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Smokers and Periodontal Disease: The Role of Antioxidant Therapy

Dentists and other professionals involved with the science of oral hygiene have dealt with a number of symptoms and pathologies of the mouth, gum and teeth. Periodontal disease, which includes inflammation of the gums, is one of the most prevalent health problems in the world and is the major cause of tooth loss in the adult population. Compelling evidence indicates that periodontitis is initiated and exacerbated through tobacco consumption, both smoked and chewed, and may be responsible for more than half of the periodontitis cases among adults in the United States.

Tobacco, whether smoked as cigarettes, cigars or pipe or used as smokeless tobacco, causes devastating effects in the oral cavity. Tobacco smoke has two chances to exert its deleterious effects in the mouth – first, when it is inhaled by the smoker, and second, on its exit during exhalation. In addition to the destruction it does to the gums (gingivitis and periodontitis), smokers have more dental calculus than non-smokers and suffer from increased discoloration of the teeth and bad breath. Over 30,000 new cases of cancer of the oral cavity are diagnosed annually. Oral cancer also kills 8,000 patients each year and only half of the cases diagnosed annually have a five year survival. The good news here is that by understanding exactly how periodontal disease and oral cancers develop, we can begin to take measures to prevent and interfere with the destructive path of these diseases. Prior attempts to treat diseases of the gingiva and oral cavity have failed for they have not recognized the role played by toxic molecules known as “free radicals” and the healing and protective benefits of the endogenous antioxidant defense system.

Periodontal disease is caused by inflammation and infection in both the gingiva and the connective tissue that supports the teeth. There is initially an inflammation in the local blood vessel walls, which accounts for the most common sympton of bleeding gums. This is also accompanied by migration of white blood cells to help combat the tissue invasion by pathogenic mouth bacteria. During this inflammatory reaction, most cells liberate histamine and also locally generate countless toxic free radicals, both of which contribute to tissue pathology. Collagen production may also then be interfered with due to local vitamin C deficiency, which contributes to the swelling and redness of gum tissues.

Cigarette smoke is divided into two phases, tar and gas-phase smoke. Cigarette tar contains high concentrations of free radicals, however, the cigarette filter acts as a “trap” for the free radicals in cigarette tar. By comparison, each puff of a cigarette in the gas-phase smoke is said to contain 1015 of toxic free radicals. The filter does not currently protect the smoker (or the secondary smoker) from these free radicals and left unchecked, these billions of free radicals are free to induce inflammatory reactions (resulting in periodontal disease), destroy cell structure and function and damage DNA, all of which are implicated in oro-pharyngeal diseases and malignancies.

Thankfully, the body has a built-in system of defense from these toxic free radicals – antioxidants. Antioxidants scavenge and neutralize free radical species to a less toxic or non-toxic compound. Antioxidants have also been found to inhibit all stages of carcinogenesis. However, when the body’s built-in antioxidant defense system fails to suppress uncontrolled toxic free radicals in the body due to either an overwhelming production of free radicals such as from smoking or a depletion of critical compounds used by the body’s antioxidant defenses, the body goes into a state of “oxidative stress.” Since oxidative stress leads to disease, free radicals are considered to be contributors to over fifty prevalent and chronic diseases, including cardiovascular disease, immune disorders, neurodegenerative diseases, premature aging and a variety of cancers. Indeed, periodontal disease is now considered a risk factor for atherosclerosis through the genesis of oxidative stress on the vascular tree.

The state of oxidative stress is remedied by increasing antioxidants through diet (fruits and vegetables) and by antioxidant supplements. Reduction of the noxious stimulus of free radicals, such as through the elimination of tobacco abuse, likewise will reduce this oxidative stress. While there are numerous antioxidants within the body, however, the latest scientific studies reveal two critical points: (1) all antioxidants are not equal; and (2) combinations of synergistic antioxidants are far superior to singular antioxidants.

While each of the many antioxidants in the body play a role in ridding the body of excess free radicals, it is the antioxidant known as glutathione that acts as “commander in chief.” Glutathione is found in body fluids and in every cell in the body. Working intra and extra-cellularly in its reduced form, glutathione acts as the body’s key antioxidant, detoxificant and protectant. It is the gatekeeper in the respiratory tract and lining of the gut and has multiple functions in disease prevention and in detoxification of chemicals and drugs. The body uses glutathione to preserve the integrity of cell structure from deterioration and to nullify the effect of toxic free radicals that operate at the cellular level and in extra-cellular fluids.

Glutathione levels inside the cells must be maintained in order to have healthy cells and a strong defense system. Cells die without adequate levels of glutathione, suggesting that glutathione may be a key anti-aging factor. However, glutathione does not work alone. To provide maximum beneficial effects against free radicals, glutathione must work SYNERGISTICALLY with other cellular enzymes and antioxidants such as glutathione peroxidase, selenium and vitamins C and E.

It works like this. One antioxidant molecule attacks and neutralizes one free radical molecule, but in the neutralization process, the antioxidant molecule itself becomes oxidized. It then has to undergo a reduction reaction in order to be regenerated as an antioxidant otherwise it remains as an inert molecule, unable to fulfill its antioxidant function. In some cases, the oxidized by-product is itself a toxic free radical and remains so until it is neutralized or regenerated into an antioxidant again.

