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WHY DO GUMS BLEED?The Impact of Sugar on Systemic Health
Trisha E. O’Hehir, MS, RDHPhone: 520-444-2279 [email protected]
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
U of Minn 1967
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
I became an oral health detective!
We are all oral health detectives!OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Understand how sugar impacts oral and systemic
Describe how sugar influences inflammation
Understand the sugar industry coverup
Apply a 3-step approach to perio treatment
Implement a radical change in approach to health
Using our detective skills…
1.
2.
3.
4.
5.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Why do gums bleed?
Is it really poor oral hygiene?Where does the blood come from?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
1. Natural inflammatory response destroys tissue around blood vessels - granulation tissue. Easily penetrated.
2. Sugar compromises the mitochondria in every cell.
3. Blood sugar causes damage
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
1. Excess AGE production
2. Increased gut permeability
3. Higher “bad” LDL
4. Weight gain
5. Addictive
Sugar & Refined Carbohydrates
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Now I’m going to lay out the clues to prove my case
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• Expand your view of oral/systemic link
• Think differently to get different results
• See yourself as an oral health coach
My goals for you from today’s class…
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Hunter/Gatherers did not feed their oral bacteria, no oral hygiene needed
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Oral hygiene became necessary when the Western Diet of refined
carbohydrates was introduced.
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Dr. Weston Price
1930s traveled the world to discover how nutrition impacted dental caries
1939 published his book: Nutrition and Physical Degeneration
Western diet led to oral/systemic disease
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Dr. Weston Price
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Dr. Weston Price After Parents Adopted a Western Diet
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Humans do not need sugar No physical need to consume sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Diet of the Alaskan Inuits
• Fish protein and fat
• Diet of the Swiss mountain folk
• Dairy, meat
No SugarNo Refined Carbohydrates
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
2009 - Stone Age Diet - Switzerland • 10 subjects in a controlled Stone Age
environment
• Provided a small supply of whole grain barley, wheat and spelt, some salt, herbs, honey, milk and meat from domestic goats and hens.
• Not enough food for the 4 week study
• They foraged for berries, • edible plants and fishing
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
2009 - Stone Age Diet
• No oral hygiene products or tools
• Stone Age clothes, tools and huts
• Filmed for a TV special
• Sports medicine physicians monitored
• Dental examinations before and after
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
2009 - Stone Age Diet
• Plaque increased, as expected
• Surprised by reduction in gingivitis & probing depths
• Bleeding upon probing reduced from 35% to 13%
• Bacteria changed to a balance favoring health rather than disease
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Pottenger’s Cats A Study of Nutrition-Cooked vs Raw Meat
First generation - end of life, lazy with degenerative diseases
Second generation - degenerative diseases by mid-life, loosing coordination
Third generation - degenerative diseases early in life, born blind, weak, shorter lifespan, fewer offspring
All died out by fourth generation
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Pottenger’s Cats Milk: raw, pasturized, evaporated or
sweetened condensed
Cats on raw mild did better than the others that showed degeneration similar to the meat study
Conclusion: missing protein necessary for growth and development of healthy cats
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Understand how sugar impacts oral and systemic
Describe how sugar influences inflammation
Understand the sugar industry coverup
Apply a 3-step approach to perio treatment
Implement a radical change in approach to health
Using our detective skills…
1.
2.
3.
4.
5.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Sugar Topical and Systemic Effects
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Topically, sugar feeds acid producing bacteria leading to caries
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Topically, sugar wicks into subgingival area feeding bacteria
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Dietary sugar is measured in GCF, which also feeds subgingival bacteria
Systemically, sugar directly impacts oral bacteria
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Systemically, sugar impacts periodontal health on a cell level & leading to bleeding
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There is an oral - systemic connection
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Blood vessel walls altered byperiodontal disease
! Invade endothelial cells, trigger immune response
! Immunological Sounding! Immune response to PD, activation of endothelial cells
! Transport of bacteria, activation of endothelial cells
! Auto-immune Reaction! Bacteria elicit specific antibodies, react with host cells
Pathogen Trafficking
Microbial Invasion
Immunological Sounding - activates endothelial cells
Auto-immune Reaction bacteria elicit antibodies
Perio-Systemic Mechanisms These are secondary to
dietary sugars
Cytokine movement
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
There is a connection between oral disease and systemic disease.
