Precision Dental Medicine is a phrase coined by Dr. Christian Stohler, DMD; Dean of Columbia University College of Dental Medicine.  “We want to redefine dentistry within a healthcare environment… ” says Dr. Stohler, “aiming for totally integrated care that takes into account diseases, environment, lifestyle, and even genetics to customize care for each particular person.” This is a paradigm shift redefining dental medicine, specifically periodontics, the dental specialty  that treats gum disease. Periodontal or gum disease is the only disease specific to the mouth besides oral cancer.

Typically gum disease has been diagnosed based on the measuring gum pockets, where the gums pull away from the teeth. Precision Dental Medicine is no longer just about measuring pockets; it means looking  at the totality of the situation, including the body’s equilibrium and response to inflammation. The mouth is a prime indicator of inflammation in the body, an underlying cause of many disease like Alzheimer’s, strokes diabetes and heart disease.

Why Gums Need to be Healthy and Strong

Through unhealthy gums you will also be introducing unhealthy microbes into your blood stream to cause inflammation in your body and weaken key organs like your heart, the endothelial lining of your blood vessels, and your brain. In addition, a study from Harvard suggests that the microbes camping out between your teeth and gums may affect your risk for cancers of the stomach and esophagus.

In short the gums around your teeth need to be strong and vibrant. This means they should be pink and healthy, not red and bleeding.

Why Is Gum Health So Important?

Gum Disease and Health
Gum Bacteria and
Systemic Health

The barrier systems of our body need to be healthy as they protect our overall health. The 3 main barrier systems of our bodies are the skin, the intestinal lining and the blood/brain barrier. Simply stated, your gums are also a barrier system, meant to protect your teeth, jaw bone and the rest of your body from bacteria and microbes that can damage them. So your gums, along with the lymphatic system in your mouth, are a first line defense system protecting the body against foreign invaders. In addition, without healthy gums, you will eventually loose your teeth and lose your ability to chew.

Here are examples that illustrate how important barrier systems are to our health:

  • When the gut lining gets inflamed and it’s barrier systems becomes violated or ‘leaky’, it can lead to Irritable Bowel Syndrome, SIBO, Crohn’s disease, and other conditions too numerous to list here. Some of the causes of this breakdown could be poor diet, toxicity, chemicals, drugs, heavy metals, imbalance in the microbiome from antibiotics, and even stress.
  • When the blood brain barrier is violated, chemicals, heavy metals and microbes can invade the brain causing inflammation, neuronal breakdown and eventual neuronal death. The medical evidence of inflammation in the brain is amyloid plaque, whose effect is similar to the plaque found in our blood vessels, i.e. inflammation. In conditions of the brain, amyloid plaque has been linked to Alzheimer’s disease and Dementia. Research shows that once microbes cross the blood brain barrier they contribute to the inflammatory amyloid plaque found there, and two of the offenders found are P. Gingivalis and Spirochetes. Spirochetes are among the most aggressive bacteria in the mouth. They can change form to evade an immune response and will bore into cells to replace and destroy healthy tissue. They often contribute to gum disease, as illustrated in this video.
  • When the placental barrier is violated by mercury, which is a heavy metal, it can lead to adverse birth outcomes including preterm birth (PTB: <37 weeks vs 39 weeks gestation) and low birth weight (LBW: <5.5 lbs) and can result in severe infant morbidity and mortality. This is why some of our patients have their mercury levels tested and amalgam fillings removed before they become pregnant.

How Can I Tell if I Have Gum Disease?

The best way to tell if you have gum disease is by their look and feel. If your gums look red and bleed when you brush or floss, this is usually an indicator of gum disease. Another warning sign is if the gums are sensitive to the touch or if your teeth are loose. If you have these problems, you should definitely see a dentist or specialist to evaluate what is going on, as this is a situation that can only get worse over time. From a preventive standpoint, you would want to establish a baseline of how your gums look when they are healthy. Valuable input about this will come from your dentist and the dental hygienist who cleans your teeth.

Periodontal Disease

Here is an example of what gum disease can look like. Notice the pale, unhealthy looking color of the gums and the tissue loss, especially on the lower front teeth.

After treating periodontitis

Here is the same patient after treatment. Notice the improved tone, texture and color of the gums, including how they filled in the gaps between the teeth. This was done with a combination of cleanings and gum work, home care instruction, veneers and implants.

The Cause of Gum Disease

To summarize, bacteria that live along and under your gums cause the inflammation that can result in gum loss and loss of bone around your teeth. These bacteria are the bad actors that can live in an oxygen depleted environment, thus they are coined ‘anaerobic bacteria’. These anaerobic bacteria release very toxic waste and byproducts (basically bacteria poop) into the gap between your gums and teeth. The toxicity of this bacteria waste causes inflammation, redness and bleeding in our gums. If this inflammation is allowed to remain unchecked and untreated it eventually results in loss of gum and bone tissue around our teeth (and often inflammation in our bodies, as described above. This is the hallmark and definition of gum disease.

What is Periodontitis

The First Line of Defense – Home Care

Actually the most important thing you can do is keep your teeth and gums clean. For most people this means brushing, flossing and using a rubber tip daily. At Integrative Dentistry we replace your toothbrush and rubber tip every time you come in for a cleaning. (You may consider replacing your tooth brush even more often).

The purpose of using these tools is to remove the white film that collects along your gum line and between your teeth. This white film is called plaque and is the primary food source for bacteria in your mouth. Once bacteria colonizes plaque it will start to create inflammation in the gums and bone of your teeth. This is the precursor to red and bleeding gums and gum disease.

