Home > Dental Health, Diabetes, Heart Health > Dental Health Matters

Dental Health Matters

June 8, 2011 Written by JP    [Font too small?]

Diseased gums and decaying teeth spell trouble far beyond the quality of a smile. Within the oral cavity lies the potential to influence everything from cardiovascular disease and diabetes to the risk of potentially life threatening infections. Good to remember if you ever wonder whether it’s truly necessary to brush and floss twice daily.

In recent months, several studies have been published that support the rather bold statements I made in the opening paragraph. With respect to cardiovascular disease (CVD), it is now understood that those with chronic periodontitis tend to have higher C-reactive protein levels, a measure of systemic inflammation and a suspected risk factor for CVD. Preliminary evidence also suggests that periodontal treatment improves “indices of functional and structural vascular health” in heart patients. Poor oral health is similarly correlated with type 2 diabetes. However, once again, appropriate treatment not only improves gingival health, but also decreases long term blood sugar levels or HbA1c. Finally, pneumonia, “the leading cause of death in nursing home residents”, appears to decline dramatically when patients are treated for dental plaque and gingivitis. (1,2,3,4,5,6)

Apart from brushing, flossing and regular dental visits, there are a number of other lesser known self care measures that can be taken. These are not intended to replace the handy work of a dentist and periodontist, but rather compliment it.

Dental Tip #1: One of the many reasons to drink green tea is that it helps minimize the growth of cariogenic microflora such as mutans streptococci. A new study presented in the Journal of Medicinal Food reports that rinsing with a green tea extract for one minute, three times/day is enough to cause a significant decline in pathogenic oral microbes. In addition, population studies link high green tea consumption with a lower incidence of tooth loss. (7,8,9)

Dental Tip #2: Probiotic-rich yogurt is another food to actively seek out. Cultured and fermented foods that contain friendly bacteria are now being used to control bad breath (halitosis), gingival inflammation and plaque build-up. Probiotics can be administered via food (kefir, yogurt, etc.), mouthwashes and oral supplements. (10,11,12)

Dental Tip #3: Sources of omega-3 fatty acids are beginning to appear on the radars of scientists looking for a dietary connection to periodontal disease (PD). A Japanese study from May 2011 determined that a high ratio of omega-6 fatty acids to omega-3 fatty acids was associated with an elevated likelihood of PD in older men and women. Omega-6 fatty acids are typically found in processed foods and vegetable oils. Previous examinations at institutions including Harvard Medical School support the proposed link between higher intakes of DHA and EPA, omega-3 fatty acids found in fish, and a lower prevalence of periodontitis (13,14,15)

Dental Tip #4: Homeopathic medicine is a controversial practice which uses extremely dilute amounts of “like” substances to treat symptoms. An example can be found in the January-February 2011 issue of the journal Alternative Therapies in Health and Medicine. In it, a remedy known as Pulpa D30, which is comprised of a minute quantity of dental pulp from calves, was used to treat patients with acute reversible pulpitis – inflamed dental pulp. Of the 32 patients treated, 58% “achieved pain remission without invasive dental treatment”. Unfortunately, the trial did not include a comparison or placebo group, which reduces its scientific value. Another trial involving Traumeel S, a popular homeopathic supplement, reported distinct antioxidant activity. This is relevant because oxidative stress is strongly suspected as a contributing factor in periodontal disease. The incomplete and preliminary nature of this data is part of the reason why many holistic experts recommend using homeopathy not as, “a replacement or alternative to good clinical dental care, but alongside conventional treatments and drug regimens”. (16,17,18,19,20)

Probiotic Mouthwash Reduces Plaque Build Up

Source: J Indian Soc Pedod Prev Dent. 2010 Jul-Sep;28(3):179-82. (link)

Dental Tip #5: Now that we’ve addressed some of the most promising dietary and supplemental avenues, it’s time to discuss the latest topical alternatives. According to the current scientific literature, you might do well looking for products that contain: bee (green) propolis and pomegranate extract. Mouthwashes including each of these natural antimicrobial and anti-inflammatory agents may improve objective measures of dental health as assessed by gingival and plaque indexes. Adding an oral irrigator to your dental hygiene routine is yet another way to combat gingivitis and resulting symptoms including bleeding gums. You might even consider pouring some pomegranate extract or propolis into your irrigation water for possible synergistic benefits. (21,22,23)

Finally, if it’s been awhile since you’ve visited a dentist and the reason is anxiety, please know that this phobia can be overcome. At least three studies published in 2011 alone reveal that select mind-body practices including biofeedback, cognitive behavioral counseling and hypno- and music therapy are all capable of easing fear of dentists. My hope is that the practical information provided today will further ease your mind. Seeing a dentist is much easier if you’re confident that your gums and teeth are already something to smile about. (24,25,26)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


Tags: , ,
Posted in Dental Health, Diabetes, Heart Health

27 Comments & Updates to “Dental Health Matters”

  1. Mark Says:

    From one who has suffered bone loss, dental health should be a major concern for everyone. Do you have recommendations for probiotic mouthwashes?

  2. Allison Says:

    I recently read something about oil pulling and specifically using coconut oil. What are your thoughts on that for good oral health?

  3. JP Says:


    I’m not aware of any commercially available, clinically validated probiotic mouthwashes currently on the market. The Indian study I cited used an experimental mouthwash – that, to the best of my knowledge, isn’t being sold at this time. However, there are some probiotic lozenges (sold mostly in health food stores, online and in pharmacies) whose intent is to support oral health. Personally, I get my dental/probiotic fix by eating plenty of probiotic-rich foods (cultured coconut milk, goat’s milk kefir, Greek yogurt, etc.). These typically provide a good source of calcium as well.