Oral disease does not cause systemic disease
The common issue is sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Understand how sugar impacts oral and systemic
Describe how sugar influences inflammation
Understand the sugar industry coverup
Apply a 3-step approach to perio treatment
Implement a radical change in approach to health
Using our detective skills…
1.
2.
3.
4.
5.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Infection - triggered by bacterial biofilm
• Inflammation - response of the immune system and more
Cause of periodontal disease
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Biofilm
good
bad
ugly
non-cariogenic, supragingival
acid producing strep mutants, subgingival anerobes
biofilm over an open wound
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Biofilm - it’s a complex ecosystem worthy of our respect
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Too bad plaque biofilm isn’t
green!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
What do your teeth feel like
when you wake up?
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Does it feels like the teeth
are wearing sweaters?
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Does it feels like the army
marching through?
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Does it feels like the
bottom of a bird cage?
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Or does it feel just
plain fuzzy!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Babies are born nearly germ-free
How do I getbacteria in my mouth?
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Bacteria: transferred from parent to child
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Bacteria: transferred from parent to child
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Bacteria: transferred from parent to child
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Bacteria: transferred from parent to child
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What happens when it falls on the floor?
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Bacteria are spread by the
family dog
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It’s true, moms spit on their kids either directly or on a Kleenex
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Bacteria are spread
between partners by
kissing
Troil-Lindén et al JCP, 1996
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OHEHIR Yankee 2019 why gums bleed - February 2, 2019
fimbria
fibrillsText
Quorum sensing
Biofilm Formation
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fibrillsText
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1/3 bacteria 2/3 slime - to absorb water and trap particles
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Biofilm grows in a fluid
environment: saliva and
crevicular fluid
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Bacterial toxic waste subgingivally includes endotoxins that penetrate pocket walls and trigger the
immune response destroying tissue and bone
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
•Biofilm - the good, the bad and the ugly
good
bad
ugly
non-cariogenic, supragingival
acid producing strep mutants, subgingival anerobes
biofilm over an open wound
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
WARNINGUgly biofilm
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
photo courtesy of Dr. Randall WolcottOHEHIR Yankee 2019 why gums bleed - February 2, 2019
Medicine Learns from Dental Hygiene
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photos courtesy of Dr. Randall Wolcott
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Biofilm causes ear infections
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Medicine Learns from Dental Hygiene
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Look at your Toes Squirt your Nose
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All are biofilm diseases
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More prevalent
Forms more readily
More acidogenic
Interdental Plaque Biofilm
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Interdental Plaque Biofilm
Dr. Oscar H. Arribasplata, Lima, PeruOHEHIR Yankee 2019 why gums bleed - February 2, 2019
Col Area Isn’t Keratinized
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Biofilm - it’s a complex ecosystem worthy of our respect
Would you agree?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Pathogenesis Immune Response
Why do gums bleed?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
White blood cells destroy connective tissue and bone on the way to the sulcus
diagram from text: Periodontal Disease, Page,
Schluger and Youdalis,
Pathogenesis
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Translate cell biology
into cartoons
bacterial endotoxins bacterial antegens
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Endotoxin from bacteria Toxic waste of the bacteria Triggers the immune response
Bacterial endotoxins
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Endotoxin from bacteria Toxic waste of the bacteria Triggers the immune response
Permeation Agents VSCs Volitle Sulfur Compounds
hydrogen sulfide and
methal mercaptan
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Signals alert the immune system
• Mast cells around the blood vessels release histamine, causing vasodilation
• PMNs are sent to
• OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Vasodilation
Endotoxins also trigger a cascade of immune
responses to protect the body from bacteria and
viruses
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PMN
Endothelial cells separate to allow PMNs to exit the
blood vessel
PMN
PMN
PMN
PMN
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
MMP
prostaglandin(pre-term birth) interleukin
collagenase
Breakdown of the active transport
PMNs release chemical machetes
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In aggressive cases, the PMNs
are over active and produce more than the normal amount
of destructive chemicals
PMNs release chemical machetes
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Breakdown of GAGS Glue
glycosamino-glycans
Breakdown of
active the transport system
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Krebs CycleATPs
With oxygen - 24-28 ATP molecules from one molecule of glucose converted to pyruvate, plus the 4 molecules from glycolysis.
