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Healthy Smile And Nutrition

white-teethGot teeth? Wanna keep ‘em? Brush the ones you want to keep. The others? Might as well brush them while you’re at it. How come? Because we said so? We can do better than that. Since prevention is truly worth more than the cure, give it a go to keep periodontal disease, like gingivitis, at bay. Though the two terms are often interchanged, they are actually different conditions in the spectrum of periodontal (which means “surrounding the tooth”) disease. Gingivitis refers to inflammation of the gums from excess plaque on the teeth, often resulting in redness and swelling, and bleeding when you brush your teeth. In contrast, periodontitis is more severe and the gums pull away from the teeth to form pockets where bacteria can set up house and cause an infection. If it hurts when you chew, if your teeth are getting crooked, if they’re getting loose or overly sensitive, it’s time to see the tooth doctor. Periodontitis is rare in kids; gingivitis is not. Diligent oral hygiene that entails flossing as well as brushing, and regular professional cleaning, go the distance in the prevention of gum disease and the inflammation that comes with it. Free radicals, reactive oxygen species (ROS), and pathogenic micro-organisms can cause collagen and periodontal cell degradation. It’s been found that oral ROS can be scavenged by specific anti-oxidants, thereby reducing collagen abasement (Prakash, 2010). This doesn’t mean that a person can pop pills and forget the paste and brush, but it does allow at least one adjunctive measure to enhance their efficacy. The one we have in mind is also the one with the best reputation and subsequent publicity—Co-Enzyme Q 10, sometimes called ubiquinol, ubiquinone, or CoQ10. CoQ10 belongs to a family of substances that are fat-soluble and participate in the electron transport chain, a pathway that produces energy in the form of adenosine triphosphate (ATP), which is the stuff that fuels our cells.

For the record, number 10 is not the only coenzyme Q. This digital appellation is based on the number of isoprenoids units in the “tail” of the molecule. Isoprenoids, also called terpenoids, are generally the most common hydrocarbons in the human body. In fact, we make them at a rate of about seventeen milligrams a day, to be used in the manufacture of cholesterol and other endogenous steroids, such as the sex hormones and vitamin D. Isoprenes are found in foods. Carotenes, such as beta-carotene, lycopene and lutein are relatives. The coenzymes Q number from 1 to 12.

An enzyme is not the same thing as a coenzyme. Enzymes are proteins (usually) that increase the speed of a chemical reaction without being used up by the reaction; coenzymes are non-proteins (usually) that carry chemicals between enzymes and are continuously recycled. Levels of Co-Enzyme Q10 are depleted by the statin drugs prescribed to reduce cholesterol. This occurs because CoQ10 and cholesterol share a common pathway. When CoQ10 values are diminished, a cell’s mitochondria cannot convert food to usable energy.   What compounds the matter is that CoQ10 levels decline with age, which often is the time of life when cholesterol is mistakenly treated as an agent of disease. In some countries outside the U.S., statins are combined with CoQ10 to buffer the drugs’ side effects, namely the myopathies (Zlatohlavek, 2012) (DiNicolantonio, 2012) (Willis, 1990).

Intake of supplemental CoQ10 has benefits beyond statin amelioration. As an anti-oxidant, CoQ10 prevents damage by ROS and increases efficiency of mitochondrial energy production (Saini, 2011). That it has other significant roles in human health is secondary to the aim of this newsletter, however.  Persons with active gingival disease have been found to be deficient in Co-enzyme Q10 (Littaru, 1971) as determined by gingival biopsies (Nakamura, 1974). Because these tissue samples exhibit persistent oxidative stress, researchers inferred that CoQ10 could reverse it (Battino, 2005). Investigating leukocytes from gum tissue deficient in CoQ10, scientists found that such a coenzyme deficit could predispose this tissue to periodontitis, and that periodontitis exacerbates CoQ10 deficit (Hansen, 1976), leading to the suggestion that adjunctive use of CoQ10 will improve outcome.