    Be well!


  4. JP Says:


    Several studies confirm that there is indeed something of value to be found in oil pulling:




    Be well!


  5. JP Says:

    Update: Aspirin + fish oil improves periodontitis …


    J Periodontal Res. 2015 Jan 21.

    Effect of omega 3 fatty acids plus low-dose aspirin on both clinical and biochemical profiles of patients with chronic periodontitis and type 2 diabetes: a randomized double blind placebo-controlled study.


    The aim of this study was, first, to investigate the effect of omega 3 (ω3) fatty acids plus low-dose aspirin with closed debridement in the treatment of patients with periodontitis and type 2 diabetes mellitus (DM), and second, to estimate the expression of monocyte chemoattractant protein-3 (MCP-3) in response to the supposed modulatory therapy.


    Forty patients with chronic periodontitis and type 2 DM were equally divided into groups 1 (patients received ω3 plus low-dose aspirin for 6 mo) and 2 (patients received placebo during the same period). Evaluation was done clinically (pocket depth, clinical attachment loss, gingival index and plaque index) and biochemically by estimating levels of interleukin 1β and MCP-3 in gingival crevicular fluid, plus investigating the effect of treatment on glycemic control by levels of glycated hemoglobin A1c in serum. All data were collected at baseline, 3 and 6 mo after treatment.


    Subjects of group 1 showed a highly significant reduction in pocket depth, clinical attachment loss, gingival index (p ≤ 0.01) after 3 and 6 mo compared to group 2. Glycated hemoglobin A1c levels showed a reduction in both groups at the end of the study period, with a non-significant difference (p > 0.05). Furthermore, the treatment protocol showed a significant reduction in levels of MCP-3 and interleukin 1β at 3 and 6 mo compared to the placebo group.


    Within the limits of the present study, ω3 plus low-dose aspirin proved effective as an adjunct to closed periodontal therapy in the management of patients with periodontitis and type 2 DM. Moreover, MCP-3 was proven to be effective both in the pathogenesis of the disease and as a biomarker in evaluating the response to periodontal treatment.

    Be well!


  6. JP Says:

    Update 05/18/15:


    Ann Epidemiol. 2015 Apr 18.

    Higher vitamin D intake during pregnancy is associated with reduced risk of dental caries in young Japanese children.

    PURPOSE: The intrauterine environment, including maternal nutrition status, may affect the development, formation, and mineralization of children’s teeth. We assessed the relationship between self-reported maternal dietary vitamin D intake during pregnancy and the risk of dental caries among young Japanese children.

    METHODS: This study is based on a prospective analysis of 1210 Japanese mother-child pairs. Information on maternal intake during pregnancy was collected using a validated diet history questionnaire. Data on oral examination at 36-46 months of age were obtained from the mothers, who transcribed the information from their maternal and child health handbooks to our self-administered questionnaire. Children were classified as having dental caries if one or more primary teeth had decayed or had been filled.

    RESULTS: Compared with the lowest quartile of maternal vitamin D intake during pregnancy, adjusted odds ratios (95% confidence intervals) for quartiles 2, 3, and 4 were 1.06 (0.72-1.56), 0.53 (0.34-0.81), and 0.67 (0.44-1.02), respectively (P for trend = .01). When maternal vitamin D intake was treated as a continuous variable, the adjusted odds ratio (95% confidence interval) was 0.94 (0.89-0.995).

    CONCLUSIONS: Higher maternal vitamin D intake during pregnancy may be associated with a lower risk of dental caries in children.

    Be well!


  7. JP Says:

    Updated 08/13/15:


    J Clin Diagn Res. 2015 Jun;9(6):ZC35-8.

    Influence of Vitamin D & Calcium Supplementation in the Management of Periodontitis.

    INTRODUCTION: It has long been recognized that vitamin D is a hormone and were many studies reporting that patients in periodontal maintenance programs taking vitamin D and calcium supplementation had a trend for better periodontal health compared to patients not taking supplementation.

    AIM: To evaluate the effect of vitamin D and calcium supplementation in reducing gingival inflammation, using clinical parameters like gingival index (GI), oral hygiene index-simplified (OHIS), probing pocket depth (PPD), clinical attachment level (CAL) and bone density (BD). Also, to assess whether calcium and vitamin D oral supplementation influences alveolar Bone Density (BD).

    DESIGN AND SETTINGS: A nonrandomised clinical trial done in Amrita School of dentistry, Kochi, India.

    MATERIALS AND METHODS: Group A taking vitamin D (250IU/day) and calcium (500 mg/day) supplementation, and Group B were not taking oral supplementation. All subjects had at least one or more teeth with chronic moderate periodontitis. Digital Orthopantomogram images were taken to assess bone density. Data were collected at baseline and three months.

    STATISTICAL ANALYSIS USED: OHI-S, GI, PPD, CAL, and Bone Densities (BD) were calculated per group. Karl Pearson Coefficient of correlation was used to test correlation of bone density with GI and OHI -S. Intergroup comparison of parameters were done using Independent two Sample t-test. Intragroup comparison of parameters at recall interval was done using Paired sample t-test. The results were considered statistically significant when p-value was <0.05.

    RESULTS: Both Groups showed significant change in the periodontal parameters and bone density after three months and intragroup comparison showed highly significant results for vitamin D group in relation to GI, OHI S and bone density.

    CONCLUSION: Calcium and vitamin D supplementation has got a positive effect on periodontal health and it can be used as an adjunct to non surgical periodontal therapy.