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Mitochondria
Mitos means thread Chondria means grains
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Mitochondria
Not just one mitochondria per cell, but as many as 2,000 in each liver cell
(20% of the cell)
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Inflammation research…
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Understand how sugar impacts oral and systemic
Describe how sugar influences inflammation
Understand the sugar industry coverup
Apply a 3-step approach to perio treatment
Implement a radical change in approach to health
Using our detective skills…
1.
2.
3.
4.
5.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Mitochondria
•Uses sugar and oxygen to generate energy for the cell
•Energy stored as chemical bonds
•With too much “sugar” there is an increase in oxidative stress which leads to inflammation
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Mitochondria Goal is equilibrium
•Oxidation - giving away an electron
•Reduction - gaining an electron REDOX reactions
Generate unstable free radicals = ROS ROS will strip electrons from other molecules
Leaving more unstable free radicals = domino effect
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Mitochondria Goal is equilibrium
With adequate oxygen and good nutrition, the antioxidant defenses will control free radicals the keep
ROS within the cells where they were produced.
When free radicals and ROS exit the cell = inflammation
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Mitochondria Goal is equilibrium
Too much refined carbohydrate = mitochondrial dysfunction
•Oxidative stress
•DNA alternations in the mitochondria
•Reduced numbers of mitochondria
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Mitochondria Goal is equilibrium
Primary Source of ROS
• In health, 90% of oxygen in a cell is absorbed
• Only 1-5% of oxygen is converted to ROS
• Under normal circumstances - antioxidants enough to handle ROS
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Mitochondria Goal is equilibrium
Impacting both periodontitis and systemic disease
• Systemic oxidative stress affects • liver, adipose tissue, pancreas
• Mitochondrial dysfunction
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Inflammation research…
Mitochrondial function is critical to each individual cell of the body and to the person as a whole and appears to be a critical mechanism connecting sugar to not only oral diseases, but
also many systemic diseases. OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Limited ATPs of energy
requires a big decision
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Immature epithelial
cells
granulation tissue
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Infection and Inflammation
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Bleeding is not normalIt’s a sign of infection Too much sugar in
the blood stream damages blood
vessels.
Endothelial cells take in too much glucose - causing
damage
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Bleeding is not normalIt’s a sign of infection
Sugars in the blood stream bond with protein or fat
producing advanced glycation
end-products (AGE)
Fructose - 10 X glycation than
glucoseOxidative StressOHEHIR Yankee 2019 why gums bleed - February 2, 2019
Oxidative Stress
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The Common Cause: Sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The pathogenesis of heart disease
• Leading cause of death in the Western world
• Atherosclerosis - plaque on vessel walls
• Becomes fibrous, obstructs blood flow
• Plaque surface ruptures, allowing leakage
• Leakage is thrombus, blocks there or travels to other blood vessels and blocks
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The pathogenesis of heart disease
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Thrombus can happen in any vessel
• Usually self regulated and healing occurs
• Serious when it affects heart or brain
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The pathogenesis of heart disease
• Sugar triggers insulin resistance
• Sugar lowers good cholesterol
• Sugar causes inflammation in the arteries
• All of these - direct causes of heart disease
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The pathogenesis of diabetes
• A person gets fat - eating sugar and flour
• Fat cells become inflamed
• Inflammation causes insulin resistance
• Body has to make more insulin
• Eventually the pancreas stops making insulin and diabetes follows
Thomas Van Dyke, Scientific American, 2016
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The pathogenesis of diabetes
• Fat - reserve energy supply
• Fat takes instructions from insulin
• Highly refined carbohydrate diet breaks down fast leading to increased insulin levels
• Fat gets signal to suck energy out of blood
• High insulin levels=weight gain, hunger, fatigue
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
According to Dr. Gary Taubes author of “Why We Get Fat”
“Obese people are not fat because they are overeating and sedentary – they are overeating and sedentary because they are fat, or getting fatter.”
