A Periodontist Discusses Gum Disease and Its Prevention with Dr. William Levine

Welcome to the Living to 100 Club Podcast.

Here's our host, Dr. Joseph Casciani.

Well, hello to everyone joining us today on our podcast. You're listening to one of our Successful Aging episodes this month on the Living to 100 Club program, and I'm your host, Joe Casciani. Each week, our conversations educate and inspire, helping you get the best out of all the years we're given, regardless of what obstacles come our way. You can learn more about our club at our website, Be sure to take a look at my new training and activities manual, Better, Longer, and Happier: A Guide to Aging with Purpose and Positivity. This is a series of 12 modules in a card deck format developed for activities directors at senior living communities to learn more about psychologically healthy aging. And these modules help to engage senior residents in activities that are cognitively challenging and foster a positive mindset. Module 1 is on sale now. Visit my website, livingto100.club/blh. Now on to our podcast. On today's program, we invite Dr. William Levine to discuss the topic of gum disease, its incidence, its causes, and treatments. Dr. Levine has practiced the specialty of periodontic dentistry for over 35 years and has been at the forefront of revolutionizing the way we treat and manage disease. We discuss why gum disease is so prevalent, its connection to inflammation, and the consequences of leaving gum disease untreated. Our guest discusses a mouthwash product he created PeriActive and its makeup as a safe and natural product to treat inflammation. The makeup of this mouthwash relies on plant bioactive compounds that allow for safe therapeutic benefit with everyday use. How can we treat inflammation naturally using specific plant bioactives? How does gum disease cause other health problems such as heart or lung disease, and dementia. These and other topics are explored in this very worthwhile educational conversation today. First, a little background. Dr. William Levine is a board-certified periodontist for 35 years and expert in oral inflammation. Dr. Levine has a private dental practice that specializes in periodontal disease and implantology. He is also the chief scientist at PeriActive Oral Rinse and founder of IZUN Pharmaceutical Corp and founder of the Jerusalem Perio Center. He has spent the last 15 years researching specific plant bioactives that naturally reduce inflammation so he could help his patients prevent and manage gum disease. Dr. Levine, welcome to our program today.

Thanks, Joe. Thanks for inviting me, and we appreciate the time.

Yeah, well, we look forward to this conversation. So, uh, Bill, I always like to open my program by asking our guests to describe the journey. I touched on your history a little bit, but tell us about the journey that brought you to where you are today.

So it, I mean, obviously journeys start a very long time ago sometimes. And so at a certain point in my college education, actually, I was studying different non-connected topics. And you get to know yourself and your educational bent as you're going through college in a liberal arts education. And I was very good at the sciences. And not so good at some of the other things that interested me. So little by little, I just morphed into the sciences, and I enjoy working with my hands, and I ended up in dentistry. And I was blessed with a mentor who, in my third year in dental school, 3 out of 4, sort of cherry-picked me out of the group and said, I will make you into a great periodontist. You have the skill set.

Wow.

And he I actually trained under him, and it's been a wonderful journey since then. I think you go through a lot of steps as you go through a journey, and the first one was really just soaking up information and learning from my mentors, and then at a certain point being accepted as their equal, and then growing into your own person. And I had the pleasure of my mentor thanking me as he began to practice and saying to me, thank you for the teachings that you've given me since you've matured. So it's a very— he actually just passed away this year, and we were close friends for over 30 years, so it was nice.

Wow. So tell us— sorry. Okay. What's your current practice look like? Seeing patients, research?