    Be well!


  8. JP Says:

    Updated 08/19/15:


    J Nat Sci Biol Med. 2015 Jul-Dec;6(2):364-8.

    The antiplaque efficacy of propolis-based herbal toothpaste: A crossover clinical study.

    BACKGROUND: In recent years, herbal products have been suggested as an economic, safe and probably effective alternative for prevention and control of various oral diseases. But still there are some products which need to be evaluated. Of lately, Propolis is one such product. To assess and compare the efficacy of herbal dentifrice containing Propolis with Miswak and Colgate total toothpastes in controlling plaque formation.

    MATERIALS AND METHODS: A double blind, randomized, crossover study design was conducted among thirty healthy dental students. After oral prophylaxis all subjects were given a washout product for one week period. Subjects were then made to brush with (washout product) for 1 minute followed by 1 minute brushing with assigned test product. The baseline MGMPI plaque scores were recorded. Subjects were then refrained from oral hygiene for 24 hours, and were recalled to be re-disclosed and re-measured for plaque formation. This procedure was repeated according to crossover design after a washout period of (2 week). Statistical tests used were Krukalwallis and Wilcoxon sign rank test.

    RESULTS: There was a significant difference in 24 hour score between the test products evaluated. When the change from baseline to 24 hours was analyzed, the test product Propolis resulted in a consistently and significantly (p < 0.05) lower MGMPI mean scores than the Colgate Total and Miswak toothpastes. CONCLUSION: Propolis was found to be safe and effective in reducing plaque accumulation when compared to Miswak and Colgate total toothpaste. Be well! JP

  9. JP Says:

    Updated 11/10/15:


    J Clin Periodontol. 2015 Nov 9.

    Java project on periodontal diseases: effect of vitamin C/calcium threonate/citrus flavonoids supplementation on periodontal pathogens, CRP and HbA1c.

    OBJECTIVE: To assess in a periodontally diseased rural population deprived from regular dental care and having poor dietary conditions, the effect of vitamin C/calcium threonate/citrus flavonoids (VitC/Ca/Fl) supplementation on subgingival microbiota and plasma levels of vitamin C, HbA1c and hsCRP.

    MATERIAL & METHODS: The study population consisted of 98 subjects who previously participated in a prospective study on the natural history of periodontitis. Participants were instructed to consume one tablet/day containing 200mg Ester C® calcium ascorbate, 25mg calcium threonate and 100mg citrus flavonoids for 90 days. Following parameters were evaluated: prevalence/amount of seven traditional periodontal pathogens, cytomegalovirus, Epstein Barr virus (EBV); and plasma levels of vitamin C, HbA1c and hsCRP.

    RESULTS: After VitC/Ca/Fl supplementation, 100% of subjects showed normal plasma vitamin C values compared to 55% before. At baseline, 48% of subjects harbored A. actinomycetemcomitans, >97% the other periodontal pathogens and 73% EBV. Supplementation with VitC/Ca/F reduced the subgingival load of all studied bacteria (p-values: 0.014-0.0001) and EBV (p<0.0001) substantially in all initially positive subjects. Plasma levels of HbA1c and hsCRP dropped in all subjects (p<0.0001).

    CONCLUSION: This uncontrolled study suggested that supplemental VitC/Ca/Fl may be helpful in reducing subgingival numbers of periodontal pathogens and EBV, and promoting systemic health.

    Be well!


  10. JP Says:

    Updated 12/16/15:


    Int J Clin Pediatr Dent. 2015 May-Aug;8(2):114-8.

    Comparative Evaluation of the Effects of Fluoride Mouthrinse, Herbal Mouthrinse and Oil Pulling on the Caries Activity and Streptococcus mutans Count using Oratest and Dentocult SM Strip Mutans Kit.

    BACKGROUND: As the technological level of healthcare increases, it is important not to lose sight of the basics of patient care. No matter how sophisticated dental techniques have become, preventive dentistry still remains the foundation for oral health. Therefore, antimicrobial mouthrinses are developed to provide an effective means of preventing colonization by micro-organisms.

    AIM: The aim of this study was to evaluate and compare the antimicrobial activity of oil pulling, herbal mouthrinses and fluoride mouthwash on the caries activity and S. mutans counts in the saliva of children, using Oratest and Dentocult SM kit.

    DESIGN: Fifty-two healthy children between the age group of 6 to 12 years were selected for the study and divided into four groups based on the mouthrinse used as group 1: fluoride, group 2: herbal, group 3: oil pulling and group 4: control. The estimation of caries activity and S. mutans was done prior to and after the subjects were instructed to use the mouthrinse twice daily for a period of 2 weeks.

    STATISTICAL ANALYSIS: The comparisons were made by applying paired ‘t’ test with the level of significance set at p < 0.05. Difference between more than two mean values was done by using ANOVA and Post hoc Bonferroni test was used for multiple comparisons. RESULTS AND CONCLUSION: The efficacy of fluoride and herbal mouthrinses was found to be comparable while oil pulling did not provide any additional benefit to be used as an effective antimicrobial agent in reducing the bacterial colonization of an individual. Be well! JP

  11. JP Says:

    Updated 1/18/16:


    J Dent Res. 2016 Jan 8.

    Probiotic Compared with Standard Milk for High-caries Children: A Cluster Randomized Trial.

