyromonas gingivalis. In the November 17 issue of the journal Cell Host & Microbe, scientists supported by the NIDCR report they have solved in mice the mystery of how P. gingivalis can trigger the common dental condition periodontitis while residing in low numbers within the subgingival crevice, the space between tooth and gum.

The researchers report that P. gingivalis hacks into the front-line immune cells that police the subgingival crevice and reprograms them to create living conditions more to its microbial liking. As more immune cells are co-opted to follow the wrong program, the usually benign bacterial residents of the subgingival crevice – not P. gingivalis, as long suspected – opportunistically rise up in number, altering their community dynamics and prompting them to infect the tooth’s supportive structures, or periodontium.

“As the other bacteria attack and immune cells counterattack, progressively damaging the integrity of the tooth in the process, P. gingivalis sits in the shadows and feasts on the inflammatory spoils,” said George Hajishengallis, D.D.S., Ph.D., a researcher at the University of Louisville School of Dentistry and a co-lead author on the study. “This is one ingenious little bug.”

According to Hajishengallis, their discovery marks the first documented case in microbiology of a keystone species, or more specifically, a keystone pathogen. Coined by ecologists in the late 1960s, the keystone concept refers to a low-abundance species that exercises a disproportionate influence on its environment. In this case, low-abundance P. gingivalis shapes a microbial community and catalyzes the onset of an oral disease.

The next step is to test whether P. gingivalis follows a comparable evolutionary strategy in people. If so, they already have in their sights drugs that can be applied topically to the affected tooth to block this keystone pathogen from reprogramming the immune cells, providing a more targeted approach to prevent and/or treat periodontitis.

Periodontitis has afflicted humans from time immemorial, and today remains one of the most common causes of tooth loss worldwide. An estimated 53 million American adults have the condition, approximately 2 out of every 10 adults, at a total annual healthcare expenditure of more than $14 billion.

In the late 1970s, P. gingivalis became a subject of research interest when scientists noticed this rod-shaped anaerobe popping up consistently at low levels in studies that explored the microbiology of periodontitis. Further laboratory work showed that this late colonizer of the subgingival crevice arrives bearing an extensive arsenal of noxious chemicals. The assumption being, P. gingivalis employs them selectively to thwart the native, or innate, immune cells that patrol the gingival crevice and keep bacterial levels in balance.

But showing that P. gingivalis actually can cause periodontitis has remained scientifically tricky. The assumption has been that the bacterium could directly cause damage to the periodontium in animal models, independent of periodontitis and its natural disease process. Moreover, scientists have found themselves traversing new conceptual territory to explain how such a low-abundance – some say stealth – pathogen could wreak such havoc in the mouth.

The research story has picked up in recent years as scientists have gained more technologically sophisticated tools to study P. gingivalis and more biological information from which to form workable hypotheses.

A case in point is the progress in understanding how immune cells process incoming information to respond to the threat at hand. Studies show that some incoming defense signals converge within innate immune cells, a process called signaling crosstalk, which helps them to coordinate their early internal response to infection.

Last year, Hajishengallis and colleagues reported in mouse studies that P. gingivalis has learned through the millennia to exploit this crosstalk. The bacterium does so by jointly activating convergent defense signals involving the Toll-like receptor 2 (TLR-2), which helps to recognize pathogens, and the C5a receptor that is a part of the complement system that will respond to the threat.

“P. gingivalis exploits both receptors to induce a signal with an emergent property,” explained Hajishengallis. “In other words, the property doesn’t emerge from manipulating just one receptor. Both must be punched.”

Hajishengallis said the emergent property impairs the affected immune cell from killing P. gingivalis. It also seems to initiate low-level inflammation that serves no immunological purpose other than possibly to generate nutrients for P. gingivalis.

This discovery pointed to an evasion mechanism that P. gingivalis employs to subvert innate immunity. Left unanswered was the larger question of whether this stealth mechanism also played a role in causing periodontitis.

