Before it is possible to learn what is abnormal it is essential to know what is normal, so it is possible to appreciate what are the problems and then how can these problems be addressed.  Many people question how it is possible for bacteria that are involved with gum infections to also be the cause of general or systemic health problems.  This blog is going to first show you what is normal, then we will discuss how gum disease begins and how this starts to affect the infection process.  This blog will first show how the bacteria grow in infected gum tissues and then get into the blood stream.  Other parts of this blog will deal with how the bacteria once in the blood stream can cause general health concerns or inflammation.
A healthy smile is no accident and the health of the mouth is something that most people do not appreciate but take for granted.  Health is essential to maintain, for if there is a loss of health this is replaced with disease.  The health of these person's mouths are maintained on a daily basis because they uses the Perio Protect Method that enables them to control the bacteria that cause disease.

Healthy gum tissue is demonstrated in this picture.  There is a small valley or sulcus around each tooth that should be about 1 to 2 mm deep when the tissues are healthy.  The cells of this region make a fluid that flushes out this valley to keep food and bacteria under control and this fluid continues to "flush" out this region about every minute or so when it is healthy.  There are bacteria present in this region, but they are ones that live in a good relationship with the tissues and don't cause any inflammation or damage.  These first bacteria are few in number and live in an oxygen rich environment as the valley is still small.








We need to briefly discuss the bacteria as we just don't appreciate how significant they are in our health and the part they play in disease.  First bacteria are extremely small, much smaller than we may have been taught to appreciate.  Here we are looking at the head of a pin under a microscope.  Even with the microscope it is not possible to see most of the bacteria as you can place between 1,000,000 and 10,000,000 million bacteria on the head of a pin, so we can begin to appreciate how many bacteria there may be in our mouth!


Looked at under higher magnification we see the bacteria that are sitting on the head of this pin.  They don't just sit there, but they actually attach to the surface wherever they live.  If conditions (food and water) are plentiful they begin to make proteins (quorum sensing) and other substances that stimulate growth and other bacteria join the group to live in a community (biofilm).  What one bacteria makes as a waste product the next bacteria can use as food.  The more food that is present helps determine how well the bacteria grow and help determine the size of the community.

The community of bacteria is called a biofilm, a term coined by one of my good friends (now deceased) Dr. Bill Costerton.  Bill was a unique individual that realized we do not have all of the answers and owe it to those who follow us to look at everything with an open mind.  Bill realized that Robert Koch was only been partially correct with his Koch's Postulate that one bacteria causes disease and he was tenacious in his search for the truth that the community of bacteria is what is really responsible for disease, not the individual bacteria.
A biofilm is a community of bacteria that live in an environment as a group.  In the mouth, which is an ideal incubator for bacteria, one bacteria can grow and when challenged it can divide about every 20 minutes.  One bacteria dividing every 20 minutes can result in 5,000 billion, billion bacteria in one hour.  The bacteria are so small, they attach to their surface and they grow so fast.  It is not possible for most people to control these bacteria with just brushing, flossing and using oral rinses, which cannot get into the valley where the bacteria live.

If we don't have health we have disease.  The World Health Organization studied the status of oral health in 144,000 individuals and the graph at the right shows that less than 5% of the people living in North America were healthy without disease.  This can best be explained by understanding how the bacteria live and realizing that brushing and flossing and oral rinses are just not enough to control the bacteria.  This first damages the tissues around the teeth, but the damage does not remain there as the bacteria invade the host blood stream and are carried anywhere in the body in just minutes.

 This artist’s representation shows the gum tissue and bone to the left of the tooth.  Bacteria begin to grow on the surface of the tooth at the top of the valley or sulcus.  These early growers are bacteria that live quite well in an oxygen rich environment and the bacteria and their waste products don't cause much local damage. However, as the bacteria community grows, other bacteria grow that don’t need oxygen and these bacteria can live off of the fluid that is made to flush the area clean, or off of the waste products of the early colonizers   These later bacteria cause much more of the damage seen in advancing gum disease.