    The aim of this study was to compare milk supplemented with probiotic lactobacilli with standard milk for the increment of caries in preschool children after 10 mo of intervention. The study was a triple-blind, placebo-controlled randomized trial. Participants were children aged 2 and 3 y (n = 261) attending 16 nursery schools in a metropolitan region in Chile. Nursery schools were randomly assigned to 2 parallel groups: children in the intervention group were given 150 mL of milk supplemented with Lactobacillus rhamnosus SP1 (107 CFU/mL), while children in the control group were given standard milk. Interventions took place on weekdays for 10 mo. Data were collected through a clinical examination of participants. The primary outcome measure was the increment of caries in preschool children. This was assessed using the International Caries Detection and Assessment System (ICDAS). The dropout rate was 21%. No differences in caries prevalence were detected between the groups at baseline (P = 0.68). After 10 mo of probiotic intake, the caries prevalence was 54.4% in the probiotic group and 65.8% in the control group. The percentage of new individuals who developed cavitated lesions (ICDAS 5-6) in the control group (24.3%) was significantly higher than that in the probiotic group (9.7%). The increment of dental caries showed an odds ratio of 0.35 (P < 0.05) in favor of the probiotic group. At the cavitated lesion level, the increment of new caries lesions within the groups showed 1.13 new lesions per child in the probiotic group compared with 1.75 lesions in the control group (P < 0.05). The probiotic group showed an increment of 0.58 ± 1.17 new lesions compared with 1.08 ± 1.70 new lesions observed in the control group. The difference in caries increment was significant at the cavitated lesion level (P < 0.01). In conclusion, the regular long-term intake of probiotic-supplemented milk may reduce caries development in high-caries preschool children (ClinicalTrials.gov: NCT01648075). Be well! JP

  12. JP Says:

    Updated 03/06/16:


    J Periodontol. 2016 Mar 4:1-12.

    Clinical Effects of Lactobacillus Rhamnosus in Non-Surgical Treatment of Chronic Periodontitis: A Randomized Placebo-Controlled Trial With 1-Year Follow-up.

    BACKGROUND: Probiotics are living microorganisms that provide beneficial effects for the host when administered in proper quantities. The aim of this double- blind placebo- controlled parallel- arm randomized clinical trial was to evaluate the clinical effects of a Lactobacillus rhamnosus SP1-containing probiotic sachet as an adjunct to non-surgical therapy.

    MATERIAL AND METHODS: Twenty-eight systemically healthy volunteer with chronic periodontitis were recruited and monitored clinically at baseline and 3, 6, 9 and 12 months after therapy. Clinical parameters measured included plaque accumulation, bleeding on probing, pocket probing depths (PPD) and clinical attachment loss. Patients received non-surgical therapy including scaling and root planing (SRP) and were randomly assigned to a test (SRP + probiotic, n = 14) or control (SRP + placebo, n = 14) group. The intake, once a day for 3 months, of a L. rhamnosus SP1 probiotic sachet commenced after the last session of SRP.

    RESULTS: Both test and control groups showed improvements in clinical parameters at all time points evaluated. The test group, however, showed greater reductions in PPD than the control. Also, at initial visits and after 1-year follow-up, the test group showed a statistically significant reduction in number of participants with PPD ≥ 6mm, indicating a reduced need for surgery, in contrast to the placebo group.

    CONCLUSIONS: The results of this trial indicate that oral administration of L. rhamnosus SP1 resulted in similar clinical improvements compared to SRP alone.

    Be well!


  13. JP Says:

    Updated 03/25/16:


    J Int Soc Prev Community Dent. 2016 Jan-Feb;6(1):22-27.

    Comparison of efficacy of herbal disinfectants with chlorhexidine mouthwash on decontamination of toothbrushes: An experimental trial.

    BACKGROUND: Toothbrushes in regular use can become heavily contaminated with microorganisms, which can cause infection or reinfection. There is a need for toothbrush disinfection methods, which are rapidly effective, cost-effective, nontoxic, and that can be easily implemented.

    AIM: To compare the efficacy of 3% neem, garlic of concentration 4.15 mg/mL and green tea of concentration 40 mg/mL with 0.2% chlorhexidine mouthwash as toothbrush disinfectants.

    MATERIALS AND METHODS: The study was a parallel in vitro comparative experimental trial conducted among 75 randomly selected boys aged between 18 years and 21 years. The subjects were divided into five groups, namely, Group I, Group II, Group III, Group IV, and Group V. They were provided with a new set of precoded toothbrushes and nonfluoridated tooth pastes. After 14 days of tooth brushing, the toothbrushes were immersed in antimicrobial solution for 12 h [Group I–distilled water (control), Group II–3% neem, Group III–garlic of concentration 4.15 mg/mL, Group IV–green tea of concentration 40 mg/mL, and Group V–0.2% chlorhexidine] and then subjected to microbial analysis to check the presence of Streptococcus mutans. The t-test and analysis of variance (ANOVA) were done using Statistical Package for the Social Sciences (SPSS) software version 16.

    RESULTS: All test solutions showed a statistically significant reduction of Streptococcus mutans count (P < 0.001). There was no statistical difference between the efficacies of neem, garlic, and green tea when compared with chlorhexidine mouthwash (P > 0.05).

    CONCLUSION: Neem, garlic, and green tea are equally efficacious as chlorhexidine and these herbal products can be used as potent alternatives to chlorhexidine as disinfectant for toothbrushes.

    Be well!


  14. JP Says:

    Updated 04/17/16:


    J Indian Soc Pedod Prev Dent. 2016 Apr-Jun;34(2):120-3.

    The role of cacao extract in reduction of the number of mutans streptococci colonies in the saliva of 12-14 year-old-children.

