I have had an epiphany. While I admit to recognizing that diet is important to health any many ways, I have been influenced by Dr. Dean Edell to resist dietary supplementation by pills. Dr. Edell is in a position to read more of the medical literature than any doctor who actually sees patients, so I credit him with being able to keep up with all the latest research. And he seems to be honest in his advice, so I tend to trust his advice to his listeners.

But now I think he is wrong about nutritional supplements, like vitamins. His reasoning is that he is healthy and personally doesn’t take supplements. It is likely that he is correct in assessing his own needs.

This week I attended a conference on the oral-systemic connection in Reno, where I shared the podium with Dr Lisa Marie Samaha, Dr, Lee Ostler, and Dr. Bill Domb, and Robert Maccario. Dr. Samaha presented case after case of people whose periodontal disease was helped greatly by nutritional supplementation. They still needed treatment to reach optimum periodontal health, but the improvement was unmistakable from the nutritional supplements.

I saw her present briefly last November, and we have started offering nutritional supplements to our periodontal patients. But I admit it was half hearted. I didn’t understand the mechanism of how supplements helped, and I wanted to be able to repeat Dr. Samaha’s success in our own office.

It was Dr. Ostler’s presentation that brought the epiphany. He explained the nature of a few genetic defects which make the body work harder to repair damage on a molecular level. I won’t try to explain, and I am not sure that I can. But suffice it to say that there may be about 20% of the population whose genetics interfere with the body’s defenses or repair mechanisms enough to affect there ability to defend themselves against the pathogens of periodontal disease. And if we can provide molecules to help them in the diet, their defenses or repair mechanisms can be more normal. I would speculate that Dr. Edell does not have any of these genetic anomalies, so he would be correct in saying that he does not need them.

The day of genetic medicine and dentistry is coming, and soon. Doctors will be able to look at the entire genome for known genetic polymorphisms and either repair them or provide the work-around to help people avoid getting sick. Right now the reams of data from the entire genome is overwhelming and expensive to acquire. But the days of computer interpretation of the data are here and soon the practice of medicine and dentistry will be vastly changed by the information from the genetic testing.

So my take on this new understanding, is that we must infer from unusual presentations of periodontal disease that nutritional supplementation is necessary or the person will not ever get healthy. And there is another bit of evidence that it is just not always the fault of the person that they are not healthy. We have placed too much blame on people for their dental diseases. Good oral hygiene certainly helps people prevent dental diseases. But for somebody who has been infected with aggressive pathogens, or is genetically missing the ability to effectively fight the pathogens, good oral hygiene is just not enough.

I have never felt so needed. Now be well.

Leading Cardilologist Comments on Gum Disease

If you are a cardiologist, a dentist, or even just any American over the age of 40, I recommend that you spend the fourteen minutes to hear the message above. Dr. Ridker, the director of the Center for Cardiolovascular Disease Prevention, Brigham and Women’s Hospital, was the keynote speaker at the American Academy of Periodontology this year.

Dr. Ridker is proposing double blind studies to prove that inflammation from periodontal disease is related to death by cardiovascular disease. In a previous blog, I proposed that we stop discussing the possible relationship between gum disease and heart attacks and admit that the bacteria from the gum disease are causing heart attacks. Dr. Ridker is recognizing that inflammation is a more important indicator of cardiovascular risk than high cholesterol, and proposing studies to prove just that.

I don’t know about you, but I don’t want to be part of the control group. The scientist in me wants the definitive proof, but the clinician in me already knows the likely outcome. We test the C reactive protein of our periodontal patients before we commence treatment. We see dramatic declines in the C reactive protein levels of the patients who get their periodontal disease under control. And as Dr. Ridker admits, your C reactive protein levels are a better indicator of heart attack risk than your cholesterol levels. Yet while most American adults know their blood cholesterol levels, almost none know their C reactive protein level.