Dry mouth from reduced saliva secretion, often connected to aging, was assuaged in sixty-six patients given oral doses of either ubiquinone or ubiquinol at 100 mg/day (Ryo, 2011). Is this a factor in periodontitis? Yes. Xerostomia is associated with an increase in cavities, gingival disease, and even Candida (Ram, 2011). Prevention of periodontal disease may even be accomplished with xylitol-laced chewing gum (Feio, 2005) (Curro, 2008) because of increased saliva production. Treatment with CoQ10 reduces the likelihood of long-term tooth loss, too, with the promise of reversal of symptoms. If nicotine, especially, is one’s toxin of choice, CoQ10 supplementation is indicated. Spanish investigators discovered that CoQ10 stimulated the pathway of biological mechanisms that promote bone health and growth by exciting the synthesis of powerful hormones dedicated to bone formation (Figuero, 2006). Nicotine is a catabolic oxidative agent—it breaks things down. CoQ10 intervenes.

Good nutrition is related to periodontal health. Several supplements promote the biochemistry of teeth and related bone (Folkers, 1977). For example, zinc and copper enhance immunity; vitamin C helps to prevent bleeding gums; calcium and magnesium help to prevent bone loss; and chamomile tea, though not a supplement, may sooth gum tissue. Control of plaque, therefore, is not the only step to oral health. Diet counts, as well. Topical use of CoQ10 can improve the clinical parameters in periodontal assessment and treatment can heal in a fashion labeled as “extraordinarily effective” (Wilkinson, 1975).  If topical sources interest you, there are mouthwashes and toothpastes available made with CoQ10.

Oral supplements of CoQ10 are well-tolerated. Doses of more than 100 mg a day should be separated if mild gastric effects arise. Since most of us don’t eat mammal organ meats regularly, capsules might be the most convenient form, although sardines and mackerel count as decent food sources. Vegetables have only moderate amounts of CoQ10, with spinach, broccoli and sweet potatoes leading the pack. Cooking reduces levels in all food sources. If you opt to take CoQ10 for dental health, you’ll be glad to realize the benefits we didn’t have room to mention.

References

Battino M, Bompadre S, Politi A, Fioroni M, Rubini C, Bullon P.
Antioxidant status (CoQ10 and Vit. E levels) and immunohistochemical analysis of soft tissues in periodontal diseases.
Biofactors. 2005;25(1-4):213-7.

Curro FA.
Gum chewing as an adjunct to use of medications.
J Am Dent Assoc. 2008 May;139 Suppl:6S-8S.

DiNicolantonio JJ.
CoQ10 and L-carnitine for statin myalgia?
Expert Rev Cardiovasc Ther. 2012 Oct;10(10):1329-33.

Feio M, Sapeta P.
Xerostomia in palliative care.
Acta Med Port. 2005 Nov-Dec;18(6):459-65. Epub 2006 Mar 6.

Figuero E, Soory M, Cerero R, Bascones A.
Oxidant/antioxidant interactions of nicotine, Coenzyme Q10, Pycnogenol and phytoestrogens in oral periosteal fibroblasts and MG63 osteoblasts.
Steroids. 2006 Dec;71(13-14):1062-72. Epub 2006 Oct 11.

Folkers K, Watanabe T.
Bioenergetics in clinical medicine-X. Survey of the adjunctive use of coenzyme Q with oral therapy in treating periodontal disease.
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Hanioka T, Tanaka M, Ojima M, Shizukuishi S, Folkers K.
Effect of topical application of coenzyme Q10 on adult periodontitis.
Mol Aspects Med. 1994;15 Suppl:s241-8.

Mayank Hans, Shobha Prakash, and Subhash Gupta
Clinical evaluation of topical application of perio-Q gel (Coenzyme Q10) in chronic periodontitis patients
J Indian Soc Periodontol. 2012 Apr-Jun; 16(2): 193–199.

Hansen IL, Iwamoto Y, Kishi T, Folkers K, Thompson LE.
Bioenergetics in clinical medicine. IX. Gingival and leucocytic deficiencies of coenzyme Q10 in patients with periodontal disease.
Res Commun Chem Pathol Pharmacol. 1976 Aug;14(4):729-38.

Gian Paolo Littarru, Ryo Nakamura, Lester Ho, Karl Folkers, and William C. Kuzell
Deficiency of Coenzyme Q10 in Gingival Tissue from Patients with Periodontal Disease
Proc Natl Acad Sci U S A. 1971 October; 68(10): 2332–2335.