So it's a combination. We have our own laboratory, but we have a very active dental practice. It's a Multidisciplinary practice. It's my— I am the managing partner of the practice, but I have two other periodontists who work for us, and we have a prosthodontist that's a specialist in oral reconstruction. So in a sense, I do the infrastructure and the bone and the gums and the teeth, and then he builds the crowns and the work that goes on top of that that the patient uses. And we have also an oral medicine department which deals with oral pathologies, different cancers in the mouth, different other diseases that present inside the mouth that are not classic dental diseases, but simply systemic diseases that manifest themselves in the mouth. And so we have a— and then we have 5 hygienists to work with us. So it's a relatively large practice. I think it's actually the largest practice probably in Israel and possibly in the Middle East. But it's— some of our staff is university affiliated, some are not., but it's heavily scientifically driven and we challenge each other and teach each other and maintain, you know, regular meetings to, you know, present new material and to see how we, you know, coordinate cases. So it's a fun place. My goal was I want my staff to come in with a smile and I want my patients to leave with a smile.

So that's a good operation. Yeah. So I love that. I love the multidisciplinary aspect. I've always found that to be so crucial in healthcare when you get all different perspectives working together on a single individual. So you have, you have practice there in Israel, and are you also in the States here, or?

No, I did. I practiced in the States for a while in the Brooklyn area in New York. And but at a certain point, the travel really became very difficult. And I, it was hard on my family and it was hard on me. And my other obligations were just taking up too much time. So I relocated to here and it's been— I think that we bring the highest level of dentistry that's possible to our patients. And I think I've watched dentistry in Israel actually emerge and rise up to the standards that we brought with us. It's not that I taught them, it's just the country has evolved into a newer and more valuable healthcare in general. So I'm glad to watch that happen, but it didn't really impact us.

Yeah, but you're contributing to that too.

I'd like to think so, but you know, sure, sure, sure. I don't want to aggrandize my role. They did it themselves.

So, so let's, let's jump into the topic of gum disease. Why, why is gum disease so prevalent today?

It's an interesting phenomenon. I think that aside from the common cold, periodontal disease is probably the most ubiquitous disease that exists. According to the Center for Disease Control, the CDC, in the USA, 50% of the adult population over the age of 35 has significant periodontal disease. And that percentage raises or rises as the population gets older, so that when you hit in the '70s, those numbers are 65, 80, 75%. So it increases. But what's critical about periodontal disease is, and what makes it so prevalent, is simply the system is our teeth are anchored into our jawbone, and that has to be by definition a sterile environment. You can't have an infection or bacterial population inside the body that's normal. The body will react to it. But the teeth function in the mouth, which is a non-sterile environment. That's the only organ in our bodies that we have that does that. So that what happens is the body has a very active defense system which helps prevent infection from the mouth penetrating below through alongside the root and causing infections. But sometimes when people don't brush their teeth that often, or when people don't take excellent care of their teeth, that bacterial infection or different traumas or different systemic conditions may impact on the functionality of that defense system. And what it is is it starts to act faster and faster and faster trying to prevent this disease. And it goes into an overdrive, much like our computers when you open up too many windows and all of a sudden it freezes. So it's not that the computer's not working, it's just that it's not doing what you want it to do. And that's what's happening in that gum disease. The prevention system, the defense system actually begins to, function, but it begins to function inappropriately. We call that a dysregulated system. And in that system, what happens is the defense system becomes the problem and it causes local bone destruction, which leads to spaces, or we call pockets between the teeth and the bone. And eventually that can lead long-term to loose teeth, different abscesses, painful abscesses, and eventual loss of teeth. So the reason it's so prevalent is simply the system is a delicate system and hard to take care of. And everybody has teeth, so it's not like it's unusual. And the problem is that this really is very life-impacting disease because we often take parts of our body for granted, like our teeth, and we don't realize just how important they are for our daily function. So for example, when you greet somebody and you smile, or when you're angry at someone and you grimace, you're using your teeth to express a very deep and very important emotion, especially the smiling when you're saying hello. And if you don't have that smile that backs up your emotion, you've lost a valuable communication system. It's also critical to the way we speak and to our diction, and it's also critical to the way we eat and function, and not just from a nutritional basis, Also from the fact that we, if we have functioning teeth, we actually will enjoy our food better, get more taste out of it, and have the eating as a more pleasurable experience. So it's a very important part of our function, especially as we get older where nutrition becomes more of an important part.