This is the point where synergy becomes critical. A singular antioxidant cannot regenerate itself. In order to continue to perform its antioxidant function, each oxidized “antioxidant” must be regenerated by a specific SYNERGISTIC antioxidant or by specific cellular enzymes. In the body, glutathione and selenium assume the pivotal role in this process. In other words, although singular antioxidants such as vitamin C or vitamin E are physiologically useful, once they have accomplished their job, attacking a free radical, they themselves are oxidized and become a free radical. However, if they are combined with other specific synergistic antioxidants, particularly glutathione and selenium, they become rejuvenated and then can continuously do their job – just like the cellular defense system. The Thione Antioxidant Complex™, a unique patented formulation, was created to replicate and enhance the incredibly complex synergistic antioxidant defense system in the body, repleting the body of critical compounds, particularly at the site of the injury or inflammation, so that the defensive antioxidant cycle can keep functioning even when it is overwhelmed by free radicals.

Nevertheless, while replication of the cellular antioxidant defense system could have far-reaching implications for systemic disease prevention and therapy, the inventor of the Thione Antioxidant Complex™, Dr. Theodore Hersh, a gastroenterologist, recognized that ingestion of an antioxidant capsule would be less than adequate to help prevent or treat periodontal disease because it bypasses the oral cavity. Determined to treat periodontal disease in addition to systemic disease, Dr. Hersh drew upon his 30 years of academic, clinical and research experience with “buccal absorption” (absorption by the lining cells in the oral cavity) and decided to use a tablet, lozenge and intra-oral spray method of delivering his antioxidant complex to the body rather than a capsule.

Here’s why. Ingestion of a capsule delivers the antioxidants to the small intestine. The capsule itself protects the active ingredients from being denatured or inactivated by the gastric acids, but then has to dissolve in order to permit the active ingredients to be absorbed by the small intestine. In some cases, the capsule does not dissolve and instead travels through the entire gut from which it is later expelled without delivering the active ingredients. When the capsule does dissolve properly, the active ingredients are released into the small intestine. At this point, two reactions occur. First, some of the active ingredients remain in the lumen of the gut while others are absorbed by the lining cells of the small intestine (allowing it to retain some of the active ingredients for its own use). Thereafter, the remainder of the active ingredients are transported through the portal vein to the liver. The liver then utilizes the portion of the active ingredients that it needs and releases the remaining active ingredients to the general systemic circulation for delivery to the body’s other organs. Intestinal absorption of antioxidants results in a lower initial peak blood level of the antioxidants and less sustained concentrations for continuous delivery to the other organs.

Conversely, buccal absorption of antioxidants, particularly those contained in the Thione Complex, results both in an early high peak blood level and then in sustained higher concentrations for continuous delivery to all tissues. The buccal mucosal cells in the lining tissues of the oral cavity are capable of absorbing intact molecules, like glutathione and other ingredients contained in the Thione Complex, via various physiologic transport mechanisms. Once absorbed by these cells, these compounds are picked up and transported in the blood by the systemic circulation to all the organs of the body. Thus, unlike intestinal absorption, when the active ingredients are delivered to the body through buccal absorption, all of the tissues, the major organs and the body fluids receive their proportionate amount of the antioxidants rather than receiving “left-overs” from the small intestine and liver. As a result, the Thione Complex can replenish and maintain synergistic antioxidant levels in all cells and body fluids for preventative and therapeutic functions.

Most importantly, in addition to providing systemic circulation of these critical antioxidants, through absorption of the Thione Complex directly into the buccal mucosal cells, the antioxidants are also delivered directly to the oral cavity and in the oral cavity, glutathione and its synergistic partners have been shown to reduce the inflammatory reaction and to promote the normal process of attachment, spreading and growth of gingival fibroblasts, vital in periodontal tissue repair.

Tobacco, whether smoked or chewed, and betel quid chewing, worldwide health problems, inhibit these mechanisms and locally deplete intracellular glutathione levels. Repletion with glutathione and its endogenous antioxidant partners abolishes the damaging effects of the free radicals on the periodontal tissues, thereby promoting normal functioning gingival fibroblasts, decreasing the inflammation and enhancing collagen synthesis for gum repair. Since scientists have recently discovered a link between periodontal disease and numerous other conditions such as cardiovascular disease, strokes and diabetic complications, the unique formulation and delivery format of Thione’s products make them the first products specifically designed to treat both periodontal disease and the potentially associated devastating systemic effects it causes.

Periodontal disease and other oro-pharyngeal pathologies, including cancers of the mouth and throat, are serious complications of smoking and chewing tobacco. The topical application of the Thione Antioxidant Complex™ helps reduce potential tobacco damage to the oral cavity and helps reduce the signs and symptoms of the inflammatory reaction caused by tobacco. When used locally and systemically, the Thione Antioxidant Complex™ helps replete the tissue stores of defensive antioxidants and helps promote the body’s repair processes.

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