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Dr. Robert Lustig - the connection is sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The common issue is sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
People don’t know how much sugar they eat
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Monosaccharides - building blocks of carbs
• Glucose - body’s preferred carbohydrate
• Fructose
• Disaccharide
• Sucrose = glucose + fructose = table sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
People don’t know how much sugar they eat
Sugar consumption: 1822 — 45 grams per day, 1/8th to 1/4 cup (1.6 oz)
2012 — 152 grams per day, 3/4 cup (5.4 oz)
130 pounds per year/person!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Recommended Daily Allowances
American Heart Association & World Health Organization
Women - 6 teaspoons, 25 grams
Men - 9 teaspoons, 38 grams
Children - 3-6 teaspoons, 12-24 grams
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Recommended Daily Allowances
American Heart Association & World Health Organization
5%-10% of daily calories fromadded sugars
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
12 oz Coke contains 9 teaspoons of HFCS
38 grams of added sugar
Women - 6 teaspoons, 25 gramsMen - 9 teaspoons, 38 grams
Children - 3-6 teaspoons, 12-24 grams
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Humans do not need sugar No physical need to consume sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Sugar is addictive - the more we eat, the more we want!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Nearly every packaged food contains sugar
sucrose high fructose corn syrup
dextrose honey
maple syrup
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Panocha• Powdered sugar
• Raw sugar• Refiner's syrup• Rice syrup• Saccharose• Sorghum Syrup• Sucrose• Sugar (granulated)• Sweet Sorghum• Syrup• Treacle• Turbinado sugar• Yellow sugar
• Confectioner's sugar• Corn sweetener• Corn syrup• Corn syrup solids• Date sugar• Dehydrated cane juice• Demerara sugar• Dextrin• Dextrose• Evaporated cane juice• Free-flowing brown sugars• Fructose• Fruit juice• Fruit juice concentrate• Glucose• Glucose solids
61 Names for Sugar
Golden sugar• Golden syrup• Grape sugar• HFCS (High-Fructose Corn Syrup)• Honey• Icing sugar• Invert sugar
Malt syrup• Maltodextrin• Maltol
Maltose• Mannose• Maple syrup• Molasses• Muscovado• Palm sugar
Agave nectar• Barbados sugar• Barley malt• Barley malt syrup• Beet sugar• Brown sugar• Buttered syrup• Cane juice• Cane juice crystals• Cane sugar• Caramel• Carob syrup• Castor sugar• Coconut palm sugar• Coconut sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Foods containing sugar that will surprise you
Bacon Green Beans
Table Salt Tomato Sauce Salad Dressing
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
If patients with 5mm bleeding pockets don’t want to clean between their teeth, simply
cut out all added sugar!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Would you agree we need to eliminate added
sugar from our diet?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Reduced plaque biofilm formation • Reduced acid production by bacteria • Stronger blood vessels and capillaries • Better general health • Weight loss
Benefits of reducing sugar and flour
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Understand how sugar impacts oral and systemic
Describe how sugar influences inflammation
Understand the sugar industry coverup
Apply a 3-step approach to perio treatment
Implement a radical change in approach to health
Using our detective skills…
1.
2.
3.
4.
5.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The oral systemic link connected to sugar consumption
Dr. Phillipe Hujoel, 2009 JDR
Sugar is the reason gums bleed.
Six animal studies confirm
In humans, add two sugary drinks per day and increase pocket depth by 0.4mm -1965
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The Common Cause Theory1950-1960
Excessive consumption of fermentable carbohydrates led first to dental diseases and then systemic diseases. Dental disease was an alarm bell for systemic disease.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The Common Cause Theory1950-1960
Excessive consumption of fermentable carbohydrates led first to dental diseases and then systemic diseases. Dental disease was an alarm bell for future systemic disease.
• OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The Common Cause Theory
Two researchers - Cleave and Yudkin
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
“My research on coronary heart disease has convinced me beyond doubt that sugar plays a considerable part in this terrifying modern epidemic.” 1972
John Yudkin (1910-1995)
•
The Common Cause Theory
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
“From an evolutionary point of view, the refined carbohydrates…are always the foods most likely to be at fault (for the diseases of civilization), and not the fats.” 1975
Thomas Cleave(1906-1983)
The Common Cause Theory
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
They considered refined carbohydrates (white flour and sugar) to be the most transformed or refined food, and therefore the most dangerous.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The Common Cause Theory flour and sugar cause both
dental diseases and systemic diseases
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The opposing theory Fat was the culprit
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Ancel Keys, 1904-2004
He was a scientist, studied business, political science,
zoology and oceanography.
He researched
starvation, created K-rations.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
President Eisenhower
1955 he suffered a heart attack
Dr. Paul White’s advice
1. stop smoking
2. cut down on fat & cholesterol
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Ancel Keys was charismatic, popular
and had a big following.
