By Trisha E. O'Hehir
Here's the gum disease secret: Despite being a bacterial infection, our own immune system causes the bone loss. A few months back, we took a scuba trip into the sulcus (June 2003 issue) to see firsthand the tissue destruction associated with periodontal disease. It's our own immune system that produces the cytokines that break down connective tissue and bone. Until now, options to improve the immune system were minimal, and so bacteria remained the focus. We can do something about bacterial biofilm — mechanically remove it, and, to a lesser degree, chemically affect it with mouthrinses, toothpastes, and local delivery systems. That focus limits us to just half the equation. It's time to do something about the other side of that equation — the immune system.
What can you do about the immune system? Until now, not much. I'm sure you've instructed your patients to eat a balanced diet, get enough rest, avoid tobacco and alcohol, and cut down on the stress. You recognize the long list of risk factors that influence the immune system, and talk with patients about their lifestyles. Perhaps the anti-collagenase drug Periostat™ was part of your treatment plan. Maybe you've even gone out on a limb suggesting nutritional supplements, if you take them yourself.
Until recently, nutritional supplements focused on general health. Now you will see them designed specifically to complement your periodontal therapy.
Some companies will adapt their advertising to position general health products to also fit the dental market. Advertisements will lure you from general health claims to assumptions of oral health benefits. In most cases, companies will lean heavily on personal stories of improved periodontal health. But, as a professional, keep looking for scientific research. Before making a recommendation to patients, check out clinical research on individual nutrients, plus periodontal studies testing specific formulations.
The blending of alternative and traditional medicine requires a new vocabulary. "Nutraceutical" is the word you'll hear as this trend moves into the periodontal field. Quite simply, nutraceuticals are pharmaceutical grade nutrients. Nutritional supplements generally are available without regulation, so nutraceuticals are filling the gap between regulated drugs and supplements.
Nutraceuticals are pharmaceutical grade nutritional and botanical compounds manufactured according to FDA regulations. In other words, you know exactly what you're getting in these products and ingredient quality is consistent.
Pharmaden™ in Scottsdale, Ariz., is the first company to offer nutraceuticals to strengthen the immune system of people with periodontal disease.
Periodontal research completed by dentists and dental hygienists at Loma Linda University in California demonstrated the benefits of one of their nutraceuticals. In this study, 60 subjects with periodontal disease participated; 30 receiving the Pharmaden supplement and 30 receiving a placebo.
Clinical indices were measured at baseline, 30 days, and 60 days, but no mechanical therapy was provided. After one month, improvement was seen in both groups, with greater reduction in bleeding, gingivitis, and pocket depth in the Pharmaden group. Healing was maintained for 60 days. Some of the healing in both the test and placebo groups is due to the Hawthorne Effect, which shows improved oral hygiene in study participants simply because they're in a study.
The greater healing in the test group can be attributed to "PerioTherapy," the nutraceutical the participants took twice daily.
Among the nutrients found in PerioTherapy are: Co-enzyme Q-10, grape seed extract, folic acid, vitamin C, vitamin B-12, Echinacea, and black pepper. I first became aware of Co-Q-10 in the 1970s when French researchers gave it to patients for the treatment of heart disease and a side effect was improved oral health. Co-Q-10 is found in the mitochondria of all cells and is needed for basic function.
Grape seed extract was also developed in France as a potent source of bioflavonoids to enhance vascular integrity. It's also a potent antioxidant, 20 times more potent than vitamin C and 50 times more potent than vitamin E.
Folic acid is a vitamin B used for the manufacture of DNA. In periodontal studies, it reduces gingival bleeding and binds to bacterial derived endotoxins.
Echinacea enhances the immune system, by aiding in T-cell replication, macrophage activity, antibody binding, and neutrophil migration.
Black pepper is added to enhance bioavailability of the ingredients leading to increased absorption.
You can fight periodontal disease with mechanical, chemical, and now nutraceutical approaches. Mechanically remove the bacteria, chemically alter the remaining bacteria and the accumulation of more bacteria, and also enhance the immune system with nutraceuticals.
I haven't taken these capsules yet myself, but will try the PerioCare maintenance formulation before I recommend them to patients. I've taken all the components separately, so the combined formulation will be much more convenient.
Always on a quest for better general as well as oral health, my research with a study size of one (me) will not make the perio journals, but I'll let you know my experience.
Trisha E. O'Hehir, RDH, BS, is a senior consulting editor of RDH. She is also an international speaker, author, instrument designer, inventor, and oral health detective. Her Web sites are www.perioreports.com and www.toothpastesecret.com. She can be reached at (800) 374-4290 or at [email protected].