To prevent bleeding, redness, swelling and atrophy of gums, is it enough to add amino acids to toothpaste?

"Toothache is not a disease, but it is really painful when it happens." I believe many people have heard of this sentence, or even experienced it personally. But when your gums are red, swollen, and bleeding, someone may tell you: "This is 'getting angry'."

Are red, swollen and bleeding gums really caused by "getting angry"? Or is gum recession caused by "malnutrition" of the gums? Are the advertisements on the market that claim that adding amino acids to toothpaste can eliminate these hidden dangers reliable? What is the real purpose of adding amino acids to toothpaste?

Misunderstood periodontitis

Tooth decay and periodontitis are the two most common diseases in the dental department. With the increasing popularity of dental knowledge, many people have clearly understood that the key causes of tooth decay are oral bacteria and sugary diets , and they also know that if they have tooth decay, they should go to the hospital to repair it as soon as possible.

However, many people still think that the cause of periodontitis is "getting angry and lacking nutrition". Therefore, once they encounter early symptoms of periodontitis such as bleeding or swollen gums when brushing their teeth, they tend to use folk remedies to "reduce heat and supplement nutrition". In particular, gums often shrink in the later stages of periodontitis, which makes people believe that periodontitis is caused by lack of nutrition in the gums.

But is nutritional deficiency really the root cause of red, swollen, bleeding, and even atrophic gums?

Gum health is also very important | Pixabay

The real cause of these oral problems is still oral bacteria . Unlike caries-causing bacteria that cause tooth decay, another faction of bacteria, periodontal pathogens, causes gum problems.

Caries-causing bacteria are usually aerobic or facultative bacteria, mostly stationed on the tooth surface above the gingival margin; while periodontal pathogens are usually anaerobic or facultative bacteria, mostly hiding in the shallow grooves at the junction of the gums and teeth. When these periodontal pathogens cause periodontitis, they first penetrate deep into the periodontal tissues (gingiva, periodontal membrane, alveolar bone, etc.), weakening the defense capabilities of the surrounding environment, and ultimately "eat" the periodontal tissues with the substances on the surface of the bacteria and the enzymes, toxins and metabolites they produce.

Therefore, unlike cariogenic bacteria that work together with sugars, periodontal pathogens directly damage periodontal tissues and threaten oral health, and the effect is more thorough - causing teeth to loosen and eventually fall out .

A healthy set of teeth can also ensure the quality of life | Pixabay

Therefore, redness, swelling, bleeding and atrophy of gums are all caused by biological stimulation produced by periodontal pathogens, rather than internal heat or nutritional deficiencies. "Interstitial heat" is a folk description of such symptoms, which cannot really explain the oral problem of gingivitis. As for nutritional factors, scientists have not yet explored the specific relationship between them and periodontal health.

Is it safe to add amino acids to toothpaste?

Although amino acids are indeed nutrients, they are not necessarily good for gums. First of all, for food to play a nutritional role, it must be digested and absorbed by the body. Diet affects oral health in two major ways: local effects and systemic effects.

Local effects can be understood as substances acting directly on teeth. For example, the local effect of sugar on oral health is that it is metabolized by oral bacteria into acidic substances, which lowers the pH value of the oral environment and then corrodes the teeth. Correspondingly, the local effect of amino acids on oral health is mainly reflected in that it can be metabolized by oral bacteria into alkaline substances (such as ammonia), thereby raising the pH value of the oral environment and helping teeth resist corrosion. However, it should be noted that although an increase in pH can prevent tooth decay, too high a pH value will lead to tartar deposition .

The damage of local effects on teeth cannot be underestimated | Pixabay

Whether it is sugar or amino acids, their systemic effects on oral health can only be exerted after being digested and absorbed by the body. The systemic effects of diet on oral health (or the effects of nutrition) focus more on the impact on the construction of tissues and organs during development, rather than the maintenance function in the later stage.

In addition, oral bacteria compete with gums for amino acids . As mentioned earlier, amino acids can be metabolized into ammonia by oral bacteria. In other words, it is very likely that the amino acids are "eaten" by certain oral bacteria before they are used by the gums. After all, those who are close to the water get the moon first, and local effects often precede systemic effects . While it is uncertain whether the health of the gums will benefit from the presence of amino acids, it is "a foregone conclusion" that some oral bacteria will benefit.

What is the use of amino acids in toothpaste?

