why do gums bleed? › ... › 2016 › 04 › ...gums-bleed.pdf2009 - stone age diet • no oral...

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



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…

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Why do gums bleed?

Is it really poor oral hygiene?Where does the blood come from?


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


1. Excess AGE production

2. Increased gut permeability

3. Higher “bad” LDL

4. Weight gain

5. Addictive

Sugar & Refined Carbohydrates


Now I’m going to lay out the clues to prove my case


• 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…


Hunter/Gatherers did not feed their oral bacteria, no oral hygiene needed


Oral hygiene became necessary when the Western Diet of refined

carbohydrates was introduced.


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


Dr. Weston Price


Dr. Weston Price After Parents Adopted a Western Diet


Humans do not need sugar No physical need to consume sugar


• Diet of the Alaskan Inuits

• Fish protein and fat

• Diet of the Swiss mountain folk

• Dairy, meat

No SugarNo Refined Carbohydrates


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


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


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


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


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








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Sugar Topical and Systemic Effects


Topically, sugar feeds acid producing bacteria leading to caries


Topically, sugar wicks into subgingival area feeding bacteria


Dietary sugar is measured in GCF, which also feeds subgingival bacteria

Systemically, sugar directly impacts oral bacteria


Systemically, sugar impacts periodontal health on a cell level & leading to bleeding


There is an oral - systemic connection


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


There is a connection between oral disease and systemic disease.

Oral disease does not cause systemic disease

The common issue is sugar








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• Infection - triggered by bacterial biofilm

• Inflammation - response of the immune system and more

Cause of periodontal disease


Biofilm

good

bad

ugly

non-cariogenic, supragingival

acid producing strep mutants, subgingival anerobes

biofilm over an open wound


Biofilm - it’s a complex ecosystem worthy of our respect


Too bad plaque biofilm isn’t

green!


What do your teeth feel like

when you wake up?


Does it feels like the teeth

are wearing sweaters?


Does it feels like the army

marching through?


Does it feels like the

bottom of a bird cage?


Or does it feel just

plain fuzzy!


Babies are born nearly germ-free

How do I getbacteria in my mouth?


Bacteria: transferred from parent to child








What happens when it falls on the floor?


Bacteria are spread by the

family dog


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



fimbria

fibrillsText

Quorum sensing

Biofilm Formation


fibrillsText

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



Biofilm grows in a fluid

environment: saliva and

crevicular fluid



Bacterial toxic waste subgingivally includes endotoxins that penetrate pocket walls and trigger the

immune response destroying tissue and bone


•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


WARNINGUgly biofilm


photo courtesy of Dr. Randall WolcottOHEHIR Yankee 2019 why gums bleed - February 2, 2019

Medicine Learns from Dental Hygiene


photos courtesy of Dr. Randall Wolcott


Biofilm causes ear infections


Medicine Learns from Dental Hygiene


Look at your Toes Squirt your Nose


All are biofilm diseases


More prevalent

Forms more readily

More acidogenic

Interdental Plaque Biofilm


Interdental Plaque Biofilm

Dr. Oscar H. Arribasplata, Lima, PeruOHEHIR Yankee 2019 why gums bleed - February 2, 2019

Col Area Isn’t Keratinized


Biofilm - it’s a complex ecosystem worthy of our respect

Would you agree?


Pathogenesis Immune Response

Why do gums bleed?


White blood cells destroy connective tissue and bone on the way to the sulcus

diagram from text: Periodontal Disease, Page,

Schluger and Youdalis,

Pathogenesis


Translate cell biology

into cartoons

bacterial endotoxins bacterial antegens


Endotoxin from bacteria Toxic waste of the bacteria Triggers the immune response

Bacterial endotoxins


Endotoxin from bacteria Toxic waste of the bacteria Triggers the immune response

Permeation Agents VSCs Volitle Sulfur Compounds

hydrogen sulfide and

methal mercaptan


• 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


PMN

Endothelial cells separate to allow PMNs to exit the

blood vessel

PMN

PMN

PMN

PMN


MMP

prostaglandin(pre-term birth) interleukin

collagenase

Breakdown of the active transport

PMNs release chemical machetes


In aggressive cases, the PMNs

are over active and produce more than the normal amount

of destructive chemicals

PMNs release chemical machetes


Breakdown of GAGS Glue

glycosamino-glycans

Breakdown of

active the transport system


Krebs CycleATPs

With oxygen - 24-28 ATP molecules from one molecule of glucose converted to pyruvate, plus the 4 molecules from glycolysis.


Mitochondria

Mitos means thread Chondria means grains


Mitochondria

Not just one mitochondria per cell, but as many as 2,000 in each liver cell

(20% of the cell)


Inflammation research…








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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


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



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



Too much refined carbohydrate = mitochondrial dysfunction

•Oxidative stress

•DNA alternations in the mitochondria

•Reduced numbers of mitochondria



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



Impacting both periodontitis and systemic disease

• Systemic oxidative stress affects • liver, adipose tissue, pancreas

• Mitochondrial dysfunction


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



Immature epithelial

cells

granulation tissue


Infection and Inflammation


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


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


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




Thrombus can happen in any vessel

• Usually self regulated and healing occurs

• Serious when it affects heart or brain



• Sugar triggers insulin resistance

• Sugar lowers good cholesterol

• Sugar causes inflammation in the arteries

• All of these - direct causes of heart disease


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


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


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.”



