The Science of Peridontal Disease

By Dr. Iman Sadri

September 19, 2022

There is a saying among oral health professionals, ‘The mouth is the window to the health of the body.’ The evidence of an unhealthy body manifests its deleterious effects in many systemic co-morbidities. Dental decay is the #1 most prevalent disease in the world. Over 3.5 Billion globally have tooth decay in permanent teeth. Dental decay, however, is confined to the mouth, unless an abscess starts. The biggest culprit in the oral cavity that is linked to systemic pathologies is Periodontal Disease.

 The oral cavity is the start of the GI tract. Over 700 bacteria species are found in the mouth among a biofilm, known as dental plaque. The bacteria proliferate with excessive food supply. Their food is our food that we don’t brush and floss away. The remnants of the particles we consume in and around the teeth and gum-line are fuel for toxic bacteria to thrive. The majority of the gum disease bacteria that is most destructive is anaerobic bacteria. They live in the absence of oxygen. The advent of the agriculture revolution in 10,000 B.C. catalyzed worldwide periodontal disease, which can lead to tooth loss. Teeth don’t decompose with eternity. However, humans can lose their teeth due to excessive plaque accumulation.   

Periodontal disease results in destruction of the gum tissue and bone structure that supports teeth. Teeth, even without cavities can fall out on their own. Why is this ? How do teeth, which can last millions of years in the afterlife and not decompose buried in the Earth, fall out when we’re alive. To reemphasize the discussion is pertaining to permanent dentition. Baby teeth fall out and are replaced by permanent teeth. There are some genetic anomalies, in less than 12 % of patients sometimes their baby teeth are not replaced by permanent premolars. However, generally speaking baby (deciduous teeth) are replaced with permanent teeth. 

My third book is entitled, ‘Why Teeth are Like Diamonds : The Case for Conservative Dentistry.’ The book gets into dental anthropology, and how a majority of root canals, crowns and extractions (excluding wisdom teeth and excluding teeth getting loose due to gum disease), are due to the fact that teeth are the strongest substance in the body. They last millions of years. However, while humans are alive periodontal disease can lead to teeth getting loose. The excessive plaque and calculus accumulation is food supply for the bacteria to proliferate and release toxins. The body inadvertently tries to get rid of the calculus by releasing its own molecules to ward off the buildup. The release of these neutrophils from the body, actually eats away the bone surrounding the teeth. The teeth don’t get the calculus removed and the bone structure also gets dissipated around the teeth. Teeth get loose due to advanced periodontal disease. On many occasions, teeth can fall out without cavities. 

Periodontal disease leads to the periodontal ligament that connect the teeth to the bone to break down. If there is a clean mouth with no calculus or plaque then the bacteria all but die off. At least to the level of developing a biofilm. The proliferation of bacteria induces an inflammatory response from the body. The host (human) introduces the excessive plaque, the bacteria proliferate and the inflammation, if chronic can lead to bone resorption. There is bleeding, malodor, pain and exudate leading up to tooth loss in advanced periodontal disease. 

New research from Japan published in 2022 explains the complex science of tooth loss from periodontal disease. Using osteoblasts and bone marrow cells from mice, plus a synthetic molecule analogous to dsRNA, the study authors experimented with exposure of the cells to dsRNA. They observed that the dsRNA clearly induced the differentiation of more osteoclasts, the cells that break down bone. The dsRNA caused osteoblasts to produce more of the hormone-like PGE2 that in turn upregulated RANKL and stimulated osteoclasts to differentiate. So, the osteoblasts, through interactions with the dsRNA molecules, sent cellular signals that increased the production of the bone-eroding osteoclasts. The dsRNA also made mature osteoclasts survive longer. Double stranded RNA induces bone loss during gum disease

Periodontal disease is associated with diabetes, stroke, cancer, osteoporosis, Alzheimer’s Disease, heart disease, and respiratory disease, just to name a few.

Focus on wellness and keeping your teeth by brushing and flossing regularly. I also suggest getting a professional cleaning at the dentist every 90 days. For geriatric patients, I recommend professional cleanings every 2 months, and for skilled nursing facility patients, confined to a bed, they should get a professional cleaning every month. People on average eat two hours per day and brush for 90 seconds. That’s a big discrepancy. Patients should also brush four minutes, twice per day, at least. Ideally four minutes, three times per day.

Learn more oral hygiene tips by following Dr. Iman Sadri on social media @DrImanSadri