    BACKGROUND: Cacao bean husk ethanol extract (CBHEE) has polyphenol that acts as an antibacterial agent, specially anti-glucosyltransferase.

    AIM: This study is aimed to see the effectiveness of CBHEE to reduce the number of mutans streptococci colonies in the saliva of children (with young permanent teeth), when CBHE is used as mouth rinse.

    MATERIALS AND METHODS: This study used cross-sectional study design with time-series experimental study and used simple random sampling on 30 subjects. The chosen subjects are those who have middle oral hygiene status (OHI-S). Each subject was given the same intervention; in the first step, saliva was collected from the subjects (prior to intervention), in the second step, the subjects were given 15 mL of CBHEE 0.1% mouth rinse to rinse their mouth for about 30 s. After intervention, their saliva was collected twice in 15 min and 30 min after intervention. Furthermore, the number of mutans streptococci colonies were measured in colony-forming units (CFU) and the data was statistically analyzed using analysis of variance (ANOVA) and paired t-test. The data was analyzed and proccessed using Statistical Package for the Social Sciences (SPSS) 22.0 for windows versions.

    RESULTS: The data statistically showed, significantly, the reduction of Streptococcus mutans colonies before and after 30 min of intervention. Before intervention, there were 59.10 CFU/mL of mutans streptococci, and after 15 min of intervention it showed reduction of mutans streptococci to 25.73 CFU/mL and after 30 min of intervention, the counts of mutans streptococci showed a reduction to 9.40 CFU/mL. From the test results, statistical value of this research was P = 0.000 (P < 0.05), which means that the reduction of the mutans streptococci count was significant. CONCLUSION: Using CBHEE as mouth rinse for children has been proven highly effective in reducing mutans streptococci colony counts in the mouth. Be well! JP

  15. JP Says:

    Updated 06/09/16:


    Int J Clin Pediatr Dent. 2016 Jan-Mar;9(1):25-30.

    Antimicrobial Efficacy of Probiotic and Herbal Oral Rinses against Candida albicans in Children: A Randomized Clinical Trial.

    Background: A growing number of dentists are embracing the philosophy that natural agents are better for children’s oral health. Knowledge of probiotics on host immune system has entered a new phase of research, and progression in this field is likely to offer novel means by modulating host immunity for prevention and treatment of a wide variety of oral diseases.

    Aim: To compare the antimicrobial efficacy of probiotics in reducing salivary Candida albicans counts with commonly used antimicrobial agents like 0.2% chlorhexidine and herbal rinse.

    Materials and methods: A randomized clinical trial was conducted on 60 subjects aged between 6 and 14 years, for a period of 9 months. The subjects were randomly divided into three groups comprising 20 subjects in each group. Three oral agents were administered twice daily for a maximum period of 1 week. Candida albicans counts were recorded before and after intervention and the results were submitted for statistical analysis using Statistical Package for the Social Sciences (SPSS) version 15.0 software.

    Results: The change in mean log10 colony-forming unit (CFU)/ ml of C. albicans in groups A to C was 0.43 ± 0.72, 0.68 ± 1.05 and 0.22 ± 0.66 CFU/ml respectively.

    Conclusion: Data obtained from the study demonstrated that probiotic rinse was equally effective as 0.2% chlorhexidine digluconate rinse in reducing C. albicans counts after 1 week of intervention. Herbal oral rinse was least effective. Probiotic oral rinses have opened new horizons in improvement of oral health by maintaining healthy ecosystem. However, a longitudinal study with larger sample size needs to be undertaken to evaluate the therapeutic effects of probiotics and herbal agents.

    Be well!


  16. JP Says:

    Updated 06/28/16:


    BMC Complement Altern Med. 2016 Jun 7;16(1):171.

    Adjunctive use of essential oils following scaling and root planing -a randomized clinical trial.

    BACKGROUND: Hitherto no study has been published on the effect of the adjunctive administration of essential oils following scaling and root planing (SRP). This study describes the effect of a mouthrinse consisting of essential oils (Cymbopogon flexuosus, Thymus zygis and Rosmarinus officinalis) following SRP by clinical and microbiological variables in patients with generalized moderate chronic periodontitis.

    METHODS: Forty-six patients (aged 40-65 years) with moderate chronic periodontitis were randomized in a double-blind study and rinsed their oral cavity following SRP with an essential oil mouthrinse (n  =  23) or placebo (n  =  23) for 14 days. Probing depth (PD), attachment level (AL), bleeding on probing (BOP) and modified sulcus bleeding index (SBI) were recorded at baseline and after 3 and 6 months. Subgingival plaque was taken for assessment of major bacteria associated with periodontitis.

    RESULTS: AL, PD, BOP and SBI were significantly improved in both groups after three (p   <   0.001) and 6 months (p   ≤   0.015). AL improved significantly better in the test than in the control group after 3 and 6 months (p < 0.001), so did PD after three months in the tendency (p  =  0.1). BOP improved better in the test group after 3 months (p  =  0.065). Numbers of Treponema denticola (p  =  0.044) and Fusobacterium nucleatum (p  =  0.029) decreased more in the test than in the control group after 3 months, those of Tannerella forsythia after 6 months (p  =  0.039). Prevotella micra (p  <  0.001, p  =  0.035) and Campylobacter rectus (p  =  0.002 , p  =  0.012) decreased significantly in both groups after 3 months. CONCLUSIONS: The adjunctive use of a mouthrinse containing essential oils following SRP has a positive effect on clinical variables and on bacterial levels in the subgingival biofilm. Be well! JP

  17. JP Says:

    Updated 07/13/16:


    Sci Rep. 2016 Jul 7;6:28824.