Yeah. Wow. So just from a layman's point of view, it's a breakdown of the defense system. So the bacteria in this non-sterile environment in our mouth gets to the sterile environment, gets to our bone, and it actually—

But actually what happens is the destruction itself is an inflammatory process. You're right. The bacteria cause a microinfection, which when perpetuated, causes that defense system to activate and become a destructive force, which causes the loss of bone. The infection doesn't actually cause the loss of bone in this case. It's your body that's causing it.

I see. Okay. Yeah, and I'm sure there's multi-levels from mild to severe, but how, you know, what's the general approach to treating this type of gum disease?

So the first thing you want to do is really reset the system so that it's no longer causing damage. So you need to remove the bacterial population from there. When I say remove it, we generally, the best way that we do that is different antiseptics, but also mechanical cleaning. That goes deep underneath the gums. We call that process scaling, which is the, the gross debridement. And then the second stage of scaling would be something called root planing, which simply means taking the poisons, or we would call toxins, off the root surface so that the body can actually start to heal. So the first set is to remove the bacterial infection so that the, the inflammatory protective system can reset itself and become healthy again. At that point, when we've done the easier non-invasive care, we try to reassess and say, okay, where did we— what did we accomplish here? How healthy is this system? How viable is it? How maintainable is this? If, if we're lucky, or if we do our jobs right, or if the system situation allows for it, then we actually— that's all we need to do. The body will be healthy. If we don't reach that level where we can have a stable environment and that we can— and one that we can maintain, we need to consider alternative therapies. And for alternative therapies, we may use different laser therapies. There are a lot of new lasers out in the dental market today. Each one has a different function. That's a topic in and of itself. If you use the wrong laser for the wrong purpose, you won't get the right results. And the other area is surgical reconstruction, where we try to make those roots biocompatible so the body can heal.. And oftentimes we're actually able to rebuild some of the bone that's been lost. So there, the technology of treating periodontal disease has increased our capabilities of saving teeth tremendously. But as a fallback position, when we've reached that junction where either the patient came to us without teeth or missing certain teeth, or that he doesn't have sufficient amounts of teeth, we often will use implants to replace those teeth. And so That's something that we have treated patients significantly into their 90s. I don't think I've treated anybody yet over 100, but your podcast is Living to 100, so I felt safe saying that the 90s are okay.

Yeah, exactly. You're right.

We have quite a— it's— if you do the surgical procedures correctly, they're relatively non-invasive and patients can easily tolerate them. And it's important to make sure that people have and keep their oral function.

Yeah. Yeah. And I, you know, I've always said living to 100 is a great destination, but more importantly, it's a matter of making the right decisions, more and better informed decisions along the way.

So I think I would quote my father on this one where he said, I wanted to be older, not old.

That's right. That's right. Yeah. Well, I know you touched on this, Bill, but tell us again about the connection between inflammation and gum disease. What, which, where does it start? Where does that cycle start?