He was so popular at the time that he was
featured on the cover of Time Magazine.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Fatty foods are unhealthy
President EisenhowerDr. White Dr. Keys
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Saturated fat makes you fat and caused heart disease
He postulated that fats caused systemic disease, thus advocating a diet high in fruits, veggies and fermentable carbohydrates instead.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Based on the Low Fat Diet
• No more steak, bacon, butter, eggs or cheese
• Take fat out of processed food and add sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Increased risk of diabetes, heart disease, stroke, cancer, intestinal disorders – just about any illness –
the standard American Diet has them all.
Standard American
Diet (SAD)
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Ancel Keys studied 6 countries
Data was collected from 22
countries!
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He selected data from only 6 countries showing a linear relationship.
Masai - S KenyaInuit - Arctic Rendille - NE KenyaTodelau - S Pacific
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
He bullied other professionals.
Not only did Ancel Keys cheat on the research, he was a bully!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
“My research on coronary heart disease has convinced me beyond doubt that sugar plays a considerable part in this terrifying modern epidemic.”
Yudkin, 1972 (1910-1995)
•
The Common Cause Theory
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The evidence for sucrose as the “greatest killer” in Western societies is “utter nonsense” and “would never pass an acceptable term paper in an undergraduate course in home economics.” Ancel Keys, 1975
Ancel Keys destroyed the careers of both Cleave and Yudkin
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Dental disease was simply a necessary side effect for the greater good of preventing heart disease by decreasing fats and increasing sugars.
Saturated fat made you fat and caused heart disease
Ancel Keys, 1975
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Does this make sense to you?
A diet causing dental disease will prevent heart disease?
Saturated fat made you fat and caused heart disease
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Dental disease considered a local infection to be treated/prevented with fluoride, OHI, restorations, sealants, etc.
Saturated fat made you fat and caused heart disease
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
The Caries Research Foundation (CRF)
Sugar Industry
Dental Association
It’s not about reducing sugar in the
diet - all about improving oral hygiene!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
National Institute for Dental Research
1971 National Caries Program - eradicate caries within a decade
Sugar industry documents from 1959-71 adopted strategies to deflect attention away from sugar
Funded studies on enzymes to break up plaque and a vaccine with questionable potential
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
National Institute for Dental Research
78% of sugar industry submissions were incorporated into the NIDR call for research applications
Research harmful to the sugar industry was omitted
Opportunity missed to develop scientific strategies to reduce sugar consumption
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
From then on, research conclusions focused on brushing, flossing, fluoride and restorative dentistry - not on sugar!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Tobacco Industry Cover-Up?
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Timeline
1957 Yudkin warned about sugar and heart disease
1967 NEJM published the reviews pointing to fat as the cause of heart disease
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Three Harvard Medical School researchers were bribed ($50,000) by the sugar industry to write literature reviews that focused on fat as the cause of heart disease rather than sugar. Published in the NEJM, 1967
Cristin E. Kearns, DDS, MBAPostdoctoral Fellow
UCSF School of Medicine
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
1972
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Timeline
1977 US Dietary Guidelines warned about dangers of excessive dietary sugars but got lost amid the anti-fat hysteria
1986 FDA declared there is no conclusive evidence on sugars that demonstrates a hazard
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Timeline
2004 Dr. George Gray LSU showed increased obesity mirrored the increased use of HFCS
2009 Hujoel’s JDR article appeared
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Timeline
2014 American Diabetes Association website stated “Experts agree that you can substitute small amounts of sugar for other carbohydrate-containing foods into your meal plan.”
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Biofilm Infection Systemic Inflammation
Why do gums bleed?
Fermentable carbohydrate diet
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Learn more about sugar and fat
• The Big Fat Surprise, Nina Teicholz
• Why We Get Fat, Gary Taubes
• The Great Cholesterol Con, Malcolm Kendrick
• Youtube: “Sugar: The Bitter Truth,” Dr. Robert Lustig “The Skinny on Obesity,” http://www.uctv.tv/skinny-on-obesity
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
… but we need an alternative to sugar for the occasional
sweet.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol the good sugar Best alternative
• Looks and tastes like “sugar” • broad category: carbohydrate • narrow category: polyol • 2.4 calories per gram • 40% fewer calories than other
carbohydrates
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Xylitol - 5 carbon polyol
• Erythritol - 4 carbon polyol
• Stevia - extracted from stevia leaves
Alternatives to sugar you will like
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Acesulfame potassium (Ace-K) Aspartame Saccharin Sucralose (Splenda)
Artificial Sweeteners to Avoid
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Biggest Game Changer in DH?