    Toothbrushing, Blood Glucose and HbA1c: Findings from a Random Survey in Chinese Population.

    Both diabetes and periodontal disease are prevalent in China. Poor oral hygiene practice is the major cause of periodontal disease. An association between oral hygiene practice and blood glucose level was reported in individuals with diabetes, but not in the general population. We examined the association in a population-based random survey recruiting 2,105 adults without previously diagnosed diabetes in Chongqing city, China. Plasma glucose and hemoglobin A1c (HbA1c) were measured, and a 2-hour oral glucose tolerance test was conducted for each respondent. Self-reported toothbrushing frequency was used as a proxy for oral hygiene practice. In a linear model controlling for potential confounders (demographic characteristics, socio-economic status, lifestyle risk factors, BMI, dental visit frequency, etc.), urban residents who barely brushed their teeth had an increase of 0.50 (95% CI: 0.10-0.90) mmol/L in fasting plasma glucose, and an increase of 0.26% (0.04-0.47%) in HbA1c, relative to those brushing ≥twice daily; for rural residents, the effects were 0.26 (0.05-0.48) mmol/L in fasting plasma glucose and 0.20% (0.09-0.31%) in HbA1c. Individuals with better oral practice tended to have lower level of blood glucose and HbA1c. Establishing good oral health behavioral habits may be conducive to diabetes prevention and control in the general population.

    Be well!


  18. JP Says:

    Updated 07/28/16:


    BMC Oral Health. 2016 Jul 26;17(1):28.

    An oral health optimized diet can reduce gingival and periodontal inflammation in humans – a randomized controlled pilot study.

    BACKGROUND: The aim of this pilot study was to investigate the effects of four weeks of an oral health optimized diet on periodontal clinical parameters in a randomized controlled trial.

    METHODS: The experimental group (n = 10) had to change to a diet low in carbohydrates, rich in Omega-3 fatty acids, and rich in vitamins C and D, antioxidants and fiber for four weeks. Participants of the control group (n = 5) did not change their dietary behavior. Plaque index, gingival bleeding, probing depths, and bleeding upon probing were assessed by a dentist with a pressure-sensitive periodontal probe. Measurements were performed after one and two weeks without a dietary change (baseline), followed by a two week transitional period, and finally performed weekly for four weeks.

    RESULTS: Despite constant plaque values in both groups, all inflammatory parameters decreased in the experimental group to approximately half that of the baseline values (GI: 1.10 ± 0.51 to 0.54 ± 0.30; BOP: 53.57 to 24.17 %; PISA: 638 mm(2) to 284 mm(2)). This reduction was significantly different compared to that of the control group.

    CONCLUSION: A diet low in carbohydrates, rich in Omega-3 fatty acids, rich in vitamins C and D, and rich in fibers can significantly reduce gingival and periodontal inflammation.

    Be well!


  19. JP Says:

    Updated 09/07/16:


    BMC Oral Health. 2016 Sep 2;16(1):89.

    Low vitamin D status strongly associated with periodontitis in Puerto Rican adults.

    BACKGROUND: Periodontitis and vitamin D deficiency are both highly prevalent in Puerto Rico. The aim of this pilot study was to evaluate the association between vitamin D levels and periodontal disease in Puerto Rican adults.

    METHODS: A sex-, age-, and BMI-matched case-control, cross-sectional study was conducted on 24 cases of moderate/severe periodontitis and 24 periodontally healthy controls aged 35 to 64 years. Each participant completed a socio-demographic questionnaire, underwent a full-mouth periodontal examination and provided blood sample to measure serum 25-hydroxyvitamin D (25 (OH) D) levels to assess vitamin D status.

    RESULTS: A total of 19 matched case-control pairs (28 females, 10 males) completed the study. Mean serum 25 (OH) D levels were significantly lower in cases (18.5 ± 4.6 ng/ml) than in controls (24.2 ± 7.1 ng/ml; p = 0.006). Lower odds of periodontal disease were observed per unit of 25 (OH) D level (OR 0.885; 95 % CI 0.785, 0.997; p < 0.05). CONCLUSIONS: Lower serum vitamin D levels are significantly associated with periodontitis in Puerto Rican adults. Be well! JP

  20. JP Says:

    Updated 11/19/16:


    Caries Res. 2016 Nov 3;50(6):579-588.

    Long-Term Effect of Erythritol on Dental Caries Development during Childhood: A Posttreatment Survival Analysis.

    OBJECTIVE: To assess the effect of daily consumption of erythritol, xylitol, and sorbitol candies on caries development in mixed dentition during a 3-year intervention and 3 years after the intervention.

    METHODS: 485 Estonian first- and second-grade primary school children participated. Children were randomly allocated to an erythritol, xylitol, or sorbitol (control) group. Polyol-containing candies were administered on school days with a daily polyol consumption of 3 × 2.5 g. Yearly, caries development was assessed by calibrated dentists using the ICDAS criteria. Six years after initiation of the study and 3 years after cessation of daily polyol consumption, 420 participants were re-examined to identify potential long-term effects of polyol consumption. Survival curves were generated at the end of the intervention period and 3 years after intervention. The model included age of the subjects, schools, tooth surface ages and years of surface exposure to intervention. ICDAS scoring system-based events included enamel/dentin caries development, dentin caries development, increase in caries score, and dentist intervention.

    RESULTS: At the end of the intervention, time to enamel/dentin caries development, dentin caries development, increase in caries score, and dentist intervention were significantly longer in the erythritol group as compared to the sorbitol group. Except for increase in caries score, all effects persisted 3 years after cessation of daily polyol consumption.