Gum disease in the past used to be thought of as an infection, and it is. It's a micro infection that initiates a process, but the process that initiates is the body's defense system responds to the bacteria, which is normal. We call that reactive inflammation, where we would expect that to happen. The body is supposed to do that, but if that infection persists, and remains there, then what happens is that reactive inflammation will change its face. It'll change its activity. It'll become chronic inflammation. Chronic inflammation is no longer a, a healthy body reaction. It's actually a diseased process where part of that body is not working. And so what will happen because of that inflammation is you will lose the bone and the attachment that can— that fuses the tooth to the body. And at that point, you're— all those problems will begin to ensue: loose teeth, drifting teeth, abscesses, and loss of teeth. And it's, it's a painful and unpleasant process. So it's the inflammatory process that's actually driving that destruction. And because of that, because this is also an infectious and inflammatory disease, we have— periodontal disease has a very large impact on our systemic health. We don't really pay attention to it, but if you took the whole area of the teeth that are attached into the bone and spread it out on a flat surface, it would be about as large as the palm of your hand. And that's a big area to have. If you think about it, if you had an infected area on your skin that large which was penetrating into your body, you'd be quite concerned. You'd probably be hospitalized. So we have a very large space, infectious area, which is spewing into our bloodstream bacteria and what we would call inflammatory mediators. Inflammatory mediators are all those chemicals that the body uses to signal processes, which drives up the inflammation and accelerates it. Now, if you expose the body to a large number of inflammatory or pro-inflammatory mediators, then it's going to make every disease that you have slightly worse because your whole inflammatory profile of your body has been increased. So you, therefore, if you have active periodontal disease, you will be at an increased risk of cardiac diseases, strokes, diabetes, arthritis, dementia, and a myriad of other diseases, even ranging so far as to increase risk for cancer. And for other problems that you would think are not connected. But when you raise the inflammatory profile, you can— you expose yourself to almost every disease that's out there. On the flip side of that equation, when you have a disease that already exists, it will also make your periodontal disease worse. And so there is that bidirectionality that exists.

Wow. Yeah. So it's a culprit. I mean, it, it puts, um, this high— it, the inflammation goes into hyperdrive and it kind of spills over into the rest of the body. And if the body is already struggling with some other conditions, some other disease, diabetes or, um, any other condition, it will exacerbate that, that disease. And the reverse happens also. It if we have some other inflammation in different part of the body, it can influence the inflammation in the mouth, in the, in the bones. Yeah.

You know, it's, it's, it's actually the bidirectionality is so important that, but the dentists are aware of it now because it's been drilled into our heads over the last decade or so, maybe more, but the medical doctors are not as aware of it. Excuse me. And what happens is if a patient has a heart condition, their medical doctor should say to them, listen, please make sure your teeth are in good health. And in fact, a lot of times they will not put in or do surgical procedures that are complicated, different cardiac procedures or different vascular procedures, unless they get a letter from the dentist saying the patient is in good health and can undergo this procedure. So your listeners here should be aware that if they suffer from any of these medical problems, they should be seeing their dentist concomitantly with the medical doctor just to make sure that they're not having an increased risk factor that's in their body for their life-threatening disease.

Yeah, it's really so interactive, isn't it? Yeah. This is great information for our listeners. I really appreciate your sharing these insights and recommendations. So, and I know you touched on dementia, and I have, you know, worked with dementia patients for many years, and I'm learning so much more about the modifiable risk factors for dementia, like diabetes and toxins and, you know, other factors in our environment. And they can produce dementia, but these are reversible dementias. So it sounds like this kind of exacerbation of cognitive impairment can be modifiable if it's coming from the oral inflammation.

To an extent. You know, dementia is, as you know from your own experience, is a very, very difficult disease to quantify. It's our descriptive and diagnostic terms are very blunt, so they're the— it's very hard to manage it. So we— and there's a lot we don't know about it, including the, the causative factors for it. So, um, but we do know that in many of the other diseases, in terms of the bidirectionality of dental diseases and, and systemic diseases, correcting the dental disease will reduce your, your your risk factors. We have not demonstrated this scientifically with dementia simply because it's such a hard disease to study and see change. But it's— the working assumption is that yes, if you have the early signs of dementia, you should get your whole body into better shape and it will impact it. And that includes minor things. And I'm certainly going out of my area of expertise now, but there's no question that stress impacts on the functionality of early dementia patients. So that one of the things that it's the terrible pain that a dementia patient feels, especially the early-stage dementia patients, they're stressed because they keep thinking they will forget, even if they haven't forgotten. So every action is full of stressful stimuli. And that's— so we need to find ways to give them or to empower them to help themselves. And A, I think it's going to be helpful for the disease, but also it gives them something to do, which is not a little factor.

