Common antacids could help keep gingivitis at bay

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"The American diet and the constant drip of sugar allows little time for the natural repair of teeth. All day, it's a cycle of acidic erosion and repair - or at least, it should be - but our constant sucking on hard candy and guzzling sodas with high fructose syrups leaves little time for repair," said Robert Marquis, Ph.D., of the University of Rochester Medical Center. Marquis, an internationally recognized expert on the bacteria that inhabit our mouths, is the study's lead author.

The team studied a compound known as lansoprazole, part of a family of compounds known as benzimidazoles that already have a range of uses, primarily controlling stomach hyperacidity and killing Helicobacter pylori (the bacteria responsible for stomach ulcers). Now, the compounds are brandishing potent antimicrobial actions that interfere with the dirty work of other types of bacteria that cause plaque buildup and gingivitis.

Such bacteria make their home on unbrushed teeth, which become coated with plaque, a filmy substance that, under a microscope, appears as a teeming sea of hundreds of bacteria. Among these are gingivitis-causing bacteria that break down sugars and amino acids into toxins that are harmful to our gums.

Unchecked, an accumulation of plaque and an overgrowth of these ravenous, toxin-oozing bacteria leads to one of the body's natural immune responses, inflammation, where bacteria-fighting cells are recruited to the gums to fight off the infection. Unfortunately, instead of just fending off the bacteria, the immune response also inflicts damage to the healthy gums. In the case of an intense infection, the battle drags out and results in more devastation to the gums, or gingivitis.

Since gingivitis can be a preamble for periodontal disease - an oral inflammation so persistent that it destroys the bone where the teeth anchor, causing them to fall out - researchers at the University of Rochester and Göteborg University in Sweden decided to focus on Fusobacterium nucleatum, an especially hardy bacterial troublemaker that plays a crucial role in setting the stage for gum disease.

When it's not secreting irritating chemicals itself, F. nucleatum acts as a binding site for other dangerous oral bacteria that cannot directly attach to tooth surfaces on their own. These bacteria, dubbed "secondary colonizers," rely on the help of F. nucleatum, which serves almost like an aircraft landing strip atop an aircraft carrier, allowing planes (or in this case, bacteria) to set down. With the help of F.nucleatum, these dangerous bacteria now have a place to "land" and create the damage that causes periodontal disease and tooth decay.

"It acts as a transitional organism, welcoming the bacteria which couldn't survive there on their own, and moving the infection from above the gum line to below it," said Marquis, professor of both Microbiology & Immunology and Oral Biology.

That's where lansoprazole comes in. When the oral environment becomes acidic - a telltale sign of bacteria at work - lansoprazole is chemically modified to kick into action, disabling F. nucleatum and preventing it from producing toxins or serving as a landing site. Once the oral environment returns to normal, the lansoprazole simply switches off.

"Benzimidazoles aren't just for acid-reflux anymore," said Marquis, whose research project was supported by the National Institute of Dental and Craniofacial Research. "We've shown their promise for preventing cavities in previous research, and now, perhaps even some protective benefits to guard against gingivitis. It's not unthinkable that one day these compounds might be more broadly used to promote dental health in toothpastes and mouthwashes."

University of Rochester Medical Center