Littarru GP, Langsjoen P.
Coenzyme Q10 and statins: biochemical and clinical implications.
Mitochondrion. 2007 Jun;7 Suppl:S168-74. Epub 2007 Mar 27.

Mabuchi H, Higashikata T, Kawashiri M, Katsuda S, Mizuno M, Nohara A, Inazu A, Koizumi J, Kobayashi J.
Reduction of serum ubiquinol-10 and ubiquinone-10 levels by atorvastatin in hypercholesterolemic patients.
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Marcoff L, Thompson PD.
The role of coenzyme Q10 in statin-associated myopathy: a systematic review.
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Matsumura T, Saji S, Nakamura R, Folkers K.
Evidence for enhanced treatment of periodontal disease by therapy with coenzyme Q.
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Ryo Nakamura, Gian Paolo Littarru, Karl Folkers, and Edward G. Wilkinson
Study of CoQ10-Enzymes in Gingiva from Patients with Periodontal Disease and Evidence for a Deficiency of Coenzyme Q10
Proc Natl Acad Sci U S A. 1974 April; 71(4): 1456–1460.

Päivä H, Thelen KM, Van Coster R, Smet J, De Paepe B, Mattila KM, Laakso J, Lehtimäki T, von Bergmann K, Lütjohann D, Laaksonen R.
High-dose statins and skeletal muscle metabolism in humans: a randomized, controlled trial.
Clin Pharmacol Ther. 2005 Jul;78(1):60-8.

Ram S, Kumar S, Navazesh M.
Management of xerostomia and salivary gland hypofunction.
J Calif Dent Assoc. 2011 Sep;39(9):656-9.

Shobha Prakash, J. Sunitha, and Mayank Hans
Role of coenzyme Q10 as an antioxidant and bioenergizer in periodontal diseases
Indian J Pharmacol. 2010 December; 42(6): 334–337.

Ryo K, Ito A, Takatori R, Tai Y, Arikawa K, Seido T, Yamada T, Shinpo K, Tamaki Y, Fujii K, Yamamoto Y, Saito I.
Effects of coenzyme Q10 on salivary secretion.
Clin Biochem. 2011 Jun;44(8-9):669-74.

Rajiv Saini
Coenzyme Q10: The essential nutrient
J Pharm Bioallied Sci. 2011 Jul-Sep; 3(3): 466–467.

Vervelle A, Mouhyi J, Del Corso M, Hippolyte MP, Sammartino G, Dohan Ehrenfest DM.
Mouthwash solutions with microencapsuled natural extracts: Efficiency for dental plaque and gingivitis.
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Wilkinson EG, Arnold RM, Folkers K, Hansen I, Kishi H.
Bioenergetics in clinical medicine. II. Adjunctive treatment with coenzyme Q in periodontal therapy.
Res Commun Chem Pathol Pharmacol. 1975 Sep;12(1):111-23.

R A Willis, K Folkers, J L Tucker, C Q Ye, L J Xia, and H Tamagawa
Lovastatin decreases coenzyme Q levels in rats.
Proc Natl Acad Sci U S A. 1990 November; 87(22): 8928–8930.

 Zlatohlavek L, Vrablik M, Grauova B, Motykova E, Ceska R.
The effect of coenzyme Q10 in statin myopathy.
Neuro Endocrinol Lett. 2012 Nov 28;33(Suppl2):98-101. [Epub ahead of print]

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Do I Really Need An Antibiotic Before I See The Dentist?

dental-workNo. Not really. At least, not everybody. But which of us?

It has been known for the last hundred years that the mouth—the oral cavity—is the site of many infectious and inflammatory pathogens. The connection to system-wide infections isn’t that old, though. Periodontitis is one of the prime suspects in the pathogenesis of a number of illnesses that include cardiovascular disease, bacterial pneumonia and diabetes mellitus. Poor oral hygiene, which is more common than we think, leads to the bacterial colonization of teeth and possibly an even greater introduction of bacteria into the blood stream (Rai, 2007).