That's right. Sure. Yeah. Thanks for that clarification. That, that's really important. So, um, let me ask you about your, your product, the mouthwash product that you created, PeriActive. How did you come to create this mouthwash?

So, you know, one of the things about periodontal disease is its recurrence rate. And there's been some more studies out over the last 25, 30 years which showed a very consistent reporting that even in extremely well-treated cases, there's about a 17 to 25% recurrence rate. And that's very well-treated patients. I mean, I really went through this data very carefully so that you do everything right, you, you take care of your home care, and you go to the dentist and he takes care of you well and your disease is stable. And yet here you have 25% of the cases recurring. That's not good. That's a medical failure. I mean, yes, we've helped people, but we're, we're not doing our job in helping and protect our patients. So I sort of looked into the mirror one morning. I said, well, what can I do to change that equation? And all the mouth rinses and all the home care products that we have are basically doing one thing. They are killing the bacteria and they're hoping to reset the program that way. It doesn't work well. It, it's not a big contributor because the driver has switched, as we discussed earlier, to the inflammation. None of these products modify the inflammation because they just simply— it's a swish and kill system. You brush it, you rinse, but, and it helps remove the bacterial layer, but we're not resetting the system because the bacteria are now underneath the gums. So what we designed was a very unique— we spent over 10 years of research looking at botanical materials. Now remember, my background is not as a naturalist. My background is as a medical doctor or a dental doctor. So this was a very unusual area for me to be in. But basically, our plant and the plant world is filled with pharmacologically active compounds. About 70% of our medicines today in the market have their origin from, actually, from botanical sources. Not necessarily the compound that they're using, but the way they discovered the impact on the body. And the, and these plants work in very unusual ways. So what we did was we kept the compounds available. We analyzed these products or different plants as to what was bioactive and what was not, what is accomplishing. And we put together a synergistic rinse comprised of 3 different botanical plants that we, we designed their growth patterns, their, their harvest time, their— the way we extract the active material from the plant in a way that we can preserve this historical safety of these plants so that the patient doesn't have any negative effects, yet increase their potency and give a predictable drug-like effect despite the fact that it's a natural product. Because we need to make sure that we're getting the results clinically that we need for our patients. And what this does is it actually, you rinse through the mouth and it reduces the bacterial population, but it actually stresses the reduction of the negative or pathologic bacteria, the ones that are harmful. But more important than that, it actually goes into the gums like any normal drug would. And what it does is it reduces the inflammation and resets it to be more active. More beneficial as opposed to more destructive. And it also actually initiates the healing process so that the body is actually starting to repair itself. And the repair process will actually prevent a lot of the disease from recurring. So those 3 factors, reducing and, and controlling inflammation, repairing the tissue for protection downstream, and reducing the bacteria actually are a wishlist of exactly what we need for our home care. So if you use this product twice a day ongoing, it'll help actually treat the disease. And equally importantly, it'll help prevent the progression of the disease. So it's very groundbreaking. It was a lot of research. I actually feel very proud of myself for having had the benefit of being a participant in that. And it's such a great product that there was a period of time that because of COVID we couldn't ship it in. And our patients were yelling, they were calling me up in Tel Aviv saying, where's my PeriActive? How often do you get something like that taking place?

Yeah. So the, the, the plant compounds, the bioactive compounds target, target the risks that ordinary mouthwashes don't. Over-the-counter mouthwashes do not go beyond killing the bacteria. Is that correct principle here? Correct. Yeah.

Yes, definitely. Well said.

So what, what, why is, why is the over-the-counter mouthwash so limited?

