Managing dental and periodontal symptoms

As the article on periodontal disease and gingivitis explains, these diseases are widely accepted as caused by a polymicrobial infection. Like all symptoms of inflammatory disease, dental pain and inflammation may temporarily increase during periods of immunopathology. These symptoms can be managed using the typical strategies for managing immunopathology, and should resolve through the course of the Marshall Protocol (MP).

Dental problems seem to be particularly common among patients with Th1 diseaseAny of the chronic inflammatory diseases caused by bacterial pathogens.. High levels of 1,25-DPrimary biologically active vitamin D hormone. Activates the vitamin D nuclear receptor. Produced by hydroxylation of 25-D. Also known as 1,25-dihydroxycholecalciferol, 1,25-hydroxyvitamin D and calcitirol., which is common in such patients, can cause the teeth to be resorbed into the blood,1) 2) a process which increases vulnerability to bacteria. Also, decreased production of saliva, a symptom of inflammation, can make teeth more susceptible to the mix of pathogens present in the mouth that decay teeth.

You can expect some aggravation of symptoms especially if you have had any infected tooth requiring a root canal or deep filling. Once started on minocycline, the gum inflammation and infection will improve. The tooth pain can wax and wane throughout the ramping up phase of the antibiotics but tend to be transient.

Greg Blaney, MD

Canker sores

A canker sore, also known as an aphthous ulcer, is an open sore appearing in the mouth. Canker sores are a symptom of Th1 disease. Some patients find that canker sores flare during periods of stress or tiredness.

Management of symptoms

  • Try the standard ways for managing immunopathology.
  • Use and/or apply a mild toothpaste such as a child's toothpaste or Sensodyne. Placing a dab of toothpaste on a canker sore inside the mouth may reduce the pain and heal the sore quicker.
  • Use a mouthwash.
  • Swish apple cider vinegar in one's mouth.

Dental fractures

Dental fractures are broken or chipped teeth. Note that dental fractures are sp,eto,es difficult to diagnose.

Patients experiences

All my dental fractures were painful. The cracks in my teeth extended to the tooth's core, which allowed a way for bacteria to reach the soft pulp, nerve endings and blood vessels. I didn't have abscesses.

The endodontist verified each fracture by examination. Cracked teeth can be very sensitive to heat and cold, and the crack can look much like a crack in a rock. When a light was aimed at my tooth, there was a change in the amount of light transmitted at the fracture, so the fracture was obvious to my endodontist. In one case, the tooth pulp was visible when I entered the office, and that pulp pulsed each time my heart beat.

One of my teeth was not particularly painful; the nerve had already died when I realized it was fractured. In that case, my endodontist still recommended a root canal to remove the pulp. Most people do not realize that teeth are alive and fed by blood vessels. Your dentist may be concerned for that reason, since bacteria that get through the crack would be able to get into the blood.

Belinda, MarshallProtocol.com

Halitosis (bad breath)

Several studies have confirmed that most cases of halitosis, also known as bad breath, are caused by bacteria. One environmental study of patients with and without halitosis found that 32 species including 13 noncultivable species were found only in subjects with halitosis. Solobacterium moorei was present in all subjects with halitosis but not in any control subjects.3)

Patients suffering from halitosis can use one of the mouthwashes recommended for MP patients.

Oral malodor develops mostly from the metabolic activities of indigenous bacterial populations within the oral cavity, but whether healthy or oral malodor-related patterns of the global bacterial composition exist remains unclear. In this study, the bacterial compositions in the saliva of 240 subjects complaining of oral malodor were divided into groups based on terminal-restriction fragment length polymorphism (T-RFLP) profiles using hierarchical cluster analysis, and the patterns of the microbial community composition of those exhibiting higher and lower malodor were explored. Four types of bacterial community compositions were detected (clusters I, II, III, and IV).

Two parameters for measuring oral malodor intensity (the concentration of volatile sulfur compounds in mouth air and the organoleptic score) were noticeably lower in cluster I than in the other clusters.

