Maintaining good oral and dental hygiene prevents cavities and expensive trips to the dentist, but your oral health can play a huge role in your overall health. Gum disease is one of the biggest consequences of bad oral hygiene, and it can contribute to more issues beyond your mouth. Read on to learn more about gum disease and the oral microbiome and their potential effects on Alzheimer’s disease.
What is Gum Disease?
Gum disease, also known as periodontal disease, refers to an infection of the tissue holding your teeth. Gum disease is often caused by poor dental hygiene, resulting in the buildup of plaque on the teeth. This plaque can eventually harden and turn into tartar, which can collect bacteria capable of causing further irritation and damage.1
Gum disease occurs in various stages with gingivitis as one of the mildest stages. Gingivitis is common and may be difficult to identify in some cases as it may not present with noticeable pain or discomfort. Healthy gums are pale pink in color and firm and tightly fitted around the teeth, but gingivitis is often characterized by swollen, puffy gums that appear dark red. Other common signs and symptoms of gingivitis include:
- Gums that bleed easily when you floss or brush
- Receding gums (making your teeth appear longer
- Tender gums
- Consistent bad breath2
If left untreated, gingivitis can advance to periodontitis, a more serious form of gum disease that can cause further damage to soft tissues and even begin to break down the bones that support your teeth, potentially leading to tooth loss. The infection may even affect other areas nearby, like your jaw and sinuses, or make it into your bloodstream and travel into other areas of your body. This can also result in ongoing chronic inflammation, which puts extra stress on your body and immune system.3
Understanding the Oral Microbiome
Your mouth is home to a diverse microbiota, the second largest in the body after the gut. With some reports suggesting that the oral cavity contains over 700 different species of bacteria occupying the hard surfaces of the teeth as well as the soft tissues of the gums and mouth lining, the oral microbiome presents a variety of important functions. It initiates digestion while maintaining oral and systemic health.4
Plaque, which may eventually contribute to gum disease, naturally forms when bacteria on your teeth react with starches and sugars in your food. Plaque requires daily removal because it can reform easily on its own, but it is thankfully easy to remove plaque through brushing and flossing.
Some systematic reviews have identified specific pathogens within the oral microbiota that contribute to periodontal disease.5 Furthermore, studies have found that dysbiosis in the oral microbiota may play a role in the development of periodontitis. Dysbiosis refers to a bacterial imbalance wherein the “bad” bacteria outnumber the beneficial bacteria in the mouth.6
Gum Disease and Alzheimer’s Disease
Recent studies have found that an organism associated with gum disease, Porphyromonas gingivalis, may play a central role in the development of Alzheimer’s disease. In one study, two groups of mice (30 young mice and 30 middle-aged mice) were divided into a control group or experimental group. The mice in the experimental group were infected with the P. gingivalis bacteria. Researchers measured learning and memory abilities of the mice after six weeks through the use of the Morris water maze. Results of the study found that middle-aged mice infected with P. gingivalis had more impaired learning and memory abilities compared to the uninfected control mice. Furthermore, the infected mice showed increased pro-inflammatory markers, including TNF-α, IL-6, and IL-1β, in the brain and cerebrospinal fluid. This suggests that a P. gingivalis infection could contribute to cognitive impairment issues, potentially caused by a release of pro-inflammatory cytokines.7
Evidence suggests that P. gingivalis can travel from the mouth into the central nervous system. In some rare cases, reports have found that patients with recurrent periodontitis caused by P. gingivalis infection resulted in brain abscesses.8
The potential detrimental effects of P. gingivalis are reportedly caused by toxic proteases known as gingipains. These enzymes break down important proteins involved in immune responses, such as cytokines, which allows them to elude the immune system. Gingipains also break down tau proteins in the brain, which are essential for its normal function. Studies have identified both P. gingivalis and gingipains in the brains of Alzheimer’s patients. Current scientific research is looking into methods of inhibiting and reducing gingipains.9
One study found that gingipain inhibition in mice reduced the number of P. gingivalis bacteria in the brain, blocked amyloid production (amyloid buildup in the brain is a sign of Alzheimer’s), reduced neural inflammation, and rescued neurons in the hippocampus. Gingipain inhibitors are currently being studied in humans as a treatment for Alzheimer’s.9
Preventing Gum Disease
While science continues to study ways to reduce gum disease and inhibit gingipain, here are some other proven methods of preventing periodontal disease.
1. Unsweetened Green Tea
Green tea offers a wide range of potential health benefits thanks to its high concentration of antioxidants and catechins. Catechins are a class of polyphenolic compounds that offer a variety of potential effects. Studies have found that green tea catechins and their derivatives had a moderate inhibitory effect on cysteine proteinases in P. gingivalis, which may prevent their growth.10 This suggests that drinking green tea may help to inhibit P. gingivalis to prevent gum disease.
2. Tetracycline Antibiotics
Tetracycline is a common antibiotic that is often prescribed for skin conditions, including acne and rosacea. Studies have found that tetracycline and its analogues, minocycline and doxycycline, have a noticeable inhibitory effect on the enzymatic activity of gingipains. A dose of 100 micromolar of tetracycline completely inhibited the amidolytic activity of gingipains.11 However, long term use of antibiotics may lead to antibiotic resistance and microbiome disruption.
3. Chewing Gum
A common solution for freshening up the breath, chewing gum may potentially provide help for reducing gingivitis. In a study, researchers evaluated the effects of sugared and sugar-free gum on plaque and debris in the teeth. Results of the study found that both types of chewing gum significantly reduced plaque accumulation during the 5-day study period and even reduced established plaque already existing on tooth surfaces. Chewing gum also reduced salivary debris by about 50 percent. These studies suggest that this effect mainly comes from increased saliva production.12
4. Regular Brushing and Flossing
Good dental hygiene is arguably the most important thing you can do to combat gum disease. Brushing with a toothpaste containing fluoride helps to remove plaque on the teeth and gums while strengthening your teeth to prevent cavities. Floss removes plaque and food debris from hard-to-reach areas between the teeth.
Brush your teeth for at least two minutes, two to three times per day. Many people fail to brush for that long, so consider setting a timer. Focus on massaging the gumline, where your teeth meet your gums. While brushing is effective, it generally can’t reach in areas between the teeth. This is where flossing comes in. Insert the floss between your teeth and use an up-down motion to dislodge any plaque and food particles. Curve the floss around the base of each tooth to remove any plaque under the gumline.
5. Water Flossing
Along with regular mechanical flossing, water flossing can help to remove plaque and bacteria between your teeth and in the pockets of your gums. Using water floss or a water pick regularly can help to disrupt and remove biofilm covering your teeth, which can help to prevent gingivitis.13 Biofilm refers to a layer of bacteria that can accumulate on any part of your body. Plaque is a type of dental biofilm.
The actual effectiveness of mouthwash is up for debate and still requires further research. While mouthwash may potentially kill bacteria, studies suggest that it can only kill bacteria in the outermost layer of biofilm. The bacteria in the underlying layer may then use the dead microbial biomass as a food source, allowing them to grow and spread. Results of the study found that virulence genes in P. gingivalis and P. intermedia became upregulated when in contact with the dead bacteria, suggesting increased growth and pathogenic activity.14
7. Regular Cleanings at the Dentist
Along with good oral hygiene at home, visiting your dentist for regular cleanings is foundational to preventing gum disease. While plaque can be easy to remove, they can form into tough biofilms or even harden into tartar. Tartar is much harder to remove on your own and requires mechanical removal from a dental hygienist. Your dentist can also examine your teeth for other potential problems and address them before they become more serious issues. Remember that periodontal disease can generally be reversed, but only if you treat it soon enough.
By combining the above methods you may be able to minimize gum disease and prevent any potential serious issues that could result from gum disease. Consult your dentist for more information.