Why, why did you, you have to remember that in the world of inflammation, there are only two types of drugs. And it's, it's, you're going to laugh at my categorization. But if this is actually the medical categorization, you have steroids that can modify inflammation, and you have non-steroids. That's how the drug world classifies them, drug and medical world classifies them. So in the steroid world, we have all the natural steroids that you know about, but in the non-steroidal world, that would be the ibuprofen like Advil or Motrin, aspirins, and a myriad of other inflammatory products that people will take over the counter for pain. But that's how the world divides. Now, the problem is that The steroids have a terrible systemic effect if you take them long-term. So they're out of the, they're out of the game in terms of using them to control oral inflammation on a non-life-threatening disease. Plus steroids will interfere with the body's ability to heal. And so you can't really use a steroid topically for a long time. It's contraindicated to what we're trying to accomplish. The non-steroidals are actually toxic to the tissue on contact. They're good as systemic agents, but if you put them on the gums, you will actually burn them. It'll actually cause a chemical burn on the gums and damage the tissue. So there are no drugs in our vast array of anti-inflammatory agents that can accomplish this, which is why I needed to step out of the medical pharmaceutical world and go into the natural products world.

I see. And the plant bioactives don't have that effect. Don't have that.

No, no, it's really remarkable that plants work differently and the bioactives work differently. Yeah.

Yeah. And you said they're safer. I mean, they can be used regularly more, more often than the typical mouthwash.

The compounds that I used for PeriActive can be ingested in gram levels. 2 to 3 grams a day. We're using 2 to 3 milligrams a day. So it's 1,000 times less.

Yeah. Yeah. So daily mouthwash or weekly or how often is it recommended?

Daily, twice a day for 1-minute rinse. I guarantee you the results.

We'll hold you to that. Yeah, good.

Fair enough.

And it's available for a retail basis.

I mean, actually, it's available online. A lot of dentists carry it in their offices, but it's also available online. And it's called getperiactive.com.

P-E-R-I-active.com.

Yeah, P-E-R-I-active.com.

Correct. Okay. What are the takeaways? I mean, important hygiene, you know, practices, brushing our teeth, getting checkups regularly. What's the basic point?

Make sure that when the hygienist sees the patient, that the dentist also checks because we don't want anything to be missed here. Now, it doesn't have to be every visit, but I want him to have his finger on the pulse of what's going on in your mouth. So that he knows how to prevent diseases. You need to have periodic X-rays. I don't want to use the word frequent because it's too much. Periodic X-rays that can monitor the progression or stability and make sure— I would say also, even though we haven't really touched on it, that when you have periodontal disease and you've lost some bone, the neck of your root, of your tooth, is exposed, which the area that we call the root, that's highly susceptible to decay also. So even if you're maintaining good oral hygiene and you're using PeriActive, you should also make sure that your toothpaste has a fluoride content in it and possibly even topical fluoride treatment at the dentist's office, which is a lot stronger than what you can buy in the toothpastes that are over the counter. So that array, good dental maintenance, good oral hygiene, PeriActive, and fluoride will give you a very comprehensive approach to your periodontal issues, your oral issues in general.

Yeah, yeah, and the risk remains, as you said, there's always some recurrence even with good treatment, but it's another tool in our toolbox, right? The mouthwash, the perioactive mouthwash. That's important, important consideration. Yeah, well, what a great conversation, really informative, educational, and I think gives us all some useful practical steps to take. I appreciate that. We are out of time, Bill. So before we wrap up, I just want to remind our listeners to visit my website, livingto100.club, sign up for my email list, and download a free copy of my 9 Tips to Make Living Longer Enjoyable. And if you're affiliated with a senior living setting, be sure to look for my new training manual, Better, Longer, and Happier. Bill, thanks so much for being a guest on our show today. For those who might want to contact you, how can they best do that?

We actually, if they leave a message on the getperryactive.com site, and for me personally, the people who run that part of the group will send it to me. No question. I'm happy to be in touch with anybody who has any questions. My pleasure.

Great. Appreciate that. So again, the website, getperryactive.com. That'll be great. That'll be great. So thanks very much again for being on our program today, and thanks to all of our listeners for tuning in. Hope to see you next time.