Using multivariate analysis, the differences in the levels of oral malodor were significant after adjustment for potential confounding factors such as total bacterial count, mean periodontal pocket depth, and tongue coating score (P < 0.001). Among the four clusters with different proportions of indigenous members, the T-RFLP profiles of cluster I were implicated as the bacterial populations with higher proportions of Streptococcus, Granulicatella, Rothia, and Treponema species than those of the other clusters. These results clearly correlate the global composition of indigenous bacterial populations with the severity of oral malodor. 4)

Pulp stones

Pulp stones or dental stones are spherical calcification located within the dental pulp, which is normally the softest part of the tooth. Chronic inflammation there, called pulpitis, can result in pulp stones. The stones can grow so large they fill most of the pulp chamber. These can prove quite challenging when the dentist or endodontist must remove them in performing root canal therapy. They have to successfully remove the stones from the center of the tooth without cracking the tooth.

Pulp stones are consistent with Th1 inflammation and elevated levels of 1,25-dihydroxyvitamin DPrimary biologically active vitamin D hormone. Activates the vitamin D nuclear receptor. Produced by hydroxylation of 25-D. Also known as 1,25-dihydroxycholecalciferol, 1,25-hydroxyvitamin D and calcitirol.. High 1,25-D precipitates calcium resorption from bones/teeth and deposition in soft tissues.

Dentists may be somewhat puzzled by cases of dental stones in people with Th1 inflammation, since no obvious trauma or infection may be apparent. The teeth involved may be fairly pristine teeth with little to no caries or fillings.

Teeth stains – minocycline's effect on tooth color

The use of tetracyclines, especially the MP antibiotic minocycline during tooth development, which occurs during the second half of pregnancy, infancy, and childhood up to the age of eight years, may cause permanent discoloration of the teeth (yellow/gray/brown). However, teeth staining can happen in adults as well.

This adverse reaction is more common during long-term use of the drug, but it has been observed following repeated short-term courses. Use of minocycline is generally avoided in children under age eight for that reason. In some situations, the benefits of using minocycline may outweight the risk of cosmetic changes in the teeth. The risk is probably less when the doses are low, and it does not appear that all children develop tooth staining. Enamel hypoplasia (poor development) has also been reported.5)

In some situations, the benefits of using minocycline may outweigh the risk of cosmetic changes in the teeth. The risk is probably less when the doses are low, and it does not appear that all children develop tooth staining.6)

In older children and adults, temporary discoloration of teeth occurs infrequently7) and not in doses recommended by the MP. The MP uses low doses of minocycline that are only a fraction of what is typically used for other treatments.

The staining is actually of the plaque and tartar (hardened plaque) and so may be removed with efficient cleaning or by a dental hygienist. MP patients may notice greater plaque and tartar build-up while on the MP.

It is important to point out that teeth are not white to begin with. Enamel is off-white; as it thins naturally with age, the yellow-gray color of the inner part of the tooth begins to show through.

Management of symptoms

MP patients who are unhappy with the the color of their teeth may pay to have their teeth whitened, either by their dentist or by buying a kit at their local pharmacy. Be advised that at least according to one former dental assistant, teeth whitening only works for those people whose teeth have yellow discoloration. Those with gray teeth do not change very much in color.

Patients experiences

During the first year of the Protocol, my teeth became very badly stained. They actually went black. It was quite thick and I couldn't brush it off - even with the whitening toothpaste. Luckily, my mother is a retired dental hygienist and I was able to go to her to get the really thick gunk scraped off my teeth. At one point, I had to get it done once a month to keep it at bay. Eventually, it just stopped.

Guss, MarshallProtocol.com

I did notice easier staining and faster tartar buildup on my teeth the first 18 months of MP, but it has eased off now. I had this happen with a few meds before I started the MP. I think if you take any drugs sublingually this might be more apt to happen. The good news for me is that they polished up nicely with no damage done. The poor hygienist gets a work-out. Thanks goodness for dental techs to help once in a while.

P.B., MarshallProtocol.com

I get the brown staining at the gum line too. My hygienist has me come in for cleaning every 3-4 months instead of twice a year. The buildup doesn't get too gruesome looking this way and cleaning takes less than an hour. I've had to do this since beginning MP.

Coolbeans, MarshallProtocol.com

My lower front teeth have become stained black between them for the first time in my entire life. Also at my last teeth cleaning appointment the hygienist was alarmed over how much plaque I had acquired. You see I have never had that problem ever either. She said it must be from the meds I am on now because my entire history I have had no problems before. In fact I only needed my teeth cleaned once a year until the MP.

