Gingivitis and Alzheimer’s Disease

A couple of years ago, I ran across an article in the Journal of Alzheimer's Disease with the provocative title, "Can Better Management of Periodontal Disease Delay the Onset and Progression of Alzheimer's Disease?" This topic has fascinated me for a long time, for two reasons. One thing is that, generally, there is a lot of suggestion in the literature that periodontal disease and dental issues in general play a hidden but significant role in the development of any number of chronic diseases, including dementia related diseases, heart disease, and even some cancers, including gastric cancers. Integrative medicine teachers such as Dr. Dietrich Klinghardt have long stressed the critical nature of dental health and the prevention of toxins in inflammation, which lead to most of our chronic illnesses. There are even maps relating the different areas of the mouth to different organs of the body, similar to acupuncture and reflexology charts

The second is that, specifically, there is a growing body of information establishing a link between periodontal disease and Alzheimer's disease. 10 years previously in the same journal, an article entitled "Alzheimer's disease and peripheral infections: possible contribution from periodontal infections, modeling hypothesis". In the ensuing 10 years, research has been done in a number of countries which together have begun to bear out this hypothesis.

Periodontal disease is a condition that is treated every day by dentists and ignored completely by physicians. In my own training, when we were taught to rattle off our review of systems and physical exams, gum health was either overlooked entirely or lumped into a quick "teeth and gums okay". If we were taught the proper way of examining the guns, or to incorporate gingivitis into our list of differential diagnoses, I certainly don't remember it. (Similar situations happened with the exam of the foot, which seem to have been left to the podiatrists to properly examine).

Periodontal disease actually involves two stages of an inflammatory situation. The first, known as gingivitis, affects up to 60% of the teenage population and almost 50% of adults. This is when plaque builds up along the gum line of the tooth and causes inflammation of the gums. Many factors determine the seriousness of gingivitis, including genetic susceptibility, environmental conditions such as diet, smoking and tooth care, concurrent illnesses which affect immune system function, conditions like pregnancy or puberty, and various medications. With proper oral care, gingivitis is usually reversible.

Periodontitis is the much more serious periodontal disease. 47.2% of adults over the age of 30 have periodontitis, according to one study recently. It is actually the most common inflammatory disease in humans. Inflammation destroys the connective tissue of this, of the inner gum, and weakens its attachment to the wood surface of the tooth root. Multiple bacteria colonize in the pockets created by this damage inflammation, called sub gingival pockets. It has been estimated that billions of bacteria searching for the welcoming inflammatory tissue are colonized around the teeth of a patient with periodontitis.

Although there are many different types of bacteria in these infected pockets, the one which seems to be most critical is a pathogenic organism called Porphyromonas gingivalis, or P. gingivalis. It seems that, on a post-mortem study, 100% of samples of patients’ brains had the Porphyromonas gingivalis  (Pg) infection while only 40% of the age matched controls had this insidious infection. There have also been several other  studies that show that if you put the Pg bacteria in the mouth of a mouse, that it “causes all the signs of Alzheimer’s disease” in their brains.   

This study and the researchers theorized that the bacteria traveled from the mouth to the brain.  Since the toxins secreted by these bacteria caused much of the damage and subsequent “neurofibrillatory tangles” that are the hallmark of Alzheimer’s, antibiotics were useless.  Researchers have developed a novel new drug called “investigational agent/COR388” which to target and block the toxins (toxic proteases or gingipains) released by these bacteria.  Preliminary research shows that this “investigational agent” has very minimal side effects, since it just seems to target the toxins, not anything in the body.  The drug is now in Phase 3 studies, and results look promising.

This whole line of study emphasizes two concepts that I consider very important.  One is the importance of microorganisms of all kinds, both harmful and beneficial, in the delicate balance of health.  The gums are actually an upward extension of the entire digestive tract (it’s all a continuous mucous membrane) and the effects of microorganisms on that mucous membrane (collectively known as the microbiome) can lead to (or protect against) chronic inflammation of all sorts.

The second concept relates to that inflammation itself.  Many Alzheimer’s drugs (and those for Parkinson’s and other neurodegenerative diseases) target the RESULT of inflammation, that is the beta-amyloid (or in the case of Parkinson’s alpha synuclein) deposits.   Even the COR388 targets the toxins which are already being secreted and doing their damage.   How much more sense it makes to work on establishing and maintaining the proper balance of bacteria in the gums and digestive tract?  And to address inflammation at its root, with natural anti-inflammatories?

I’m encouraged by the appearance in natural medicine of products (like OraMax, referenced below) which attempt to address both the bacterial imbalances of the oral cavity, and the inflammation that results from that imbalance.  Hopefully, conventional medicine will follow suit sometime soon.

Stephen S. Dominy, Casey Lynch, et al, Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. Science Advances  23 Jan 2019:Vol. 5, no. 1, eaau3333. DOI: 10.1126/sciadv.aau3333.



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