Gingivitis, Periodontitis, Infective Endocarditis, and MVP

As anyone with MVP should know, infective endocarditis is a serious threat to heart valve health. It can occur when bacteria adhere to the leaflets, cemented in place by platlets, fibrin, and other material from one's own circulatory system. For mechanical reasons no doubt related to the fluid dynamics of the valve, it's evidently difficult for out macrophages (white blood cells) to locate and destroy such deposits. The longterm result can be premature valve decomposition, potentially requiring repair or replacement.

Historically, the American Heart Association (AHA) recommend prophylactic antibiotics for anyone with MVP, to be delivered prior to dental surgery or even cleaning. The theory was that such treatment would preemptively inhibit bacterial infection as a result of septic dental plaque seeping into the bloodstream. Although the theory may have been correct, the AHA recently concluded that the risk inherent in taking antibiotics actually exceeded the risk eliminated by preventing this very isolated, rare source of endocarditis. Antibiotic overuse runs of risk of resistant bacterial infection, liver stress, and the destruction of one's beneficial gut bacteria which serve as part of our digestive and immune systems.

Furthermore, the AHA concluded that "daily activities", taken in the aggregate, constitute a greater risk than occasional dental procedures. No doubt this includes flossing, which as we all know, produces bleeding gums for those of us with gingivitis (gum inflammation) and periodontitis (gum disease). They have since issued a revised recommendation.

Until a couple months ago, I had been fighting gingivitis and losing the battle. Now, I produce only faint amounts of blood when I brush and floss, well within acceptable safety limits. I'd like to tell you how I won the war.

Earlier this summer, I was producing oral blood flows lasting up to 30 minutes after the fact. This is not only a bacterial hazard. At some point, it constitutes a blood loss hazard. Indeed, recent blood tests indicated that my red blood cells were disproportionately young. In other words, my body was struggling to compensate for the blood I was losing orally. It got so bad that at one point, my gums would open and bleed in my sleep, probably due to the dry air in my bedroom. In the morning, I'd awaken with the familiar alkaline taste in my mouth, as blood has an alkaline pH of 7.4. I'd spit up telltale reddish yellow fluid, left to wonder just how much I'd leaked. Yikes!

The first step was to use Metrogyl, a topical oral antibiotic whose active ingredient is metronidazole. You can get this, or a superior alternative product, from your dentist. I just rubbed it on my gums and swished it between my teeth, then spat it out, before eating each meal. After a week of use, my bleeding level had subsided, but it still wasn't what I'd call safe. I was getting worried, particularly on account of the unflattering blood tests mentioned above.

I stopped after the recommended one-week course, as I didn't want to invite the longterm problems of antibiotic use. At this point, I decided to experiment with changes in dental and nutritional habits.

The first change I made was to floss every day, whereas in the past I had been sloppy about my flossing habits, particularly on days when I didn't eat much, or just ate vegetables. Now, I floss once a day, no matter what. I rinse my mouth with purified water after the fact, in order to get the junk out. I also don't brush when my gums are bleeding, as there's all sorts of nasty stuff in toothpaste, possibly including bacteria, that I don't want in my blood. Therefore, these activities are separated by a healing period of an hour or more. And perhaps it's better to brush first.

And when I floss, I make sure to get into both little pockets at the base of neighboring teeth. (Your teeth are curved inward where they meet the gums, creating a pocket on each side of the tooth.) So I go up and down at least twice for every gap that I floss. I'm not particularly gentle, either, as I've heard numerous dentists recommend that we allow our gums to toughen, probably due to the formation of scar tissue at a microscopic level.

While no longer necessary, during my heavy bleeding periods, I would swish concentrated salt water between my teeth before and after flossing and brushing, in order to keep bacteria to a minimum. You can experiment with the salinity; I was using about a teaspoon in 4 ounces of water, which is extreme. You can also gargle salt water to cut down the bacterial population in your throat, which no doubt feeds your gingivitis, to some extent. But don't swallow, and reduce the salinity if you can't do it without gagging.

One other dental tip: I'm careful not to brush my gums crosswise, which causes them to recede, exposing the boney roots of the teeth. I brush firmly in little circles, taking care to push up or down against the gumline -- never sideways.