Dr. Robert Lustig - the connection is sugar


The common issue is sugar


People don’t know how much sugar they eat


• Monosaccharides - building blocks of carbs

• Glucose - body’s preferred carbohydrate

• Fructose

• Disaccharide

• Sucrose = glucose + fructose = table sugar


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!


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


Recommended Daily Allowances

American Heart Association & World Health Organization

5%-10% of daily calories fromadded sugars


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


Humans do not need sugar No physical need to consume sugar


Sugar is addictive - the more we eat, the more we want!


Nearly every packaged food contains sugar

sucrose high fructose corn syrup

dextrose honey

maple syrup


• 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


Foods containing sugar that will surprise you

Bacon Green Beans

Table Salt Tomato Sauce Salad Dressing


If patients with 5mm bleeding pockets don’t want to clean between their teeth, simply

cut out all added sugar!


Would you agree we need to eliminate added

sugar from our diet?


• 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








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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


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.


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


“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)

•



“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)



They considered refined carbohydrates (white flour and sugar) to be the most transformed or refined food, and therefore the most dangerous.


The Common Cause Theory flour and sugar cause both

dental diseases and systemic diseases


The opposing theory Fat was the culprit


Ancel Keys, 1904-2004

He was a scientist, studied business, political science,

zoology and oceanography.

He researched

starvation, created K-rations.


President Eisenhower

1955 he suffered a heart attack

Dr. Paul White’s advice

1. stop smoking

2. cut down on fat & cholesterol


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.


Fatty foods are unhealthy

President EisenhowerDr. White Dr. Keys


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.


Based on the Low Fat Diet

• No more steak, bacon, butter, eggs or cheese

• Take fat out of processed food and add sugar



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)


Ancel Keys studied 6 countries

Data was collected from 22

countries!


He selected data from only 6 countries showing a linear relationship.

Masai - S KenyaInuit - Arctic Rendille - NE KenyaTodelau - S Pacific



He bullied other professionals.

Not only did Ancel Keys cheat on the research, he was a bully!


“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)

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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


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


Does this make sense to you?

A diet causing dental disease will prevent heart disease?



Dental disease considered a local infection to be treated/prevented with fluoride, OHI, restorations, sealants, etc.



The Caries Research Foundation (CRF)

Sugar Industry

Dental Association

It’s not about reducing sugar in the

diet - all about improving oral hygiene!


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


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


From then on, research conclusions focused on brushing, flossing, fluoride and restorative dentistry - not on sugar!


Tobacco Industry Cover-Up?


Timeline

1957 Yudkin warned about sugar and heart disease

1967 NEJM published the reviews pointing to fat as the cause of heart disease


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


1972


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


Timeline

2004 Dr. George Gray LSU showed increased obesity mirrored the increased use of HFCS

2009 Hujoel’s JDR article appeared


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.”


Biofilm Infection Systemic Inflammation

Why do gums bleed?

Fermentable carbohydrate diet


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



… but we need an alternative to sugar for the occasional

sweet.


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


• Xylitol - 5 carbon polyol

• Erythritol - 4 carbon polyol

• Stevia - extracted from stevia leaves

Alternatives to sugar you will like


Acesulfame potassium (Ace-K) Aspartame Saccharin Sucralose (Splenda)

Artificial Sweeteners to Avoid


Biggest Game Changer in DH?

Reduces plaque biofilm by 50%!


Biggest Game Changer in DH?

Reduces plaque biofilm by 50%! Doesn’t feed bacteria

Reduces acid production No insulin needed

Enhances remineralization


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


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


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


• Side Effects

• gastric upset when

eaten in large amounts

too quickly

Xylitol the good sugar


• Side Effects

• digested as a fiber

• pulls water out of tissue

cells, thus diarrhea



•Glycemic level of 7

Glucose 100 Table sugar 68

Honey 55 Fructose 19

Xylitol 7

http://www.glycemicindex.com/



• Does not raise insulin levels

• Does not use insulin for metabolism

• Safe for diabetics



• 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



• 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 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


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


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


0.0

2.5

5.0

7.5

10.0

Control Fluoride Xylitol

DMFS Caries Increment

Hungarian Study of 1981-1984


• 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


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


Mäkinen, K., J Dent Res, 1995


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



What’s the difference between a

train

and a teacher?


while a train says "CHEW CHEW!"

Teacher says "spit out your gum"


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?


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?


Tooth Eruption

• Xylitol enhances early mineralization • Xylitol inhibits initial colonization by S. mutans

Opportunity to establish long-term protection



• 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


• 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


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


Child’s first dental visit


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


My Big Fat Greek Wedding

Put some Windex on it!








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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


Is the cause poor OHI or sugar?


How healthy can you get this mouth?


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








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Radical Change in Approach to Oral Health

Focus on Health Outcomes


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


#1 - Eliminate Soda


Time to reduce sugar intake


How many sweets are in the break room at your office?


• Read labels - look for carbohydrates and added sugars

• No daily requirement for sugar




Nutritional Coaching

Grass fed, organic beef Free range, organic chicken Organic dairy productsSustainable farming Real food, not processed


Steps to help reduce inflammation:Keep active


Steps to help reduce inflammation:

Manage Stress Levels


You are an oral health coach







We used our detective skills…1.

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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…


why do gums bleed? › ... › 2016 › 04 › ...gums-bleed.pdf2009 - stone age diet • no oral...

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