Oral infections are predominantly anaerobic gram-negative bacteria, meaning that they can survive for a long time on a moist surface. This is antipodal to the gram-positive kinds that are tougher and can live on dry surfaces. Three out of four American adults are believed to suffer mild periodontal disease, with almost a third having chronic activity. This bodes terribly for long-term health. Oral disease may affect overall health in a few ways. First, bacteria from the gums enter saliva, where they can cling to moisture droplets that are inspired from the air. These can cause respiratory issues. Second, the bacteria associated with periodontal disease can get into the circulatory system via the spaces around the gums. These can travel the body and cause illness in other organs. Third, inflammation from periodontal disease may incite another systemic inflammatory response and contribute to other conditions that have an inflammatory component, such as cardiovascular disease, diabetes or kidney disease. Whatever the case may be, it’s in our best interest to keep the mouth as clean as we can to reduce disease potential (Han, 2013).

In periodontal disease, pro-inflammatory substances called cytokines can reach high tissue concentrations. Here, the periodontium acts like a reservoir, from which place a systemic attack can be launched. One of these cytokines, an interleukin named IL-1β, favors coagulation and thrombosis while inhibiting the breakdown of fibrin, the protein that forms a clot (Clinton, 1991). It sounds odd, but these same mediators are felt to cause preterm labor and low birth weight (Page, 1998). As far back as the 1890’s, medical practitioners thought a relationship of the mouth to the rest of the body existed. In 1891 a dentist named Willoughby Dayton Miller wrote a piece titled “The Human Mouth as a Focus of Infection.”  His work associated mouth conditions with serious conditions elsewhere in the body, including the brain, lungs and digestive system. His treatise may be found here:
http://www-personal.umich.edu/~pfa/denthist/articles/Miller1891.html , which cites the 1891 issue of Dental Cosmos.

One of the most obdurate villains in this drama is Streptococcus sanguinis, formerly known as S. sanguis. This one is gram positive and is a normal inhabitant of a healthy mouth, where it is particularly found in plaque. It forms a biofilm, characteristic of the plaque, and has the uncanny ability to modify its environment to make it less hospitable to other strains of streptococcus that may cause cavities. But it also has the wherewithal to get into the bloodstream and take up residence in heart valves—namely the mitral and aortic—and cause subacute bacterial endocarditis (inflammation of the thin membrane that lines the interior of the heart). Guess how this might happen. Vigorous dental cleanings that draw blood and oral surgeries are causes. This is why an extraction or other oral surgery practically demands a course of antibiotics before and after the procedure. An infection is harder to treat than to prevent.

Biofilms are tenaciously adhesive and protective of the pathogens that live within. Plaque is an accumulation of saliva bacteria, which colonize the spaces and fissure between teeth. These bacteria use dietary sucrose to make acidic chemicals that help them stick to the teeth. The acids eat through tooth enamel, and the caries life cycle begins. Planktonic bacteria are those which float freely in their environment, while sessile are those which are firmly attached to something else. Mouth bacteria, and perhaps others, seem to have the means to switch back and forth between these states, dissolving their biofilms to become mobile. This tells scientists that bacteria communicate among themselves, perhaps by using protein mediators (Macedo, 2009) (Abraham, 2006). Once these communication media are identified, science will be able to control biofilms and halt the virulence that besets us.

There is frustration that dental biofilms cannot be eliminated because of their diversity and numbers, but their control can be realized along a few avenues, including anti-plaque surfactants and essential oils, and anti-microbial agents that include metal ions, phenols and quaternary ammonia compounds formulated into dental care products (Mash, 2010). Mechanical hygiene methods—brushing and flossing—are first steps in controlling oral bacteria colonies because, if they are not regularly removed, they will mature into pathogenic, albeit microscopic, Mongols. Teeth comprise only twenty percent of the oral surface, so mouth rinses are needed to reach the spots a brush doesn’t (Gurenlian, 2012) and help to reduce risk factors for systemic disease (Lockhart, 2009).

The chemistry of mouth rinses is expanding its purview beyond halitosis to include novel ingredients that kill biofilm bacteria. Low amounts of levulinic acid and sodium compounds have surpassed Listerine in efficacy (Wang, 2012), and herbal extracts were found to kill oral bacteria immediately upon contact, compared with chlorhexidine (Verkaik, 2011), a mouthwash component also used by surgeons to wash their hands prior to an operation.