If you want to learn more about home care and the tools that matter you can ask during your next cleaning appointment. This is the right time to ask. Don’t be shy. It’s very important that you be doing this correctly. It makes all the difference in the world for your teeth and gums. In the meantime you can go here to read more about these tools.

The Second Line of Defense – Teeth Cleanings

Buildup of hard deposits attached to your teeth need to be removed periodically to keep your gums and bone healthy and disease free. This is why you go into the dental office for periodic cleanings or ‘prophies’ as they are called. This is short for ‘prophylaxis’, which means prevention. Stain and deposits are rough and house bacteria that release poisons inflaming to your gums. Think of a microscopic apartment complex where everyone parties 24/7. In order to clean up the mess, eventually you have to evict the squatters. Another analogy is barnacles on the bottom of a boat. If the barnacles are not periodically removed eventually you get moss, seaweed, and even small fish collecting and living in this newly formed ecosystem.

Plaque calcifies into hard deposits by absorbing minerals from your saliva. It’s plaque and hard deposits that cause inflammation and results in the breakdown of the gums and bone around your teeth.

Are Cleanings the Cure for Gum Disease

The first reason why cleanings and deep cleanings are sometimes not enough is that there are bacteria and parasite populations that are very aggressive and aren’t easily controlled by routing cleanings and home care. Some of these populations have survival strategies that allow them to hide in the biofilm/plaque and even in your own cells. One of these commonly found bacteria are spirochetes, as mentioned above. Here is a video showing how these offenders operate and where they live in your mouth.

The second problem is that plaque and hard deposits are not the only cause of gum disease, or periodontitis as it is called. Gum disease is a multifactorial disease. Smoking, medications, genetics and systemic factors all play a role in it’s onset and progression. Additional factors such as clenching and grinding can also erode the teeth attachments and eventually lead to tooth loss. However, as with most diseases, the one underlying and overriding cause of gum disease is inflammation. Additional contributors are:

  • Genetics
  • Auto-immune diseases
  • Low saliva flow
  • Some medications
  • Stress, leading to acidity in the mouth
  • Chronic inflammation
  • Smoking
  • Acid Reflux
  • Viral infections

Think of cleanings like doing tune ups for your car. Usually that’s enough. But sometimes the car just needs an overhaul or rebuild. That’s what the gum specialist is for.

The Third Line Defense – LANAP

LANAP stands for ‘Laser Assisted New Attachment Procedure.’ Dr Bae, who is our resident gum specialist, does not do traditional gum surgery. Instead he uses a Nd:YAG laser to treat gum disease. The reason is that lasers encourage the attachment of healthy gum tissue to bone in your jaw and teeth without the pain and soreness associated with traditional gum surgery.

We have found that lasers are the best way to:

  • Perform surgery on teeth, gums and bone in a non traumatic way
  • Increase blood flow and stem cell activation to speed up the body’s healing response
  • Restore the mouth’s natural barrier systems and proper function
  • Control and kill harmful bacteria populations and restore a healthy microbiome of the mouth

To see how we use lasers to heal the gums and bone around your teeth, please watch the following video:

My Gums Don’t Hurt So How Can I Have Gum Disease?

What happens when your gums been damaged due to inflammation?  One of the main problems with gum disease is that it it doesn’t hurt until late in the game, so it doesn’t have any immediate consequences. By the time pain, swelling and loose teeth result, sometimes it is too late to reverse it.

Your gums are no different than any other barrier system. Examples of what happens when other barrier systems get inflamed? An inflamed intestine is usually doesn’t hurt until it reaches a more advanced stage like Crohn’s disease. An inflamed brain also doesn’t hurt but it can result in Alzheimer’s. An inflamed endothelial lining also doesn’t hurt until the plaquing occludes a major artery or results in heart disease.

Plaque is plaque. It causes inflammation wherever it is in the body. Don’t wait to treat it and then try to fix the damage it has caused. By then the problem is much harder to reverse.

The same is true with gum disease. The key to gum inflammation and gum disease, like any other disease of the body, is to catch it early and turn it around. This is the key. If you catch it early the outcomes are so much better!

An Integrative Approach to Keeping a Strong Barrier System

At Integrative Dentistry our approach is to keep a healthy barrier system in the mouth by looking for inflammation and infections. Often these problems don’t cause pain. This is somewhat surprising but true. That’s why it’s so important to be actively looking and know what to do to eliminate it once you find it, thus protecting your overall health.

How we do this is with an overall assessment of not only your mouth but how your dental health is affecting and impacted by your overall health. We start by eliminating sources of pain and all infection/inflammation. Any source of inflammation or infection is bad for your overall health as well as your dental health and needs to be addressed in the proper order with a proper understanding of the underlying imbalances and systemic conditions that allowed these conditions to manifest in the first place.

Our Philosophy

Our doctors pride ourselves in using the most bio-friendly dental materials that also look and feel natural. We also use ozone to treat bacteria, whether in deep decay situations, to remove bacteria from infected root canals or heal infections in the bone.

In general our focus is to:

  • Remove decay and restore teeth with biofriendly dental materials
  • Avoid root canals through the use of ozone
  • Identify and treat infected teeth with laser-ozone root canals
  • Restore gums to vibrancy and health through LANAP and the Pinhole Technique

Have your oral health evaluated by our integrative gum specialist, Dr Bae. Until the end of January 2022, we are offering this evaluation appointment for $75. Please call 760-632-1304 today to secure your appointment.