The second change, to which I attribute most of my success, was dietary. Surprise, surprise, when I cut out sugar (including fruit, except for avocados and tomatoes), the gingivitis stopped within days. If I eat so much as a slice of watermelon, it comes back the same day. So now, despite my love of dragon fruit as I explained in an earlier post, I've switched to tomatoes as my source of quick energy and hydration. Even then, I only eat them when I feel dehydrated, or need fast energy for impending physical labor.

But I cut something else that most people don't consider junk food: dairy. Now, the only dairy product I eat is butter. Yes, it's high-cholesterol, high-saturated-fat food. But it satisfies (meaning that it prevents me from overeating), and is nonglycemic. You see, I found that drinking milk would always result in bad breath the following morning, aparently due to its sugar content. Cheese causes less of a problem, but still contains damaged milk protein due to pasteurization, which stimulates an invalid immune response because your body mistakes the protein for pathogens, resulting in increased systemic inflammation, which certainly won't ameliorate gingivitis. If you haven't heard of this, Google for the problems of dairy. You'd be better off not consuming this stuff, except perhaps for unpasteurized milk, which has its own hazards.

Of course, this leaves me with a calcium, magnesium, phorphorus, and vitamin D debt. (Protein is easily aquired from other sources.) But primitive humans didn't have milk (except as babies) or cheese, and survived just fine. So I get my calcium from brocolli (and to large extent, vitamin pills and Tums calcium tablets, both crushed and mixed with food so as to minimize the negative digestive impact); I get my magnesium from nuts; I get my phosphorus from pumpkin and sunflower seeds; I get my vitamin D from the sun and oral supplementation. I wish I had a better calcium source. Maybe I'll start taking chlorella. I'd rather not chew on fish bones, which might carry mad cow proteins, particularly if they're from farmed sources.

I also increased my uptake of brocolli and avocados, for their vitamin K content. Vitamin K helps the blood clot. If you can get it, parsley is the ultimate vitamin K source, but in most places, it's loaded with pesticide. Good for you if you can find the organic stuff.

Additionally, I started supplementing zinc, although I don't think this did much for my gingivitis, as I increased my intake weeks after it had already improved. Zinc is involved in the skin healing process. Be careful, though, as it's possible to overdose easily, as discussed in the Wikipedia article linked above. On the other hand, it's also very hard to acquire, as the best sources are bivalves like clams and mussels, which are often heavily polluted because they filter the water in their environment. I opt for zinc picolinate capsules, which are easily obtained at GNC or online. I pour the powder out and mix it with my food. As I've said in previous posts, I don't believe in "spike supplementation", i.e. giving the body massive, highly bioavailable injections of nutrients in the form of pills.

I made one other dietary change which won't apply to most of you. You see, my diet is so healthy, that my blood takes a long time to clot. (This is desirable because it reduces the probability of heart attack, stroke, and veinous thromboembolism.) The problem, clearly, is that at a certain point, my blood is so "thin" that my gingivitis refuses to heal up. And certainly, I need to discuss this with my doctor prior to any surgery. It also doesn't help if I get banged up in an accident! The change was this: in addition to increasing vitamin K intake, I cut back on grape extract and olive oil, both of which I love to consume, but which suppress plasma clotting factors, and thus platelet aggregation at the site of a wound. In parallel, I decreased my omega 3 intake, and increased omega 6, resulting in an increased clotting tendency. After my gingivitis subsided, largely due to my low-sugar diet, I increased my intake of these generally beneficial substances once again, to the maximum possible level short of inducing gingivitis. (I still moderate my olive oil intake, as it tends to dehydrate me, despite its benefits.) Indeed, most people in the industrialized world suffer from blood which clots too readily, so these measures probably do not apply to you (except perhaps for a week or so while attempting to close your gum wounds more rapidly, while you decrease sugar intake or apply topical antibiotics).

On the rare occasion that I need fruit, I floss and brush immediately afterward. Needless to say, this reduces my appreciation of the fruit to begin with, so I only do it when I need a massive burst of energy.

By the way, watch out for hidden sugar sources, such as the infamous high fructose corn syrup found in everything from ketchup to "healthy" wholegrain bread. Craving carbs? Have a bowl of lentils, spiced and buttered to taste!

By following these steps to combat your risk of infective endocarditis, you'll improve your health generally, and no doubt save money on dental work. To your health!