Periodontal Qi

by Dr. Marcy B. Newman, DOM, MPH, RDH

Periodontal diseases are by far the most frequently occurring oral conditions known to man and the leading cause of tooth loss among the American population. In Western dentistry, it has been discovered that multiple periodontal diseases can afflict both adult and juvenile populations, thus the term diseases is used. The dental profession has already found that these diseases occur in over 70% of the United States adult population . From an Oriental medical standpoint, these statistics illustrate an increase of each manifestation categorized within our Chinese periodontal differentiations. According to my research, periodontal disease is classified as: ya xuan = gaping gums, ya lou = leaking gums, and ya nu = bleeding gums.

As quoted by the American Academy of Periodontology, the causes of periodontal diseases are multiple and include:

Note that these above factors are usually visible upon inspection of the oral cavity by a dental professional. As a dental hygienist, from an initial glance I can often detect which factor has been influencing my patients. What must be mentioned here is that each patient’s oral hygiene habits and their frequency of dental cleanings play crucial roles in their oral disease status!

Please refer to the periodontal diagram in order to visualize the process and its destruction to the periodontium as the disease progresses. Note the alveolar bone and its fibers that connect it to the cementum or root surface dissolve as the pathogenic process progresses.

From a Western standpoint the periodontal disease process begins with gingivitis or red, puffy gingiva (gums) – as illustrated on the right side of the above illustration—due to the presence of specific bacteria within dental plaque (bacteria, food, and saliva) that adheres to every tooth surface. This biofilm aggravates the tissue by causing an inflammatory response. A professional prophylaxis or cleaning usually performed by a dental hygienist, along with good oral hygiene at home and a plaque-reducing diet (limited carbonated beverages, low carbohydrate intake, and frequent crunchy snacks), can eliminate or minimize this gingivitis sequence of events. However, if the patient does not follow the above recommended treatments, their disease process can progress.

From a Western diagnostics viewpoint, any adult patient ought to receive a periodontal screening at least once per year. The dentist or dental hygienist performs this screening by placing a periodontal probe marked in millimeters in the sulcus, or healthy space, between the gumline and the tooth to record six readings in different locations. The depth of the readings reflect the extent of inflammation or disease present (as a patient, if you hear your dental professional calling out three millimeters or less, you’re in good periodontal health). Aside from periodontal probing, radiographs (x-rays) are essential in diagnosing the bone level and extent of any bone loss that may be present. Unfortunately, as with hypertension, periodontal disease is often painless until its later and more morbid stages.

The patient shown here may not have been aware of any symptoms aside from some increase spacing, slight bleeding upon brushing, and increased tooth size (due to recession of the gingiva). Upon returning to the dentist after several years absence, the hygienist found pockets or increased spaces of 6-7mm between the gingival and teeth and advanced bone loss on the radiographs.

The above radiograph (x-ray) illustrates a dramatic level of bone loss (#B) with a widened periodontal ligament space. This example illustrates advanced periodontal disease due to pathogenic influence as the disease process extends beyond this premolar to the premolar adjacent to it. In normal periodontal health, the bone height ought to be level with the tooth-root margin or Cemento-enamel junction (#A).

Let’s now look at the periodontium and its associated conditions from an Oriental medical perspective.

Chinese Differentiations of Periodontal Disease

In Relation to the Four Heat Levels

In conclusion, patients are incredibly fortunate to be able to turn to us, as acupuncturists and herbalists, to quell their periodontal pain, bleeding, and other symptoms. Our ability to address the causation factors, such as Kidney/Spleen/Yin/Yang/Heat imbalances, immune suppression, hormonal imbalances, grinding/clenching and smoking (to name a few) could tremendously benefit the prevention, severity and prevalence of periodontal diseases. Also, as holistic practitioners, aside from our treatments, we need to advise our patients to visit their dentist for regular check-ups, periodontal evaluations, and thorough dental prophylaxis! Our patients need to partake in their oral health with good hygiene practices, healthy dietary habits, and no smoking.

Any questions, please write Dr. Marcy B. Newman, DOM, MPH, RDH – drmarcy@dentalacupuncture.net.