Although amino acids cannot enhance the resistance of gums, they are not completely useless for oral health. Arginine is the most commonly used and most studied one, and its health benefits mainly include the following aspects:

Assists in tooth decay prevention

The reason why oral bacteria such as Streptococcus sanguinis and Streptococcus mitis can metabolize arginine into ammonia substances is usually because they contain arginine deiminase system (ADS). Although they belong to the same streptococcus as the strongest cariogenic bacteria, Streptococcus mutans, this type of oral bacteria is non-cariogenic and is more common in mouths with less tooth decay. Therefore, arginine, as a "nutrient" that can promote the growth and reproduction of ADS+ streptococci, can support these bacteria in competing with cariogenic bacteria, weaken the position of cariogenic bacteria , and play a certain role in preventing caries. In addition, the anti-caries effect of arginine is of course also related to the fact that its metabolites can increase the pH value of the oral environment and reduce corrosion .

It is worth noting that arginine can also be metabolized by oral bacteria into nitric oxide (NO), which may be related to the occurrence of periodontitis .

Destabilize dental plaque

The formation of dental plaque in the mouth does not rely on the random combination of any bacteria, but on the close connection between specific bacteria, which is medically called " copolymerization ". Copolymerization can make dental plaque extremely stable in the oral environment, which is one of the reasons why oral diseases are usually more stubborn.

Bacterial coaggregation | Figure provided by the author (https://www.researchgate.net/figure/Coaggregation-between-P-gingivalis-and-F-nucleatum-in-the-presence-and-absence-of-S-PRG_fig4_225302066)

However, some substances may have a loosening effect on the "tight junctions" between some bacteria, an effect called " copolymerization inhibition ", such as arginine.

Although arginine cannot kill dental plaque bacteria, it can destroy the stability of dental plaque . Specifically, it can not only change the thickness, structure and ratio of different types of bacteria in dental plaque, but also help cationic antibacterial agents penetrate into dental plaque, thereby increasing their lethality. For this reason, some oral health products choose to add arginine.

But its effect is not always positive . Studies have found that the amount of Fusobacterium nucleatum increases in dental plaque treated with arginine, and this bacterium can act as a bridge for many periodontal pathogens and is of great significance in the onset of periodontal disease.

Reduce tooth sensitivity

The main reason for tooth sensitivity is the exposure of dentin . A healthy tooth is divided into many parts. Under normal circumstances, the dentin part will be protected by layers: the crown is covered with solid and dense enamel, and the root is surrounded by cementum, alveolar bone, and gums. Therefore, it will not be directly exposed to various external stimuli such as hot, cold, sour, and sweet. Only such teeth will make you "eat everything with relish".

However, the enamel that acts as a protective shield often becomes thinner or even completely lost due to tooth decay, trauma, wear and tear, forcing the dentin to directly respond to external challenges. Although dentin is a hard tissue like enamel, its structure is very different. Dentin has a hollow structure , which looks like a lotus root from a cross-section, and contains many tubes. Therefore, once the teeth lose the protection of the outermost layer of enamel, external stimuli can directly reach the nerves inside the teeth through these tubes, so the teeth will become sensitive, and slight changes in the oral environment will cause people to feel obvious discomfort.

Parts of a tooth | Image provided by the author (https://www.aegisdentalnetwork.com/ida/2011/02/dentin-hypersensitivity)

Whether it is enamel or dentin, the main chemical composition is calcium phosphate. Arginine can promote the deposition of calcium salts and help seal the dentinal tubules, thereby isolating the stimulation from the outside .

The first choice to protect dental health is still brushing teeth | Pixabay

Therefore, adding amino acids to toothpaste has nothing to do with nourishing gums, and we cannot be sure whether it is beneficial to periodontal health. At present, the role of amino acids is more inclined to prevent tooth decay , destroy the stability of dental plaque and reduce tooth sensitivity . To prevent and treat periodontal disease, the main means is to control dental plaque. The preferred method is brushing, flossing and scaling. Some chemical methods for treating periodontal disease may have adverse reactions, so long-term use is generally not recommended.

Although toothpaste is small, it contains a lot of knowledge about preventing dental diseases. Start brushing your teeth well and protecting your teeth and gums by reading this article!

Author: Fu Rao, Shanghai Health and Health Development Research Center

Editor: Jin Xiaoming Suyu

Typesetting: Jin Xiaoming

References

[1] Meng Huanxin. Periodontology (4th edition) [M]. Beijing: People's Medical Publishing House, 2012: 35-48.

[2]Konig KG. Diet and oral health[J]. Int Dent J, 2000, 50: 162-174.

[3]Kolderman E, Bettampadi D, Samarian D, et al. L-arginine destabilizes oral multi-species biofilm communities developed in human saliva[J]. PLoS One, 2015, 10(5): e0121835.

[4] Nascimento MM. Potential Uses of Arginine in Dentistry[J]. Adv Dent Res, 2018, 29(1): 98-103.

Source: Sunflower family