To get their answer, the scientists revisited two unexplained laboratory observations. First, after mice are inoculated with P. gingivalis and develop advanced periodontitis, the levels of normally benign, or commensal, bacteria increase in the affected periodontium. Secondly, P. gingivalis is extremely difficult to detect at the site of the disease. These observations and last year’s finding on signaling crosstalk suggested that P. gingivalis might compromise the immune system, but the commensals infect the periodontium.

In the current paper, that’s exactly what they found. The scientists report that mice bred to produce immune cells without C5a receptors – meaning P. gingivalis can’t co-opt their innate immunity – did not develop periodontitis after being inoculated with the bacterium. Commensal levels also remained within the range typically seen in the subgingival space.

In healthy mice kept under conventional laboratory conditions, the opposite was true when inoculated with P. gingivalis. The mice developed active periodontitis and its characteristic damage of the periodontium. They also had increased commensal levels and hardly detectable P. gingivalis.

“In contrast, mice bred to be germ-free were resistant to periodontitis after they were colonized by P. gingivalis,” noted Michael Curtis, Ph.D., a co-lead author on the study and a scientist at Queen Mary University in London. “This was especially telling because these mice lacked the normal commensal bacteria in their mouths. In other words, in these sterile animals, P. gingivalis had no bacterial accomplices capable of causing periodontitis.”

“There is one key word that explains everything: homeostasis,” said Richard Darveau, M.S., Ph.D., a scientist at the University of Washington in Seattle and another co-lead author on the paper. “Periodontal health is a matter of maintaining homeostasis, or equilibrium, among the bacterial inhabitants of the subgingival space and innate immunity cells. P. gingivalis is a master at disrupting homeostasis. Although this bacterium certainly is not the only cause of periodontitis, it stands out as a major culprit.”

The scientists say their findings have encouraging therapeutic implications, in part because the microbial conditions in mice likely will be comparable in humans. They point to studies in monkeys that indicate the comparability.

They also note their findings provide a molecular target with tremendous specificity. “To counteract P. gingivalis and the negative outcomes that it orchestrates in patients, we will need most likely to target one of the signaling receptors,” said John Lambris, Ph.D., an author on the paper and the Dr. Ralph and Sallie Weaver Professor of Research Medicine at the University of Pennsylvania. “P. gingivalis needs to manipulate both to work its tricks.”

The National Institute of Dental and Craniofacial Research (NIDCR) is the Nation’s leading funder of research on oral, dental, and craniofacial health.

The study included 200 participants between the ages of 20 and 60 with at least 20 natural teeth. Half of the participants were hospitalized patients with a respiratory disease such as pneumonia, COPD, or acute bronchitis, and the other half were healthy control subjects with no history of respiratory disease. Each participant underwent a comprehensive oral evaluation to measure periodontal health status.

The study found that patients with respiratory diseases had worse periodontal health than the control group, suggesting a relationship between respiratory disease and periodontal disease. Researchers suspect that the presence of oral pathogens associated with periodontal disease may increase a patient’s risk of developing or exacerbating respiratory disease. However, the study authors note that additional studies are needed to more conclusively understand this link.

“Pulmonary diseases can be severely disabling and debilitating,” says Donald S. Clem, DDS, President of the American Academy of Periodontology. “By working with your dentist or periodontist, you may actually be able to prevent or diminish the progression of harmful diseases such as pneumonia or COPD. This study provides yet another example of how periodontal health plays a role in keeping other systems of the body healthy.”

Periodontal disease is a chronic inflammatory disease that affects the gum tissue and other structures supporting the teeth. Previous research has associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis.

Dr. Clem stressed the importance of routine oral care in helping to prevent periodontal disease. “Taking good care of your periodontal health involves daily tooth brushing and flossing. You should also expect to get a comprehensive periodontal evaluation every year,” he advised. A dental professional, such as a periodontist, a specialist in the diagnosis, treatment and prevention of gum disease, can conduct a comprehensive exam to assess your periodontal disease status.

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But now, with a new type of laser surgery, patients don’t have to be apprehensive anymore.

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