Preventing systemic infection with good oral hygiene is a worthwhile endeavor. The need for prophylactic antibiotics before visiting the dentist may be restricted to those with artificial heart valves, a history of infective endocarditis, serious congenital heart defects, and other cardiac abnormalities. In general, the American Heart Association suggests there be no antibiotic prophylaxis based solely on lifetime risk of acquisition of infective endocarditis, it being reasonable only for patients with underlying cardiac conditions associated with high risk of adverse outcome (Taubert et al, 2007).

References

Abraham WR.
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ADA (American Dental Association)
DIRECT ASSOCIATION BETWEEN CARDIOVASCULAR DISEASE, PERIODONTAL BACTERIA FOUND
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Vilasan Archana, Munivenkatappa V. L. Prabhuji, Bangalore V. Karthikeyan, K. Selvan Arul.
Control of Streptococcus sanguinis oral biofilm by novel chlorhexidine-chitosan mouthwash: an in vitro study
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Balestrino D, Souweine B, Charbonnel N, Lautrette A, Aumeran C, Traoré O, Forestier C.
Eradication of microorganisms embedded in biofilm by an ethanol-based catheter lock solution.
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H. CHEN, W. ZHANG, J. ZHU, and L. ZHAO
Coronary Heart Disease and Streptococcus sanguis Group (a Case-Control Study in China )
81st General Session of the International Association for Dental Research (June 25-28, 2003)

Clinton SK, Fleet JC, Loppnow H, Salomon RN, Clark BD, Cannon JG, Shaw AR, Dinarello CA, Libby P.
Interleukin-1 gene expression in rabbit vascular tissue in vivo.
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Du WX, Olsen CW, Avena-Bustillos RJ, McHugh TH, Levin CE, Friedman M.
Effects of allspice, cinnamon, and clove bud essential oils in edible apple films on physical properties and antimicrobial activities.
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Fine DH, Furgang D, Barnett ML, Drew C, Steinberg L, Charles CH, Vincent JW.
Effect of an essential oil-containing antiseptic mouthrinse on plaque and salivary Streptococcus mutans levels.
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Ge X, Kitten T, Chen Z, Lee SP, Munro CL, Xu P.
Identification of Streptococcus sanguinis genes required for biofilm formation and examination of their role in endocarditis virulence
Infect Immun. 2008 Jun;76(6):2551-9. doi: 10.1128/IAI.00338-08. Epub 2008 Apr 7.

JoAnn R. Gurenlian, RDH, PhD
The Role of Dental Plaque Biofilm in Oral Health
American Dental Hygienists’ Association. March 2012

Han YW, Wang X.
Mobile Microbiome: Oral Bacteria in Extra-oral Infections and Inflammation.
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NS Jakubovics, PE Kolenbrander
The road to ruin: the formation of disease-associated oral biofilms
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Juneja VK, Dwivedi HP, Yan X.
Novel natural food antimicrobials.
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Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FK.
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Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK, Sasser HC.
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Peter B. Lockhart, DDS
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Macedo AJ, Abraham WR
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P.D. Marsh
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Martinus J. Verkaik, Henk J. Busscher, Debbie Jager, Anje M. Slomp, Frank Abbas, Henny C. van der Mei
Efficacy of natural antimicrobials in toothpaste formulations against oral biofilms in vitro
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Miller, WD.
The Human Mouth as a Focus of Infection.
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http://www-personal.umich.edu/~pfa/denthist/articles/Miller1891.html

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B. Rai
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Rosan B, Appelbaum B, Campbell LK, Knox KW, Wicken AJ.
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Verkaik MJ, Busscher HJ, Jager D, Slomp AM, Abbas F, van der Mei HC.
Efficacy of natural antimicrobials in toothpaste formulations against oral biofilms in vitro.
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Wang BY, Hong J, Ciancio SG, Zhao T, Doyle MP.
A novel formulation effective in killing oral biofilm bacteria.
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Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, et al
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Xiaojing Li, Kristin M. Kolltveit, Leif Tronstad, and Ingar Olsen
Systemic Diseases Caused by Oral Infection
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Zwiech R, Adelt M, Chrul S.
A Taurolidine-Citrate-Heparin Lock Solution Effectively Eradicates Pathogens From the Catheter Biofilm in Hemodialysis Patients.
Am J Ther. 2013 May 9.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.