Reduces plaque biofilm by 50%!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Biggest Game Changer in DH?
Reduces plaque biofilm by 50%! Doesn’t feed bacteria
Reduces acid production No insulin needed
Enhances remineralization
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol the good sugar• Most common source
today is corn cobs and corn stalks
• Xlear/Spry products are natural and non-GMO
• They contain no corn
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol the good sugar• Side Effects • dangerous for dogs
• drop in blood sugar • liver damage
Never give your pets: * chocolate, coffee, caffeine * alcohol * avocado * macadamia nuts * grapes and raisins * yeast dough * raw or undercooked meat, eggs * onions, garlic and chives * milk
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol the good sugar• Under nourished dogs are at greatest risk
• Xylitol triggers release of insulin in dogs
• Remedy: give them sugar
• Take them to the vet - the vet will give IV glucose
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Side Effects
• gastric upset when
eaten in large amounts
too quickly
Xylitol the good sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Side Effects
• digested as a fiber
• pulls water out of tissue
cells, thus diarrhea
Xylitol the good sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
•Glycemic level of 7
Glucose 100 Table sugar 68
Honey 55 Fructose 19
Xylitol 7
http://www.glycemicindex.com/
Xylitol the good sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Does not raise insulin levels
• Does not use insulin for metabolism
• Safe for diabetics
Xylitol the good sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• How it works • 5 carbon, not 6 carbon like
sorbitol, mannitol, maltitol
• Passes through bacterial membrane; not metabolized
• Bacteria uses energy to pump the xylitol molecule out
Xylitol the good sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• How it works
• Bacteria like acid environment
• When bacteria cannot make acids
• cannot stick to each other or the teeth • bacterial communication disturbed • biofilm structure is compromised
• Bacteria slide down the digestive & nasal tracks
Xylitol the good sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol prevents biofilm formation
Metabolism and CommunicationOHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol dissolves established biofilm
Metabolism and CommunicationOHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol - research in Finland• 1970 xylitol containing caramels, sweet rolls and
beverages reduced 4-day plaque mass by 50%
• 1972 similar results after a 5-day study, dental students, no oral hygiene - SIMILAR RESULTS
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol - research in Finland
• Two-year meal replacement study - 85% reduction in caries
• Difficult study to undertake and monitor
Turku Sugar Studies
Three test groups: Xylitol Fructose Sucrose
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol - research in Finland
• One-year chewing gum study 6.7 grams vs 67 grams resulted in 85% reduction in caries incidence compared to sucrose group
6.7 grams 67 gramsOHEHIR Yankee 2019 why gums bleed - February 2, 2019
Inhibits Plaque Accumulation and Cariogenic Bacteria
• Two-week study • S mutans digest sorbitol • Gum chewed 5/day • Gums: 100% xylitol xylitol/sorbitol 100% sorbitol
-40
-20
0
20
40
60
xylitol/ sorbitol
100% xylitol
Change in plaque weight(%)
How Xylitol Fights Tooth Decay
100% sorbitol
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
0.0
2.5
5.0
7.5
10.0
Control Fluoride Xylitol
DMFS Caries Increment
Hungarian Study of 1981-1984
How Xylitol Fights Tooth Decay
• 3 year study
• 690 Hungarian students
• Test groups:
• Control - fluoridated toothpaste
• Fluoride in milk
• Xylitol 20 grams/daily in candy spread out during the day
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Belize City Xylitol Chewing Gum Study 1989-1994
• Belize study conducted by the U of Michigan
• 1277 students divided into 4 groups• 40 month study
• 100% xylitol gum- dramatic decrease in tooth decay
How Xylitol Fights Tooth Decay
Mäkinen, K., J Dent Res, 1995
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Belize City Xylitol Chewing Gum Study 1989-1994
• Five years later, follow-up study by University of Washington
• 70% reduction in tooth decay - xylitol
• Xylitol changes oral micro-flora
How Xylitol Fights Tooth Decay
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
What’s the difference between a
train
and a teacher?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
while a train says "CHEW CHEW!"
