April 2016 was the first time a dentist ever told me there was something wrong with my gums. He gave me a very scary lecture and insisted on a full periodontal deep cleaning, but I sought a second opinion. The second dentist took a more cautious approach. We did regular cleanings for a while, and he did a bit of scaling, but mostly we took it easy on my gums while I maintained good hygiene. Things didn’t really get better, but they didn’t get worse either.
Fast forward two years, I moved to a new town and found a new dentist, and received the same pressure to do a full periodontal scaling and root planing treatment. This time, I relented.
The treatment was quite painful and time-consuming. Afterward, I continued to gently treat my gums to meticulous daily hygiene, but the pain didn’t let up. At three months, I went in to see the periodontist, who stabbed me viciously with the measuring probe and reported that my pocket depths had actually gotten worse. She told me she wanted to do some very expensive surgeries and that eventually I was going to lose teeth no matter what I did. She even told me, unironically, that at some point even she would need gum surgery “even though I know all the right things to do.” Honey, if that’s the outcome you’re expecting, then you most certainly do not know all the right things to do.
After researching the “osseous periodontal surgery” she had recommended, I realized that it’s 2018 and the standard of care for diseased gums is to cut them out of your head. Nope, not for me. I headed to Pubmed and started designing a rehab program for myself.
At the time of this writing, it has been just under one month since I began phasing in these strategies. At this point, the gum pain which I was experiencing about 85% of the time is now only present about 10% of the time, so I am optimistic. In any case, the following strategies are evidence-based and subject to observation and change.
What is Periodontal Disease?
The dentists tell me again and again they want to “clean the bacteria” out of my mouth. Which bacteria? They don’t know. In fact, periodontal disease appears to be a multifactorial condition including both bacterial instigators and immunological maladaption. Here’s one of many nice descriptions I found in the literature:
Periodontitis is a complex chronic inflammatory noncommunicable disease, initiated by the development of a dysbiotic microbial plaque biofilm below the gingival margin. Whilst the pathogenic biofilm is a “necessary cause” of periodontitis, it is insufficient on its own to cause the disease, and a destructive immune-inflammatory response is a key to the translation of risk to destructive events. Other exposures or “component causes” include individual genetic predisposition, lifestyle (including smoking and nutrition), and environmental factors. (Periodontology 2000. 2018 Oct;78(1):129–153. doi: 10.1111/prd.12233.)
Dental Hygiene Routine
- Brushing 2–3x/daily with extra soft perio brush (extra fine bristle tips help clear debris below the gumline)
- Dental pocket irrigation — 1x/day using waterpik flexible pocket piks and an antimicrobial, tartar-dissolving solution consisting of Periogen (1, 2, 3) and Therasol,
- Enriched Oil Pulling — 10–30 minutes 2–3x/day, coconut oil (which contains 16% myristic acid) with added oregano oil, quercetin (2), lactoferrin, ascorbate, curcumin, Co-Q10, aspirin (see below), and fat-soluble vitamins.
- Oral Probiotics — discourage colonization by pathogenic bacteria and decrease pocket probe depth — useful species include lactobacilii, rheuteri
- Gengigel topical or subgingival application following all other dental maintenance procedures
- Intermittent fasting — decreases autoimmune activity by restoring microbial balance, decreasing inflammation, promoting cellular regeneration
- Low carbohydrate diet — reduces gingival & periodontal inflammation. I follow a highly nutritive, anti-inflammatory paleo diet.
- Exercise — daily HIIT, decreases inflammation, improves bone remodeling, reduces pocket depth & bleeding
- Sunbathing — ideally 20mins/day, improves calcium mobilization, immune response & healing
- Self-hypnosis — 3x/wk listening to self-designed script for inflammation control and enhanced wound healing
- Vitamin D (antibacterial, deficiency is shown to cause periodontitis and supplementation is shown to reduce its severity)
- Lactoferrin — systemic antimicrobial
- Hydroxyapatite — perfect calcium / phosphorous ratio, bioavailability not well established
- Magnesium before bed — improves calcium uptake & utilization, supplementation reduced periodontal attachment loss
- Vitamins D3/K2/A/E as tocotrienol
- Omega-3 fish oil 1g EPA/DHA 2x/day (as triglyceride) (effects may be potentiated by aspirin)
- BCM-95 Bio-curcumin turmeric extract 2x/day
- Ubiquinol (enhances mitochondrial respiration and suppresses periodontal inflammation)
- Vitamin C & B-complex
- Aspirin (enhances osteogenic stem cell activity, activates inflammation resolution pathways, reduces risk of periodontal attachment loss in humans, promotes recovery from periodontitis even in smokers!)
There are some additional things I’m looking into and experimenting with. One is DMSO: in addition to exerting its own anti-oxidant and anti-inflammatory effects and being bacteriostatic or bactericidal at concentrations of 5–50%, DMSO appears to be an effective penetration-enhancer for localized delivery of both hydrophilic and lipophilic drugs and vitamins, and is safe for application to a variety of external and internal tissues. The stuff tastes godawful. I’m looking at developing some kind of concentrated gel to deliver between the teeth and into the periodontal pockets, to leave in place as long as I can tolerate.