    CONCLUSIONS: A caries-preventive effect of 3-year erythritol consumption as compared to sorbitol was established in children with mixed dentition. The effect persisted up to 3 years after the end of the intervention.

    Be well!


  21. JP Says:

    Updated 04/07/17:


    Oral Dis. 2017 Mar 27.

    Cheese supplemented with probiotics reduced the Candida levels in denture wearers – RCT.

    OBJETIVES: The access to probiotics should be facilitated in order to encourage their usage. We evaluated the effect of consumption of two experimental probiotic-containing cheese on the oral colonization of Candida in denture wearers.

    METHODS: Sixty denture wearers harboring oral Candida were randomly allocated in groups who received cheese supplemented with Lactobacillus acidophilus NCFM (T1) or Lactobacillus rhamnosus Lr-32 (T2), daily for 8 weeks, and a control group (C) who received a control cheese. Oral samples were obtained through a mouthwash, and Candida levels determined (CFU/mL) at baseline and after the 8 weeks experimental period.

    RESULTS: At baseline, the mean levels of Candida spp. (log CFU/mL) were similar among the groups. However, the mean levels of Candida were significantly reduced in groups T1 and T2 but not in C (Tukey, p < 0.05). The reduction in Candida oral levels occurred independently on the colonizing Candida species, participant age, and use of bi or unimaxillary dentures. CONCLUSIONS: Daily consumption of cheese supplemented with probiotics Be well! JP

  22. JP Says:

    Updated 08/26/17:


    J Oral Microbiol. 2017 Aug 1;9(1):1355207.

    Oral microbial profiles of individuals with different levels of sugar intake.

    The aim was to compare the oral microbial profiles in young adults with an intake of free sugars above or below the current recommendations by the WHO for sugar consumption. Seventy subjects completed a Quantitative Food Frequency Questionnaire to establish the proportion of free sugars in relation to the total energy intake (% E). Subjects with <5% E (n = 30) formed the low-sugar group, while those with ≥5% E (n = 40) were regarded as reference group. Saliva and plaque samples were analyzed by qPCR, and 52 of the plaque samples were assayed by HOMINGS. The HOMINGS analysis revealed a comparable core microbiota in plaque samples with Streptococcus, Leptotrichia, Actinobaculum, and Veillonella as predominant. No major differences between groups were revealed by α-diversity testing (p = 0.83), principal component analysis, or correspondence analysis. Higher relative abundance of Streptococcus sobrinus and Prevotella melaninogenica was observed in plaque samples in the reference group. By qPCR, Scardovia wiggsiae was associated with elevated sugar intake. The findings suggests that the amount of ingested sugars had a marginal influence on microbial profiles in dental plaque and saliva. However, some caries-associated species were less abundant in the dental plaque of the low sugar group.

    Be well!


  23. JP Says:

    Updated 06/03/18:


    Int J Appl Basic Med Res. 2018 Apr-Jun;8(2):111-115.

    Effect of Short-term Consumption of Amul Probiotic Yogurt Containing Lactobacillus acidophilus La5 and Bifidobacterium Lactis Bb12 on Salivary Streptococcus mutans Count in High Caries Risk Individuals.

    Aim: This study aims to study the effect of short-term consumption of probiotic yogurt containing Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 on salivary Streptococcus mutans count in high caries risk individuals.

    Materials and Methods: A double-blind randomized control trial was conducted, and 70 high caries risk individuals with a salivary S. mutans count of more than 106 CFU/ml of saliva were followed for 4 weeks. Participants ingested 100 g yogurt containing L. acidophilus La5 and Bifidobacterium lactis Bb12 or yogurt without the two probiotic bacteria once daily at the end of meals for initial 2 weeks. Salivary S. mutans were enumerated in the laboratory by selective culture media.

    Results: A statistically significant reduction (P < 0.05) of salivary S. mutans was recorded after probiotic yogurt consumption with minimal residual effect, which was in contrast to the controls. Conclusion: L. acidophilus La5 and Bifidobacterium lactis Bb12 present in the yogurt were effective in reducing the S. mutans levels in saliva. Be well! JP

  24. JP Says:

    Updated 09/04/18:


    Oral Health Prev Dent. 2018;16(4):327-332.

    Effect of Omega-3 Fatty Acids on Chronic Periodontitis Patients in Postmenopausal Women: A Randomised Controlled Clinical Study.

    PURPOSE: To investigate changes in periodontal parameters and superoxide dismutase activity after root surface debridement with and without omega-3 fatty acid (omega-3 FA) supplementation in postmenopausal women.

    MATERIALS AND METHODS: Fifty postmenopausal women with chronic periodontitis were divided randomly into two groups. Group 1 (control group, n = 25) patients were provided with periodontal treatment in the form of scaling and root planing (SRP) plus soft gelatinous capsules containing only some olive oil, while group 2 (n = 25) received SRP along with systemic administration of omega-3 FAs in the same soft gelatinous capsules. Clinical parameters and superoxide dismutase (SOD) activity in the gingival crevicular fluid were recorded at baseline, 3 and 6 months after therapy.

    RESULTS: By the end of the study period, the omega-3-treated group achieved a greater mean probing pocket depth reduction, a mean gain in clinical attachment level especially in deep periodontal pockets, as well as a greater increase in SOD activity (p < 0.01) compared to SRP alone. CONCLUSIONS: Adjunctive omega-3 FAs supplements with SRP reduce periodontal inflammation and improve the status of systemic enzymatic antioxidants in postmenopausal women. Be well! JP

  25. JP Says:

    Updated 10/18/18:


    Inflammopharmacology. 2018 Oct 16.