Teacher says "spit out your gum"
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
0.0
0.6
1.2
1.8
2.4
Control 1 Gum 2 Gums 3 GumsXylitol Control
Frequency of xylitol use is important
• Two-year study in Finland
• 172 students
• Best - three times daily
• Better - Strive for Five
How much? How often?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Frequency of xylitol use is important
• Chew only five minutes or less
• Not a recreational chewing gum
• When flavor is gone, all the xylitol is released
• With a high carbohydrate diet - more xylitol
needed
How much? How often?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Tooth Eruption
• Xylitol enhances early mineralization • Xylitol inhibits initial colonization by S. mutans
Opportunity to establish long-term protection
How Xylitol Fights Tooth Decay
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Avoid Strep mutans until age two = less decay
• Harmless, non-acidogenic bacteria will colonize
• Harder for the Strep mutans to get a foot-hold
Xylitol and the Mother-Child Relationship Mother chews xylitol for child’s first two years
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Parent xylitol use stops vertical transmission of Strep mutans
• Restorative need at age five, 70% lower with xylitol use
• Control group 5X the risk of Strep mutans colonization
Söderling, E., J Dent Res, 2000; Caries Res 2001; Finnish Dent J, 2006
Xylitol and the Mother-Child Relationship Mother chews xylitol for child’s first two years
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Preventing The Vertical Transmission of the Streptococcus mutans Bacteria
• Two year study • 169 new mothers • Varnishes at 6,12, & 18 months
• Xylitol used 3-5 times a day
• Children: no varnish, no xylitol 0.0
17.5
35.0
52.5
70.0
fluoride chlorhexidine xylitol
Colonization Percentages
Söderling, E., JDR Vol 79 # 3, 2000
Xylitol use by mothers has long-term benefits
Xylitol Superior to Fluoride Varnish & CHX Varnish
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Child’s first dental visit
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Benefits of xylitolReduces bacterial plaque 50%
Reduces caries from 60% to 85%
Elevates pH - saliva remineralizes enamel
Prevents acid production by bacteria
Promotes mineralization and remineralization
Prevents ear infections, allergies and asthma
Promotes healing of open wounds
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
My Big Fat Greek Wedding
Put some Windex on it!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Understand how sugar impacts oral and systemic
Describe how sugar influences inflammation
Understand the sugar industry coverup
Apply a 3-step approach to perio treatment
Implement a radical change in approach to health
Using our detective skills…
1.
2.
3.
4.
5.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
3-STEP APPROACH
1. Identify the real cause of disease
2. Decide how healthy you want the patient to be and how healthy the patient wants to be
3. Be an Oral Health Coach
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Is the cause poor OHI or sugar?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
How healthy can you get this mouth?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
On a scale of 0 to 10,how healthy is your mouth?
On a scale of 0 to 10,how healthy do you want your
mouth to be?OHEHIR Yankee 2019 why gums bleed - February 2, 2019
It takes more than two encounters per year to coach
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Understand how sugar impacts oral and systemic
Describe how sugar influences inflammation
Understand the sugar industry coverup
Apply a 3-step approach to perio treatment
Implement a radical change in approach to health
Using our detective skills…
1.
2.
3.
4.
5.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Radical Change in Approach to Oral Health
Focus on Health Outcomes
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Radical Change in Approach to Oral Health
Change Diet
Keep Active
Manage Stress Levels
PLUS
OHI CoachingOHEHIR Yankee 2019 why gums bleed - February 2, 2019
Steps to help reduce inflammation:
Change Diet1. Limit processed foods and drinks2. Read food labels3. Choose whole-grain carbs4. Eat more fruits and vegetables5. Eat lots of antioxidant-rich foods
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
#1 - Eliminate Soda
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Time to reduce sugar intake
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
How many sweets are in the break room at your office?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Read labels - look for carbohydrates and added sugars
• No daily requirement for sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Nutritional Coaching
Grass fed, organic beef Free range, organic chicken Organic dairy productsSustainable farming Real food, not processed
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Steps to help reduce inflammation:Keep active
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Steps to help reduce inflammation:
Manage Stress Levels
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
You are an oral health coach
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Understand how sugar impacts oral and systemic
Describe how sugar influences inflammation
Understand the sugar industry coverup
Apply a 3-step approach to perio treatment
Implement a radical change in approach to health
We used our detective skills…1.
2.
3.
4.
5.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019
• Expand your view of oral/systemic link
• Think differently to get different results
• See yourself as an oral health coach
My goals for you from today’s class…
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019