Looking at the gum tissue in this representation from Scientific American (by permission) we begin to see that gum disease is actually a wound or small ulcer that occurs in the tissue.  We don't see this broken down tissue because it is found under that flap of gum tissue, but if we brush or floss the region it results in bleeding because the blood vessels (capillaries) are exposed at the bottom of the ulceration.  Bacteria from the gum infection is therefore able to gain immediate access to the blood stream because of these ulcerations.  This ulcerated tissue (inflammation)  is a response to the bacteria and this is the portal of entry and explains how the bacteria can get into the blood stream. 

These bacteria are both bacteria called Pg (Porphyromonas gingivalis).  The slide on the left shows the lipopolysaccharides (LPS) that serve as poisons or toxins that arise from the surface of the bacteria and remain on the bacteria surface or are released into the environment.  These toxins can be made when the bacteria grows in an environment where there is oxygen and serve to protect the bacteria from being eaten.  The slide on the right shows similar LPS poisons or toxins that can be made when the bacteria grows in an area without oxygen.  The purpose of these poisons is self protection for the bacteria.  The stronger the poisons, the more the bacteria are protected from being digested by white blood cells, but the toxins made by the bacteria when they grow in the presence of oxygen is not as caustic as the toxins made by the bacteria when growing in the absence of oxygen.  

The human body has multiple white blood cells that are responsible for recognizing bacteria and which are designed to move to the bacteria, swallow it and digest it.  The picture shows one of these bacteria being approached by the white blood cells (PMN or polymorphonuclear leukocyte).  The PMN moves to the bacteria, engulfs it and digests it, so that should be the end of the problem.  Well it is not.

If you go back to the picture of the bacteria above to the right you will see the poisons in the form of clumps on the outside and also within the bacteria.  Once digested by the PMN we do not have enzymes to digest the LPS toxins, so they are released into the environment and this can cause localized inflammation.  But it doesn't stop here!











The LPS are joined to binding proteins and these combined toxin/protein are recognized and taken in by other white blood cells called macrophages that are part of our immune system.  Once the LPS are inside the macrophage, the cell begins to make a series of proteins (called a protein cascade) that can help bind to the LPS and these are released from the cell,.
Two major problems exist.  The proteins that are made cause inflammation and once inside the macrophage, the toxins (LPS) remain for over 60 days, causing these cells to continue to develop and release the inflammatory proteins.  The photograph on the left shows the presence of these toxins (LPS) in macrophages 60 days after they were first ingested, stimulating these cells to continue to make and release proteins that cause inflammation.  Forestier  C. et al. Lysosomal Accumulation and Recycling of Lipopolysaccharide to the Cell Surface of Murine Macrophages, an In Vitro and In Vivo Study  J Immun 1999;162(11) 6784-91 

Inflammation is what causes most of the local problems and/or the general or systemic problems.  Viewed here we can begin to see the damage that occurs to the gum tissue around the tooth.  The products of this inflammation cause the gum tissue to breakdown, cause the loss of bone supporting the teeth and if the cause of disease is not corrected these conditions will result in the loss of the teeth.  This causes swelling and pain as the body attempts to control the bacteria that live in a region that is extremely difficult to reach and control.  Brushing and flossing and oral rinses are just not enough. This inflammation starts in infected gum tissue but it doesn't stay in just the gum tissue if the infection is allowed to continue.

It is possible to control the bacteria that cause gum disease with the Perio Protect Method.  The infected gum tissue above has been restored to health by controlling the bacteria that caused the disease.  The patient uses her Perio Protect Method once or twice a day for 10 to 15 minutes where she directs medication in the valley around the teeth so the bacteria that cause disease can never regrow and she can keep her teeth and improve her health.

Bacteria from gum disease have been associated with many of the general systemic problems.  It is important to understand the relationships between oral bacteria and systemic disease because gum disease can now be treated by stopping the cause (bacteria) and not getting the response (gum infection) or systemic involvement.   It is important to control the bacteria in the mouth, which is possible with the Perio Protect Method that has been shown to kill 99.98% of the oral bacteria.  Controlling a disease by controlling the source of the disease is better than dealing with all of the effects that may occur if the bacteria pass from the gum tissue into the blood stream and cause systemic inflammation and disease.