WARNING: Bleeding Gums Can Lead to Dementia
Just this last month, the journal Science Advances published an article reporting that one of the main bacterias associated with periodontal gum infections has been found in the brains of Alzheimer’s patients. The study showed that certain proteases produced by the bacteria are toxic to the brain and lead to the neurodegeneration associated with Alzheimer’s Disease.
I must admit that it is not without a bit of trepidation that I state this information. The last time I reported about a study associating dementia with dental disease, the state Board of Dentistry sued me for allegedly trying to scare the public into seeking dental treatment. The board and I fought all the way to the Supreme Court where I won by an unanimous 5-0 decision. However, I was never compensated for the extreme personal, professional, and financial price paid while defending my right to inform the public of the connections between dental health and the health of the rest of the body— including the brain.
To be clear, there is no magic silver bullet for any disease. I am by no means suggesting that by treating periodontal disease, I can either cure or guarantee prevention of Alzheimer’s. The astute practitioner understands that all diseases are multifactorial, or have multiple causes in other words. Just recently I read another report associating high blood pressure with dementia. That being said, it would be extremely foolhardy to ignore the evidence. What exactly are the signs of periodontal gum infection, how is it treated, and can it be prevented?
Signs of periodontal danger
One of the first signs of periodontal disease is swollen and red or inflamed looking gums. Gum tissue with these characteristics will often bleed when brushed, touched, or flossed. These gum issues are a major cause of halitosis, and they may or may not be tender. If this early onset condition (gingivitis) is left for too long, the infection (bacteria) tends to spread down the roots of the teeth and infect the surrounding bone and attachments, causing destruction and loss of both. It is at this latter stage that the infection begins to be called periodontitis.
One of the difficult parts of diagnosing periodontitis is that the person can go through a poor hygiene phase that leads to attachment loss and pocket formation. Frequently, though, gums will go back to appearing healthy again on the surface, after a while. The problem is that while that is happening, the pockets around the teeth get too deep for a toothbrush or floss to reach. Essentially, the infection continues out of sight until the teeth become loose or a painful acute abscess develops, seemingly overnight. This hidden nightmare is the number one cause of tooth loss and, as previously mentioned, a potential hotbed of brain toxicity.
Necessary steps to assure health and welfare
This is one reason why I always recommend regular dental inspections: to keep on top of tooth health and make sure patients are in the clear. An astounding 50 percent of American adults have been found to have some form of periodontal disease; 70 percent of those are over 65 years old. Unfortunately, in the rush to squeeze in as many patients as possible, the periodontal part of dental examinations and treatment are frequently short-changed. Below is a list of what a comprehensive whole-health periodontal examination should include.
- Pocket measurement (probing) – Dentists conduct pocket measurements due to needing to know how deep the pocket or crevice is between the tooth and gums. The deepest a toothbrush or floss will reach is 3 mm. It is also during this part that dentists may notice bleeding that the patient has been unaware of. This is because the dentist may be measuring deeper than the patient can clean themselves, and infected gums will bleed. Gums that are bleeding are often tender too. Many patients with these issues will avoid gum measurements because the gums hurt, but this is not recommended. Healthy gums should not hurt or bleed, so a visit to the dentist may be needed if these symptoms are experienced.
- X-rays – As periodontal infection spreads to the surrounding bone, it starts to dissolve it. The only way to see whether or not this is happening is to either surgically lift the gums or take x-rays. As one can imagine, x-rays are the more preferred method.
- Visual examination and plaque scores – If there are any red, swollen, dirty, loose, or receded areas, they need to be noted and addressed in the treatment plan.
- Occlusion – This refers to how the teeth bite and rub together. Any excessive pressure can rapidly lead to further bone loss and mobility.
- Bacterial screening – The ability to easily test saliva is now available for testing the presence of any bacteria proven to be harmful to teeth and/or gums. Bacterial screenings are highly recommended for anyone exhibiting signs or symptoms of periodontal infection. Screenings are also done for those patients needing dental clearance before having any surgery done.
Once all this information has been gathered and analyzed, the dentist should have a clear picture of the current condition of the patient’s gums. Hopefully, everything will turn out to be healthy and stable. If not, listed below are some of the treatment options patients can consider.
- Dental cleaning – There are two basic types of dental cleanings. The first is a simple maintenance cleaning that takes place above the gumline for those who have been given a clean bill-of-health. However, for those with active periodontal disease, the first step in treatment is to always have a professional cleaning done that extends all the way down to the roots of any infected teeth, where the gums attach or to the bottom of the pocket. This type of cleaning is variously referred to as a deep cleaning, root cleaning, root planing, or periodontal cleaning.
- Bactericidal treatment – Traditional follow-up to root planing involves the use of some form of antibiotics, either topical or systemic, to assist in preventing the area from becoming infected again. It would take an entirely separate article to cover all the problems associated with antibiotic use; in rare instances, they may still be the best option. Fortunately, dentists now have access to laser therapy, which is a great non-toxic, non-traumatic alternative; laser therapy altogether helps sterilize gum pockets. There is a growing body of evidence suggesting that this method often leads to reattachment and regrowth of the bone as well.
- Surgical grafting – In more advanced cases, it is sometimes beneficial to insert new bone around the teeth roots to re-establish the support needed to assure long-term stability.
- Occlusal therapy – Any chance of reattachment and complete healing will be impossible if any teeth are left interfering with a balanced jaw joint (TMJ) or chewing motion.
- Inflammation control – Finally and most importantly, in any wholistic approach to periodontal treatment, steps must be taken to assure that systemic inflammation is also under control. Inflammation is the common denominator between periodontal disease, as well as all of today’s major killers. This includes heart disease, diabetes, cancer, and, of course, Alzheimer’s. These leading causes of death cause inflammation that exacerbates periodontitis, and in turn, periodontitis exacerbates these diseases. The truth is that 95 percent of these diseases can be controlled with diet, exercise, and stress control. Again, this is a subject that would require a series of articles, or a whole book (check out How Not to Die by Dr. Michael Greger). But rest assured, in my office, I am not afraid to have a talk about this!
I have covered a large amount of tremendously complicated topics quite quickly in this report. Nevertheless, as can be seen in this article, periodontal health and inflammation control should be considered as a matter of life-and-death. For those that are still looking for a worthy new year’s resolution, why not pick healthy gums and strong teeth for this year?