    The effects of melatonin supplementation in adjunct with non-surgical periodontal therapy on periodontal status, serum melatonin and inflammatory markers in type 2 diabetes mellitus patients with chronic periodontitis: a double-blind, placebo-controlled trial.

    BACKGROUND: Diabetes mellitus (DM) and periodontitis are two common chronic diseases with bidirectional relationship. Oxidative stress plays a key role in the pathogenesis of these two diseases. The aim of this study was to investigate the effects of melatonin supplementation in adjunct with non-surgical periodontal therapy on periodontal status, serum melatonin and inflammatory markers in type 2 DM patients with chronic periodontitis (CP).

    MATERIALS AND METHODS: In this double-blind clinical trial study, 50 type 2 DM patients with CP were randomly allocated to the intervention and control groups. The intervention and control groups received either 6 mg melatonin or placebo (2 tablets) once a day. Serum levels of melatonin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), hs-C-reactive protein (hs-CRP), clinical attachment loss (CAL), pocket depth (PD), bleeding on probing (BOP) and plaque index were evaluated in all subjects pre- and post-intervention.

    RESULTS: Melatonin supplementation significantly increased the mean serum levels of melatonin after intervention. The mean changes of melatonin were significantly higher in intervention group compared with control group. IL-6 and hs-CRP levels were significantly (p = 0.008 and p = 0.017, respectively) reduced in the intervention group. The mean changes of IL-6 were significantly lower in the intervention group compared with the control group (p = 0.04). In the intervention group, PD and CAL were significantly decreased after intervention (p < 0.001). There were significant differences in the mean change of PD and CAL between the intervention and control groups after intervention (p < 0.001). CONCLUSIONS: Melatonin supplementation in adjunct with non-surgical periodontal therapy might improve inflammatory and periodontal status in T2DM with CP. Be well! JP

  26. JP Says:

    Updated 12/05/18:


    Clin Oral Investig. 2018 Sep 13.

    Effects of oral prophylaxis including tongue cleaning on halitosis and gingival inflammation in gingivitis patients-a randomized controlled clinical trial.

    OBJECTIVE: The objective of this study was to assess the effect of oral prophylaxis including tongue scraping on level of halitosis, clinical periodontal parameters and local cytokine response in gingivitis patients.

    MATERIALS AND METHODS: In this randomized controlled clinical trial, 36 gingivitis patients were randomly assigned into two subgroups after scaling and polishing. Group 1 received oral hygiene instructions including the use of tongue scraper; group 2 received oral hygiene instructions alone without tongue cleaning. Levels of volatile sulfur compounds (VSC), organoleptic and tongue coating scores, clinical periodontal parameters and gingival crevicular fluid (GCF) samples were collected at baseline and 7 days after oral prophylaxis. GCF samples were analyzed using multiplexing analysis for the simultaneous measurements of cytokines. The Chi-square, Mann-Whitney U, Wilcoxon, and Student’s paired and unpaired t tests were used for statistical analysis.

    RESULTS: Statistically significant reductions were found in terms of clinical periodontal parameters in both groups. However, significant improvements in VSC levels, organoleptic and tongue coating scores were observed just in tongue scraping group. Moreover, the GCF levels of IL-1β and IL-8 significantly decreased after the treatment in group 1 according to the baseline values.

    CONCLUSION: The present study indicated that oral prophylaxis including tongue scraping was effective in improving intra-oral halitosis and pro-inflammatory cytokine response in GCF in gingivitis patients.

    CLINICAL RELEVANCE: The results suggest that tongue scraping can be taken into consideration in order to manage gingival inflammation as well as VSC levels in gingivitis patients but further clinical studies are required to judge the clinical relevance.

    Be well!


  27. JP Says:

    Updated 03/09/19:


    Dent Res J (Isfahan). 2019 Mar-Apr;16(2):104-109.

    Efficacy of stevioside sweetener on pH of plaque among young adults.

    Background: Stevioside is a natural herbal sweetener extracted from Stevia rebaudiana. An in vitro study has proved the antibacterial efficacy of 0.2% Stevia aqueous solution against Streptococcus mutans and Lactobacillus acidophilus, and the present study was conducted to clinically evaluate the efficacy of Stevia leaf extract and Stevia product on plaque pH, when compared with sucrose solution.

    Materials and Methods: A clinical trial was conducted among a sample of 22 undergraduate students who volunteered. After obtaining consent, students were instructed not to brush at night and not to use any mouth rinse during the course of the study. Baseline plaque pH was measured in situ using digital pH meter. Students were asked to rinse for 1 min with 0.2% aqueous solution of Stevia leaf extract and plaque pH was measured in situ at 4 time points (5, 10, 15, and 30 min) after each rinse. After a washout period of 2 days, 10% sucrose and 1% Stevia product solutions were similarly tested. Statistical analysis was performed using analysis of variance (ANOVA) test and repeated measures ANOVA. Tukey’s HSD test was used to obtain multiple comparisons. The level of significance was set to be at P < 0.05. Results: At 5, 10, 15, and 30 min, a significant difference in mean plaque pH values was observed between three test solutions (P < 0.000). Post hoc Tukey's HSD test showed that the difference in mean pH values between aqueous Stevia extract and sucrose and Stevia product and sucrose was highly significant (P < 0.000). Conclusion: Stevia leaf extract and commercially available Stevia product did not significantly affect plaque pH values, implying that two solutions are non-fermentable and do not support bacterial survival. Be well! JP

Leave a Comment