CelticLadee, MarshallProtocol.com

Here are some recipes at this link for homemade toothpaste and mouthwash that incorporate baking soda and hydrogen peroxide.


Temporomandibular joint (TMJ) pain

Temporomandibular joint and muscle disorders, commonly called “TMJ,” are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement.

One of the first symptoms of TMJ will be that the jaw isn't working properly. Patients may be able to barely open and close their mouth, and their upper and lower bite no longer align as they once did. The teeth may no longer touch. There may be an odd clicking sound when they move their jaw.

TMJ can be affected by Th1 disease just like any other joint.

Management of symptoms

To ensure the jaw is working properly, patients who have TMJ may need to enlist the services of a professional who is trained in gentle manual therapies such as craniosacral therapy to realign the jaw to the correct position so your teeth will meet. Even if your problem is not that bad, a medical professional such as an osteopathic physician or chiropractor who uses gentle therapy and is familiar with TMJ disorders may provide immediate relief. Inflammation really is a temporary problem, but once the joint is out of alignment, a whole sequela of problems could set in, including being unable to eat and talk properly.

Some (but not all) osteopathic physicians, doctors of chiropractic, physical therapists or massage therapists are trained in gentle manual techniques.

If gentle therapies are not successful, a muscle relaxant may help, especially if a patient has muscle spasms in their jaw, neck or head.

Patients experiences

Early on in the MP, maybe 2 months or so in, I had my front teeth shift enough that the NTI bite guard device I was wearing during sleep for TMJ no longer would fit on my teeth. It's designed to fit tightly but all of a sudden it started falling right off. It's dangerous to wear if it is not tight so I stopped wearing it. I figured I would soon need to go in to the dentist to get it fixed, as it really helped with my problems with clenching teeth at night, and the associated muscle tension and pain. However, I found that my TMJ had improved enough that I never did go get the bite guard fixed. I hardly ever have teeth clenching of significance now. So, this is another area of improvement that I have had from the MP.

Catlady, MarshallProtocol.com

My upper teeth are shifting. I've been an inveterate grinder/clencher as well, but that eased up almost entirely with just the avoidance of sun and D, and then Benicar. I hardly notice it now!!! Still, I wear a major mouthguard at night, just in case. However, in the past week or so, the mouthguard has gotten loose on the front teeth - it was always tight. Now it's tight only in the far back, where it used to be loosest. On top of that, when I floss, I can feel spaces opening up between most of the upper teeth that weren't there before. My teeth have always been tight. A couple of gaps are large enough to blow air through.

Alayne, MarshallProtocol.com

===== Notes and comments =====

Normalisation of calcium status reverses the phenotype in dentin, but not in enamel of VDRThe Vitamin D Receptor. A nuclear receptor located throughout the body that plays a key role in the innate immune response.-deficient mice.

Zhang X, Rahemtulla F, Zhang P, Li X, Beck P, Thomas HF.

Department of Prosthodontics, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294-2170, USA.

OBJECTIVE: To determine the effects of vitamin D receptorA nuclear receptor located throughout the body that plays a key role in the innate immune response. (VDR) deficiency on mouse dentin and enamel mineralisation, and how normalisation of serum calcium level affects dentin and enamel phenotypes in VDR knockout mice. MATERIALS AND METHODS: Groups of VDR wild-type (VDR+/+), VDR deficient (VDR-/-) and VDR-/- rescued mice were sacrificed at 70.5 days of life. The rescued group was established by a high-calcium diet feeding the VDR-/- mice from postnatal 19 days. Micro-CT was used to compare enamel and dentin mineralisation density (MD) at different levels of mandibular incisors among the groups. The scanning electron microscope (SEM) was used to examine the ultrastructure of the enamel and dentin in the corresponding levels and of surface enamel after acidic treatment. RESULTS: Micro-CT showed that in VDR-/- rescued group, dentin phenotype was reversed and dentin MD was reversed to normal; however, enamel mineralisation was not reversible, and remained as hypermineralisation in molar region and apical region of the incisors. SEM also revealed enamel hypermineralisation in the VDR-/- rescued group. This early enamel hypermineralisation was more susceptible to acidic erosion. CONCLUSION: Vitamin D affects dentin mineralisation systemically, and it regulates enamel mineralisation locally.

PMID: 19850279 [PubMed - as supplied by publisher]

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