Improving Periodontal health
We’ve all seen the patient’s that state they are flossing nightly, using their electric toothbrushes two or three times per day for two minutes and using mouth rinse as part of their homecare routine, but still present with gingival inflammation and bleeding especially after periodontal therapy. What do you recommend for them? How can we as clinicians improve periodontal health? The research findings according to the University Of Maryland Medical Center (UMMC) suggest that individuals with periodontal disease are often associated with CoQ10 deficiency. What is CoQ10? It is very similar to a vitamin and is found in every cell in the body and our cells use it to make energy the body needs for the cells to grow and maintenance.
Aides to improve periodontal health
It is believed that when CoQ10 is applied as a topical (i.e. Mouthwash Perioclear) on the gingival tissues it might help control the bacteria that causes periodontal disease because when the antioxidants interact with the oxygen atoms it helps reduce collagen destruction and accelerates tissue repair and regeneration. Thus promoting healthy periodontal gingival tissues which leads to a healthy periodontium. I believe in introducing the patient to CoQ10 either in the natural form from foods like sardines, mackerel, and broccoli or in the pill form. Research has proven that after the age of about 35 our body’s natural ability to synthesize CoQ10 from foods slow down which is why I also discuss pill form. It has been proven that CoQ10 60-100mg/day is recommended for general maintenance and for more therapeutic purposed like after SCRP 200-600mg/day. It may be an added benefit to suggest Coq10 to patient’s after periodontal therapy to aid in the added benefit with healing. As a dental professional I always recommend that the patient’s discuss this with their medical doctor before proceeding to add this to their homecare routine to make sure there aren’t any interactions from any other medications the patient maybe taking. CoQ10 might reduce the effectiveness of anticoagulants also known as blood thinners like warfarin and clopidigrel. I have witnessed great results from patients who have successfully added CoQ10 both immediately after SCRP periodontal therapy and patients who are on the recommended three to four month periomaintenance recall. These patients are eager to show me their progress from incorporating CoQ10 with all the other steps the patients are doing at home. It is important for the patient to understand that even though there homecare has improved sometimes our body needs additional help to help achieve a healthy periodontium. CoQ10 is great in aiding our patient’s achieve this goal!
Nutritional Supplements aiding in a healthy mouth
Before jumping to nutritional supplements don’t forget to educate the patient’s about the need for a healthy diet. Educating patients about their nutrition is extremely important. A balanced healthy diet, exercise and great homecare is the key to not only oral health buy also systemic health. Encourage your patient’s to eat nutritious foods as it helps our immune system fight gingivitis and helps decrease the chances from it progressing to periodontal disease. Patients should understand how foods rich in antioxidants effect their body but most importantly boost our body’s capability to heal damaged tissues. Dental professional should discuss the importance of Vitamins C, E, A and D. Vitamin C is important as it plays an important role in the health of our tissues. I have never been great on remembering which vitamin does what but I always think the letter C stands for collagen and is related to Vitamin C. Collagen is basically connective tissue which is so important when our goal as dental professionals is for our patient’s to have strong healthy gums. Therefore patients who have a vitamin C deficiency have a higher susceptibility of gingivitis. Patients who are also smokers should also be informed that smoking will lower or deplete Vitamin C in the body. We should also encouraged cessation of smoking which will not only help make the patient’s oral tissues healthy but greatly have a positive impact on the patients’ systemic health in a positive way as well. Encourage Vitamin C enrich foods in our patient’s diet which include some of the following: bananas, green leafy vegetables and broccoli. Vitamin E enriched foods are important as these foods fight free radicals which means they promote wound healing. It is believed that wounds in the gums that get infected act as an underlying cause of gum disease. Encouraged patients to have foods rich in Vitamin E like breakfast cereal, nuts or even extra virgin olive oil. The next Vitamin A is an important vitamin that is essential for best immunity. Some Vitamin A foods that do this best are tomatoes, squash, and carrots. The hardest part of the eating a balanced diet conversation is discussing the role of coffee and caffeinated drinks affect our oral health. Coffee affects the oral tissues in two ways. The first way is it changes the pH and temperature in the mouth and gingival tissues. The second way is it reduces the blood flow the gingiva. It is both the combination of the lowered temperature and constriction of the blood vessels which means the patient’s gingival tissues don’t obtain all of the optimum oxygen needed to function properly. Now although this will not directly cause gingivitis or periodontitis it can greatly affect the declining gingival health. Caffeinated products especially coffee can and will contribute to an absence of hydration. This has a direct effect on the gingival tissues and oral health as this means less saliva production which greatly effects one’s susceptibility in developing dental caries and gingivitis which can lead to periodontal disease. Now refraining from all caffeine will be a hard task for any person to do cold turkey so have the discussion on what the patient can have as an alternative. Discuss with the patient maybe decreasing the amount of caffeine they consume a day. A great alternative to caffeine would be green tea. There was a 2009 study that was published in the Journal of Periodontology that basically discussed the results of the study that confirms the participants who did partake in green tea did in fact have less periodontal disease as well as increase in overall periodontal health. It is from this study that we should encourage a patient to drink at least one or two cups of green tea a day to help boost their oral health. Vitamin D everyone remembers being associated with milk. Besides vitamin D being found in milk other food sources include the following: tuna, eggs, salmon, cow’s, mushrooms and sardines.
In summary decreasing gingival bleeding and periodontal pockets can be achieved with the help of the dental health professional by evaluating all factors in the patient’s dietary factors by determining if the patients are having a well-balanced diet and not deficient in Vitamins C, E, A and D. If it is determined that patients are deficient encouraged the proper Vitamin enriched foods to help achieve optimum health. A great addition that should also be considered after periodontal therapy is adding CoQ10 an enzyme that will reduce collagen destruction and accelerates tissue repair and regeneration. Thus promoting healthy periodontal gingival tissues which leads to a healthy periodontium. CoQ10 can be administered topically in a mouth rinse (Perioclear) or systemically through foods or in the pill form. Patients should always discuss this their medical doctor before adding this to regimen as it can have interactions of anticoagulants like warfarin and clopidigrel.