PREVENTION, THERAPY, AND RECOVERY: DONíT WAIT TILL IT HURTS
by Seymour L. Gottlieb, DDS
Dentists, like doctors, are asked many questions by their patients. One of the most frequently asked questions is, "Can I prevent or change the course of periodontal disease nutritionally?" To assess the factors involved, one needs to know something about the disease, its causes, and the tissues involved.
Periodontal disease is a universal problem. At some point in life, three out of every four adults will be affected by it. Teenagers are commonly affected by the presence of gingivitis, the earliest and most reversible form of this disease. About 30 percent of our population will have the advanced form of gingivitis by their early 40s and an even more dramatic number will have them later in life. The greatest loss of teeth in adults is due to periodontal disease. A 1985-86 National Health Survey report by the United States Department of Health and Human Services revealed that 20 million Americans are edentulous (toothless). In 65-to-74-year-olds, one-third have lost all their teeth and many more have lost some teeth.
Periodontal disease is a chronic disease that can be treated and that is controllable until the very late stage of bone loss. The primary cause is a complex interaction of microbes from plaque (a sticky, colorless film that adheres to teeth) and their byproducts, both of which irritate the gum (gingiva). Together they cause a widening of the pocket-like space between tooth and adjacent tissues, which they invade, as well as an immunologic inflammatory response of the tissues to the microorganisms. For removing plaque, oral hygiene is the best method. Contrary to what was previously thought, fibrous or other firm foods do not remove plaque from teeth. Food ingested can affect dental decay and the type of surface bacteria, but does not as readily affect the microorganisms under the tissue.
Nutrition does play a role, but at a different, host-defense-mechanism level. Although poor nutrition does not cause periodontal disease, researchers believe that the disease progresses faster and is more severe in people who do not have ample nutrients. The gingival tissue around the teeth consists of an outer layer, epithelium, that has no keratinized (hardened) barrier like that in most other outer areas of the body. It depends on the underlying connective tissue for its nutrients. The inner-lining cell tissues of the periodontal pocket have a faster turnover than other tissues; they renew themselves every 6 to 10 days. This means that a continuous source of balanced nutrients is needed for developing new tissue cells.
Studies at Georgetown University have shown that when ascorbic acid (vitamin C) and iron are low, the tissue is more permeable. In addition, adequate folic acid must be present for proper cell turnover and to minimize tissue permeability. Research in Japan and Texas indicates the importance of coenzyme Q10 for periodontal tissue health. The periodontal fibers that act as a protective barrier by attaching tooth to tissue and bones are made up of collagen, which is high in the amino acid hyoxyproline. The co-factor ascorbic acid is necessary for the enzyme proline oxidase to complete intermediate functions in order to form new collagen fibers and connective tissue.
A research project at the University of Illinois College of Dentistry, in which I participated, dealt with the metabolism of ascorbic acid in oral tissues. The investigation revealed that radioactive-tagged ascorbic acid or its metabolites were immediately deposited in greater concentrations at the site of a recent oral wound than in adjacent, normal tissues. This consistently occurred whether the guinea pigs had ascorbic acid in their diet beforehand or were lacking in ascorbic acid. They, like men and monkeys, are among the only mammals known that do not produce or store their own ascorbic acid and who thus depend on diet and/or supplements for everyday needs.
In nature, ascorbic acid is found associated with bioflavinoids. The bioflavinoids are not true vitamins, but rather accessory factors that may potentiate the activity of ascorbic acid. This is why bioflavinoids are often present in ascorbic acid supplements. Ascorbic acid is also important in promoting white-blood-cell phagocyte (body defense) function. Ascorbic acid is found in higher concentrations if the white blood cells than in any other cells of the body. Other important nutrients include zinc, which has an important role in wound healing. Also, balanced intake of calcium and magnesium is important for calcium deposition in the jaws as well as in the rest of the body.
Another often-asked question is, "What is the prevalence of oral cancer in this country?"
In the United States, oral cancer represents about 4 percent of all cancers and 2.2 percent of all cancer deaths. In 1988, approximately 30,000 persons were newly diagnosed as having oral cancer, from which an estimated 9,000 died. It is the seventh most common cause of cancer in the United States. Although most oral cancers are surface lesions and detectable, the 5-year survival rate is a dismal 50 percent. About 95 percent of the patients diagnosed with oral cancer are over 40 and it is much more prevalent in males. The lip is the most common location, followed by the tongue and the floor of the mouth, although it can occur almost anywhere in the mouth.
Common causes of oral cancer are alcohol and tobacco, along with sunlight and chronic irritation. The most common signs and symptoms are an ulcer, a surface change (red or white swelling), or paresthesia (numbness). Foods affect the disease process in part by determining the level of macro (protein, fats, carbohydrates) and micro (vitamins, minerals, amino acids) nutrients available. Those nutrients especially associated with reducing cancer risk are beta carotene, vitamins A and E, selenium, and ascorbic acid.
Because many of my patients know of my interest in nutrition and because of the recent publicity about the use of chemical sprays on many raw foods found in supermarkets, I am often asked "How can waxes, oils, and pesticides by reduced in the foods I eat?"
Peeling will remove pesticides of the surface of produce. Also, most surface residues can be removed by giving the produce a 15-to-20 minute bath in a 5 percent solution of vinegar or hydrochloric acid, then rinsing well. None of these procedures, of course, removes residues inside the produce.
Surface oils and waxes can usually by removed by immersing the fruit or vegetable in hot water (160 to 180įF) for one to two minutes. Soapy hot water works better, but be sure to rinse well. This treatment may also help remove pesticides.
Also, when buying produce, keep the following in mind to limit your exposure to pesticides: