U of Minn 1967
WHY DO GUMS BLEED? The Impact of Sugar on Systemic Health
Trisha E. O’Hehir, MS, RDH Phone: 520-444-2279 [email protected]
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!
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Using our detective skills…
1. Understand how sugar impacts oral and systemic Why do gums bleed?
2. Describe how sugar influences inflammation
3. Understand the sugar industry coverup
4. Apply a 3-step approach to perio treatment Is it really poor oral hygiene? 5. Implement a radical change in approach to health Where does the blood come from?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 1. Natural inflammatory Sugar & Refined Carbohydrates response destroys tissue around blood vessels - 1. Excess AGE production granulation tissue. Easily 2. Increased gut permeability penetrated. 3. Higher “bad” LDL 2. Sugar compromises the mitochondria in every cell. 4. Weight gain
3. Blood sugar causes damage 5. Addictive
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Now I’m going to lay out the clues to My goals for you from today’s class… prove my case • Expand your view of oral/systemic link
• Think differently to get different results
• See yourself as an oral health coach
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Hunter/Gatherers did not feed their oral Oral hygiene became necessary bacteria, no oral hygiene needed when the Western Diet of refined carbohydrates was introduced.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Dr. Weston Price 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
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Dr. Weston Price After Parents Adopted a Western Diet Humans do not need sugar No physical need to consume sugar
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No Sugar 2009 - Stone Age Diet - Switzerland No Refined Carbohydrates • 10 subjects in a controlled Stone Age environment
• Provided a small supply of whole grain barley, • Diet of the Alaskan Inuits wheat and spelt, some salt, herbs, honey, milk and meat from domestic goats and hens. • Fish protein and fat • Not enough food for the 4 week study • Diet of the Swiss mountain folk • They foraged for berries, • Dairy, meat • edible plants and fishing
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 2009 - Stone Age Diet 2009 - Stone Age Diet
• No oral hygiene products or tools • Plaque increased, as expected
• Stone Age clothes, tools and huts • Surprised by reduction in gingivitis & probing depths
• Filmed for a TV special • Bleeding upon probing reduced from 35% to 13%
• Sports medicine physicians monitored • Bacteria changed to a balance favoring health rather than disease
• Dental examinations before and after
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Pottenger’s Cats Pottenger’s Cats A Study of Nutrition-Cooked vs Raw Meat Milk: raw, pasturized, evaporated or First generation - end of life, lazy with sweetened condensed degenerative diseases Cats on raw mild did better than the others that Second generation - degenerative diseases by showed degeneration similar to the meat study mid-life, loosing coordination
Third generation - degenerative diseases early in Conclusion: missing protein necessary for growth life, born blind, weak, shorter lifespan, fewer and development of healthy cats offspring
All died out by fourth generation
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Using our detective skills… Sugar 1. Understand how sugar impacts oral and systemic Topical and Systemic Effects 2. Describe how sugar influences inflammation
3. Understand the sugar industry coverup
4. Apply a 3-step approach to perio treatment
5. Implement a radical change in approach to health
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Topically, sugar feeds acid producing Topically, sugar wicks into subgingival area bacteria leading to caries feeding bacteria
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Systemically, sugar impacts periodontal Systemically, sugar directly impacts oral bacteria health on a cell level & leading to bleeding
Dietary sugar is measured in GCF, which also feeds subgingival bacteria
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Perio-Systemic Mechanisms Blood vessel walls altered by There is an oral - systemic connection These are secondary to Immunological Soundingperiodontal - disease activates endothelial cells dietary sugars
! Invade endothelial cells, trigger immune response
! Immunological Sounding ! Immune response to PD, activation of endothelial cells
Pathogen Trafficking ! TransportCytokine of bacteria movement, activation of endothelial cells
! Auto-immune Reaction ! Bacteria elicit specific antibodies, react with host cells Microbial Invasion Auto-immune Reaction bacteria elicit antibodies
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Using our detective skills…
There is a connection between oral 1. Understand how sugar impacts oral and systemic disease and systemic disease. 2. Describe how sugar influences inflammation Oral disease does not cause 3. Understand the sugar industry coverup systemic disease 4. Apply a 3-step approach to perio treatment The common issue is sugar 5. Implement a radical change in approach to health
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Cause of periodontal disease Biofilm
• Infection - triggered by bacterial biofilm good non-cariogenic, supragingival
bad acid producing strep mutants, • Inflammation - response of the immune subgingival anerobes system and more
ugly biofilm over an open wound
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Biofilm - it’s a complex ecosystem worthy of our respect
Too bad plaque biofilm isn’t green!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 What do Does it your teeth feels like feel like the teeth when you are wearing wake up? sweaters?
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Does it feels Does it feels like the army like the marching bottom of a through? bird cage?
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Babies are Or does it born nearly germ-free feel just plain fuzzy!
How do I get bacteria in my mouth?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Bacteria: Bacteria: transferred from parent to child transferred from parent to child
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Bacteria: Bacteria: transferred from parent to child transferred from parent to child
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Bacteria are spread by the family dog
What happens when it falls on the floor?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 It’s true, moms spit on their kids either directly or on a Kleenex
Bacteria are spread between partners by kissing
Troil-Lindén et al JCP, 1996
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fimbria Biofilm Formation
fibrills Text
Quorum sensing
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fibrills Text
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 1/3 bacteria 2/3 slime - to absorb water and trap particles
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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 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 •Biofilm - the good, the bad and the ugly
good non-cariogenic, supragingival WARNING
bad acid producing strep mutants, Ugly biofilm subgingival anerobes
ugly biofilm over an open wound
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Medicine Learns from Dental Hygiene
photo courtesy of Dr. Randall Wolcott OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Biofilm causes ear infections
photos courtesy of Dr. Randall Wolcott
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Medicine Learns from Look at your Toes Dental Hygiene Squirt your Nose
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All are biofilm Interdental Plaque Biofilm diseases More prevalent
Forms more readily
More acidogenic
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Interdental Plaque Biofilm Col Area Isn’t Keratinized
Dr. Oscar H. Arribasplata, Lima, Peru
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Biofilm - it’s a complex ecosystem Pathogenesis worthy of our respect Immune Response Why do gums bleed?
Would you agree?
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Pathogenesis bacterial endotoxins Translate bacterial antegens
White blood cells cell biology destroy connective into tissue and bone on the way to the cartoons sulcus
diagram from text: Periodontal Disease, Page, Schluger and Youdalis,
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Endotoxin from bacteria Bacterial endotoxins Endotoxin from bacteria Toxic waste of the bacteria Toxic waste of the bacteria Triggers the immune response Triggers the immune response
Permeation Agents VSCs Volitle Sulfur Compounds
hydrogen sulfide and methal mercaptan
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 • Signals alert the Vasodilation immune system
• Mast cells around the blood vessels Endotoxins also trigger a cascade of immune release histamine, responses to protect the causing body from bacteria and vasodilation viruses
• PMNs are sent to
•
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PMNs release chemical machetes
MMP PMN PMN Endothelial cells separate prostaglandin PMN to allow PMNs to exit the (pre-term birth) blood vessel PMN interleukin PMN collagenase
Breakdown of the active transport
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PMNs release chemical machetes Breakdown of In aggressive GAGS Glue cases, the PMNs glycosamino- are over active and glycans produce more than the normal amount Breakdown of of destructive active the chemicals transport system
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Mitochondria Krebs Cycle ATPs
With oxygen - 24-28 ATP molecules from one molecule of glucose converted to pyruvate, plus the 4 molecules from glycolysis. Mitos means thread Chondria means grains
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Mitochondria Inflammation research…
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 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Using our detective skills… 1. Understand how sugar impacts oral and systemic Mitochondria 2. Describe how sugar influences inflammation
3. Understand the sugar industry coverup •Uses sugar and oxygen to generate energy for the cell
4. Apply a 3-step approach to perio treatment •Energy stored as chemical bonds
•With too much “sugar” there is an increase in oxidative 5. Implement a radical change in approach to health stress which leads to inflammation
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Mitochondria Mitochondria Goal is equilibrium Goal is equilibrium
•Oxidation - giving away an electron With adequate oxygen and good nutrition, the REDOX reactions antioxidant defenses will control free radicals the keep •Reduction - gaining an electron ROS within the cells where they were produced. Generate unstable free radicals = ROS When free radicals and ROS exit the cell = inflammation ROS will strip electrons from other molecules Leaving more unstable free radicals = domino effect
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Mitochondria Mitochondria Goal is equilibrium Goal is equilibrium
Too much refined carbohydrate = mitochondrial dysfunction Primary Source of ROS
•Oxidative stress • In health, 90% of oxygen in a cell is absorbed
•DNA alternations in the mitochondria • Only 1-5% of oxygen is converted to ROS
•Reduced numbers of mitochondria • Under normal circumstances - antioxidants enough to handle ROS
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Mitochondria Inflammation research… Goal is equilibrium
Impacting both periodontitis and systemic disease
• Systemic oxidative stress affects • liver, adipose tissue, pancreas Mitochrondial function is critical to each individual cell of the body and to the person as a • Mitochondrial dysfunction 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 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Limited ATPs of energy requires a big decision
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Immature epithelial cells
granulation tissue
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Infection and Bleeding is not normal Inflammation It’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 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Bleeding is not normal Sugars in the Oxidative Stress It’s a sign of infection blood stream bond with protein or fat producing advanced glycation end-products (AGE)
Fructose - 10 X glycation than Oxidative Stress glucose
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The Common Cause: Sugar 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
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The pathogenesis of heart disease
Thrombus can happen in any vessel
• Usually self regulated and healing occurs • Serious when it affects heart or brain
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 The pathogenesis of heart disease The pathogenesis of diabetes
• Sugar triggers insulin resistance • A person gets fat - eating sugar and flour • Sugar lowers good cholesterol • Fat cells become inflamed • Sugar causes inflammation in the arteries • Inflammation causes insulin resistance • All of these - direct causes of heart disease • Body has to make more insulin • Eventually the pancreas stops making insulin and diabetes follows
Thomas Van Dyke, Scientific American, 2016
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The pathogenesis of diabetes According to Dr. Gary Taubes author of “Why We Get Fat” • Fat - reserve energy supply “Obese people are not fat because they are • Fat takes instructions from insulin overeating and sedentary – they are overeating • Highly refined carbohydrate diet breaks down and sedentary because they are fat, or getting fast leading to increased insulin levels fatter.” • Fat gets signal to suck energy out of blood • High insulin levels=weight gain, hunger, fatigue
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Dr. Robert Lustig - the connection is sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 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
• Monosaccharides - building blocks of carbs
• Glucose - body’s preferred carbohydrate
• Fructose
• Sucrose = glucose + fructose = table sugar
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People don’t know how much sugar they eat Recommended Daily Allowances
Women - 6 teaspoons, 25 grams Sugar consumption:
1822 — 45 grams per day, 1/8th to 1/4 cup (1.6 oz) Men - 9 teaspoons, 38 grams
2012 — 152 grams per day, 3/4 cup (5.4 oz) Children - 3-6 teaspoons, 12-24 grams
130 pounds per year/person!
American Heart Association & World Health Organization
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Recommended Daily Allowances 12 oz Coke contains 5%-10% of daily calories from 9 teaspoons of HFCS added sugars 38 grams of added sugar
Women - 6 teaspoons, 25 grams Men - 9 teaspoons, 38 grams Children - 3-6 teaspoons, 12-24 grams American Heart Association & World Health Organization
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Humans do not need sugar Sugar is addictive - the more we No physical need to consume sugar eat, the more we want!
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61 Names for Sugar Nearly every packaged food contains sugar
Agave nectar • Confectioner's sugar Golden sugar • Panocha • Barbados sugar • Corn sweetener • Golden syrup • Powdered sugar • Barley malt • Corn syrup • Grape sugar sucrose • Barley malt syrup • Corn syrup solids • HFCS (High-Fructose Corn Syrup) • Beet sugar • Date sugar •Honey • Raw sugar • Brown sugar • Dehydrated cane juice • Icing sugar • Refiner's syrup high fructose corn syrup • Buttered syrup • Demerara sugar • Invert sugar • Rice syrup • Cane juice • Dextrin Malt syrup • Saccharose dextrose • Cane juice crystals • Dextrose • Maltodextrin • Sorghum Syrup • Cane sugar • Evaporated cane juice • Maltol • Sucrose • Caramel • Free-flowing brown sugars Maltose • Sugar (granulated) honey • Carob syrup • Fructose • Mannose • Sweet Sorghum • Castor sugar • Fruit juice • Maple syrup • Syrup maple syrup • Coconut palm sugar • Fruit juice concentrate • Molasses • Treacle • Coconut sugar • Glucose • Muscovado • Turbinado sugar • Glucose solids • Palm sugar • Yellow sugar
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 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
Would you agree we need to eliminate added If patients with 5mm bleeding sugar from our diet? pockets don’t want to clean between their teeth, simply cut out all added sugar!
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Using our detective skills… Benefits of reducing sugar and flour 1. Understand how sugar impacts oral and systemic
2. Describe how sugar influences inflammation • Reduced plaque biofilm formation • Reduced acid production by bacteria 3. Understand the sugar industry coverup • Stronger blood vessels and capillaries Apply a 3-step approach to perio treatment • Better general health 4. • Weight loss 5. Implement a radical change in approach to health
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 The oral systemic link The Common Cause Theory connected to sugar consumption 1950-1960 Dr. Phillipe Hujoel, 2009 JDR Excessive consumption of fermentable Sugar is the reason gums bleed. carbohydrates led first to dental diseases and then Six animal studies confirm systemic diseases. Dental disease was an alarm In humans, add two sugary bell for systemic disease. drinks per day and increase pocket depth by 0.4mm -1965
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The Common Cause Theory The Common Cause Theory 1950-1960 Two researchers - Cleave and Yudkin Excessive consumption of fermentable carbohydrates led first to dental diseases and then systemic diseases. Dental disease was an alarm bell for future systemic disease.
•
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The Common Cause Theory The Common Cause Theory
“From an evolutionary point of view, the refined “My research on coronary heart disease has carbohydrates…are always the foods most likely convinced me beyond doubt that sugar plays a to be at fault (for the diseases of civilization), considerable part in this terrifying modern and not the fats.” 1975 epidemic.” 1972 Thomas Cleave (1906-1983) John Yudkin (1910-1995)
•
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 The Common Cause Theory They considered flour and sugar cause both refined carbohydrates dental diseases and systemic diseases (white flour and sugar) to be the most transformed or refined food, and therefore the most dangerous.
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The opposing theory Fat was the culprit
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Ancel Keys, 1904-2004 President He was a scientist, Eisenhower studied business, political science, 1955 he suffered a heart attack zoology and oceanography. Dr. Paul White’s advice
He researched 1. stop smoking starvation, 2. cut down on fat created K-rations. & cholesterol
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Ancel Keys was charismatic, popular and had a big following.
President Eisenhower He was so popular at Dr. White Dr. Keys the time that he was featured on the cover of Fatty foods are Time Magazine. unhealthy
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Saturated fat makes you fat and caused heart disease Based on the Low Fat Diet • No more steak, bacon, butter, eggs or cheese He postulated that fats caused systemic disease, thus advocating a diet high in fruits, veggies and fermentable carbohydrates instead. • Take fat out of processed food and add sugar
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Standard American Diet (SAD)
Increased risk of diabetes, heart disease, stroke, cancer, intestinal disorders – just about any illness – the standard American Diet has them all.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 He selected data from only 6 countries Ancel Keys studied 6 countries showing a linear relationship.
Data was collected from 22 Masai - S Kenya countries! Inuit - Arctic Rendille - NE Kenya Todelau - S Pacific
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Not only did Ancel Keys cheat on the research, he was a bully!
He bullied other professionals.
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The Common Cause Theory Ancel Keys destroyed the careers of both Cleave and Yudkin
“My research on coronary heart disease has The evidence for sucrose as the convinced me beyond doubt that sugar plays a “greatest killer” in Western societies considerable part in this terrifying modern is “utter nonsense” and “would epidemic.” never pass an acceptable term paper in an undergraduate course Yudkin, 1972 in home economics.” (1910-1995) Ancel Keys, 1975
•
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Saturated fat made you fat and Saturated fat made you fat and caused heart disease caused heart disease
Dental disease was simply a necessary side effect for the greater Does this make sense to you? good of preventing heart disease by decreasing fats and A diet causing dental disease will increasing sugars. prevent heart disease?
Ancel Keys, 1975
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Saturated fat made you fat and caused heart disease The Caries Research Foundation (CRF) Dental disease considered a local infection to Sugar Industry be treated/prevented with fluoride, OHI, restorations, sealants, etc. 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 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
National Institute for Dental Research National Institute for Dental Research
1971 National Caries Program - eradicate caries 78% of sugar industry submissions were within a decade incorporated into the NIDR call for research applications Sugar industry documents from 1959-71 adopted strategies to deflect attention away from sugar Research harmful to the sugar industry was omitted
Funded studies on enzymes to break up plaque and Opportunity missed to develop scientific strategies to a vaccine with questionable potential reduce sugar consumption
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Tobacco Industry Cover-Up? From then on, research conclusions focused on brushing, flossing, fluoride and restorative dentistry - not on sugar!
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Timeline Three Harvard Medical School researchers were bribed ($50,000) by 1957 Yudkin warned about the sugar industry to write literature sugar and heart disease reviews that focused on fat as the cause of heart disease rather than sugar. Published in the NEJM, 1967 1967 NEJM published the reviews pointing to fat as Cristin E. Kearns, DDS, MBA Postdoctoral Fellow the cause of heart disease UCSF School of Medicine
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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 1972 that demonstrates a hazard
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Timeline Timeline
2004 Dr. George Gray LSU 2014 American Diabetes Association showed increased obesity website stated “Experts agree that you mirrored the increased use can substitute small amounts of sugar for of HFCS other carbohydrate-containing foods into your meal plan.”
2009 Hujoel’s JDR article appeared
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Why do gums bleed? Learn more about sugar and fat Fermentable carbohydrate diet • 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 Biofilm Infection Systemic Inflammation Lustig “The Skinny on Obesity,” http:// www.uctv.tv/skinny-on-obesity
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… but we need an alternative to sugar for the occasional sweet.
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Xylitol the good sugar Best alternative Alternatives to sugar you will like
• Looks and tastes like “sugar” • broad category: carbohydrate • narrow category: polyol • Xylitol - 5 carbon polyol • 2.4 calories per gram • 40% fewer calories than other carbohydrates • Erythritol - 4 carbon polyol
• Stevia - extracted from stevia leaves
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Artificial Sweeteners to Avoid
Biggest Game Changer in DH?
Reduces plaque biofilm by 50%! Acesulfame potassium (Ace-K) Aspartame Saccharin Sucralose (Splenda)
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Xylitol the good sugar Biggest Game Changer in DH? • Most common source today is corn cobs and Reduces plaque biofilm by 50%! corn stalks Doesn’t feed bacteria • Xlear/Spry products are Reduces acid production natural and non-GMO No insulin needed Enhances remineralization • They contain no corn
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Xylitol the good sugar Xylitol the good sugar • Side Effects • dangerous for dogs • Under nourished dogs are at greatest risk • drop in blood sugar • Xylitol triggers release of insulin in dogs • liver damage • Remedy: give them sugar Never give your pets: * chocolate, coffee, caffeine * alcohol • Take them to the vet - the vet will give IV glucose * 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 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol the good sugar Xylitol the good sugar • Side Effects • Side Effects
• gastric upset when • digested as a fiber
eaten in large amounts • pulls water out of tissue
too quickly cells, thus diarrhea
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol the good sugar Xylitol the good sugar
•Glycemic level of 7
• Does not raise insulin levels Glucose 100 • Does not use insulin for metabolism Table sugar 68 Honey 55 • Safe for diabetics Fructose 19 Xylitol 7
http://www.glycemicindex.com/
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Xylitol the good sugar Xylitol the good sugar
• How it works • How it works
• 5 carbon, not 6 carbon like • Bacteria like acid environment sorbitol, mannitol, maltitol • When bacteria cannot make acids • Passes through bacterial membrane; not metabolized • cannot stick to each other or the teeth • bacterial communication disturbed • Bacteria uses energy to pump • biofilm structure is compromised the xylitol molecule out • Bacteria slide down the digestive & nasal tracks
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol dissolves established Xylitol prevents biofilm formation biofilm
Metabolism and Communication Metabolism and Communication
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol - research in Finland Xylitol - research in Finland • 1970 xylitol containing caramels, sweet rolls and beverages reduced 4-day plaque mass by 50% • Two-year meal replacement study - 85% reduction in caries • 1972 similar results after a 5-day study, dental • Difficult study to undertake and monitor students, no oral hygiene - SIMILAR RESULTS
Three test groups: Xylitol Fructose Sucrose
Turku Sugar Studies
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Xylitol - research in Finland How Xylitol Fights Tooth Decay Inhibits Plaque Accumulation and Cariogenic Bacteria • One-year chewing gum study 6.7 grams vs 67 grams resulted in 85% reduction in caries incidence compared Change in plaque weight(%) to sucrose group 60 100% • Two-week study sorbitol • S mutans digest sorbitol 40 • Gum chewed 5/day • Gums: 20 100% xylitol/ 100% xylitol xylitol sorbitol xylitol/sorbitol 0 100% sorbitol -20
6.7 grams 67 grams -40
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
How Xylitol Fights Tooth Decay How Xylitol Fights Tooth Decay
Hungarian Study of 1981-1984 10.0 Belize City Xylitol Chewing Gum Study • 3 year study 7.5 1989-1994 • 690 Hungarian students
5.0 • Test groups: • Belize study conducted by the U of Michigan
Control - fluoridated toothpaste • 1277 students divided into 4 groups • 2.5 • 40 month study • Fluoride in milk 0.0 • 100% xylitol gum- dramatic decrease in tooth decay Control Fluoride Xylitol • Xylitol 20 grams/daily in candy DMFS Caries Increment spread out during the day Mäkinen, K., J Dent Res, 1995
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
How Xylitol Fights Tooth Decay What’s the difference between a Belize City Xylitol Chewing Gum Study train 1989-1994
• Five years later, follow-up study by University of Washington
• 70% reduction in tooth decay - xylitol
• Xylitol changes oral micro-flora and a teacher?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Teacher says How much? How often? "spit out your gum" Frequency of xylitol use is important
2.4
• Two-year study in Finland 1.8
• 172 students 1.2
• Best - three times daily 0.6
• Better - Strive for Five 0.0 Control 1 Gum 2 Gums 3 Gums while a train says "CHEW CHEW!" Xylitol Control
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
How much? How often? How Xylitol Fights Tooth Decay
Frequency of xylitol use is important Tooth Eruption • Chew only five minutes or less
• Not a recreational chewing gum Opportunity to establish long-term protection
• When flavor is gone, all the xylitol is released • Xylitol enhances early mineralization • With a high carbohydrate diet - more xylitol • Xylitol inhibits initial colonization by S. mutans needed
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Xylitol and the Mother-Child Relationship Xylitol and the Mother-Child Relationship Mother chews xylitol for child’s first two years Mother chews xylitol for child’s first two years
Parent xylitol use stops Avoid Strep mutans until age • • vertical transmission of Strep two = less decay mutans
• Harmless, non-acidogenic • Restorative need at age five, bacteria will colonize 70% lower with xylitol use
• Harder for the Strep mutans to • Control group 5X the risk of get a foot-hold Strep mutans colonization
Söderling, E., J Dent Res, 2000; Caries Res 2001; Finnish Dent J, 2006
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Preventing The Vertical Transmission of the Streptococcus mutans Bacteria Child’s first dental visit Colonization Percentages Xylitol Superior to Fluoride Varnish & CHX Varnish 70.0
52.5 • Two year study
• 169 new mothers 35.0 • Varnishes at 6,12, & 18 months
17.5 • Xylitol used 3-5 times a day
• Children: no varnish, no xylitol 0.0 fluoride chlorhexidine xylitol
Söderling, E., JDR Vol 79 # 3, 2000 Xylitol use by mothers has long-term benefits
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Benefits of xylitol My Big Fat Greek Wedding Reduces 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 Put some Windex on it!
Promotes healing of open wounds
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Using our detective skills… 3-STEP APPROACH 1. Understand how sugar impacts oral and systemic
2. Describe how sugar influences inflammation 1. Identify the real cause of disease 3. Understand the sugar industry coverup 2. Decide how healthy you want the patient to be and how healthy the patient wants to be 4. Apply a 3-step approach to perio treatment 3. Be an Oral Health Coach 5. Implement a radical change in approach to health
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 How healthy can you get this mouth? Is the cause poor OHI or sugar?
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
It takes more than two encounters On a scale of 0 to 10, per year to coach 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 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Using our detective skills… Radical Change in Approach to Oral Health 1. Understand how sugar impacts oral and systemic
2. Describe how sugar influences inflammation Focus on Health Outcomes
3. Understand the sugar industry coverup
4. Apply a 3-step approach to perio treatment
5. Implement a radical change in approach to health
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 Steps to help reduce inflammation: Radical Change in Approach to Oral Health Change Diet
Change Diet 1. Limit processed foods and drinks 2. Read food labels PLUS Keep Active 3. Choose whole-grain carbs 4. Eat more fruits and vegetables Manage Stress Levels 5. Eat lots of antioxidant-rich foods
OHI Coaching
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
#1 - Eliminate Soda Time to reduce sugar intake
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
How many sweets are in the break room at your office? • 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 products Sustainable farming Real food, not processed
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
Steps to help reduce inflammation: Steps to help reduce inflammation: Keep active Manage Stress Levels
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019 We used our detective skills…
1. Understand how sugar impacts oral and systemic
2. Describe how sugar influences inflammation You are an oral health coach 3. Understand the sugar industry coverup
4. Apply a 3-step approach to perio treatment
5. Implement a radical change in approach to health
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019
My goals for you from today’s class…
• Expand your view of oral/systemic link
• Think differently to get different results
• See yourself as an oral health coach
OHEHIR Yankee 2019 why gums bleed - February 2, 2019 OHEHIR Yankee 2019 why gums bleed - February 2, 2019