Bleeding Gums?

Noticing blood while brushing or flossing can be alarming and shouldn’t be ignored! The importance of oral health is a concept introduced to most Canadians at a very young age, and with good reason. The Ontario Dental Hygienist’s Association reports that the link between oral infections and other diseases in the body is becoming well-documented and accepted within the health-care community.

Periodontal disease is one of the most common human diseases; many Canadians will experience gingivitis, a form of gum disease, at least once in their lives.^[1] If left untreated, the causal bacteria has the potential to spread throughout the circulatory system, increasing one’s risk of heart disease, stroke, respiratory diseases, and pregnancy complications.^[2] Knowing this, the importance of proper oral hygiene should remain a priority in every bathroom! Periodontal disease is a chronic bacterial infection that affects the gums (gingivae) and other tissues that support the teeth. Gingivitis, the most common type, affects the gum tissue solely and is caused by the accumulation of bacterial plaque, leading to a chronic inflammatory process.

Red, swollen, tender, bleeding gums, receding gums, pockets separating the gums from the teeth, and bad breath are all possible manifestations of gingivitis.^[1] If not properly treated, gingivitis can progress to periodontitis, and the inflammatory process may spread to periodontal ligaments and alveolar bone. If these structures were eventually destroyed, teeth would loosen and fall out.^[3] Despite the commonality of this disease, natural treatment options (besides oral hygiene) are not easy to find. When seeking out a natural treatment option to the chemically harsh toothpastes and oral rinse aids commonly suggested, a common trend is noticed: most products contained coenzyme Q10 (CoQ10) as the active ingredient. One brand in particular even states: “CoQ10 has powerful proven healing properties for the gums” on their product packaging.^[4]

What is coenzyme Q10?

CoQ10 is an antioxidant made within the human body and required for basic cell function. It has many known benefits, including many of the related health concerns of poor dental hygiene as previously mentioned: heart disease, stroke, respiratory diseases, and pregnancy complications.

Let’s Look at the Research…

Research compared oral tissue samples of gingivitis patients. When compared to their healthy gum tissue, the diseased tissue showed a localized CoQ10 deficiency.^[5] However, it still is not clear whether the localized CoQ10 deficiency is a cause or a consequence of periodontal disease, but such a deficiency would lead to impaired immune function and reduced healing capabilities.

Oral CoQ10 supplementation has been shown to increase CoQ10 levels in gingival tissues of patients with periodontal disease.^[6] Several clinical trials have shown that CoQ10 treatment, both oral and topical, is indeed an effective treatment for periodontal disease; however, most studies did not specify whether gingivitis was a true diagnosis, and even more so focused on the treatment of the gingivitis progression, periodontitis.

One study used gingivitis symptoms—bleeding, redness, and swelling—as an outcome measurement. Other variables measured were pocket depth, purulent exudate, tooth mobility, pain, and itching. The study involved 18 patients with periodontal disease randomly assigned, in double-blind fashion, 50 mg/d of CoQ10 or placebo for three weeks. Improvement was seen in all eight patients who received CoQ10, and in three of the 10 patients receiving placebo (p < 0.001).^[6] The same source discussed a study involving seven patients with advanced periodontitis who required surgical intervention. Each patient received 50 mg/d of CoQ10 for three weeks. Disease severity was measured by the periodontal score and improved significantly. Pocket depth also improved, decreasing significantly. The study concluded that improvement like this is said to be uncommon in patients with this advanced disease, clearly suggesting validity to the use of CoQ10 in periodontal disease treatment.^[6]

Another review paper divided the research into three separate categories. The first section involved strong evidence supporting CoQ10’s role as an antioxidant and how these antioxidant can theoretically be related to periodontal disease treatment. Secondly, the noted deficiencies found within the gingival tissue of patients with periodontal disease were explored. Here conflicting evidence arose, while some papers demonstrated CoQ10 deficiencies adequately, and others did not; overall, the review seemed to discount most of the studies for various reasons and deemed these results all inconclusive with limited efficacy. Finally the effects of CoQ10 on the patients’ immune system were mentioned: the T4:T8 ratio increased after two months of CoQ10 administration, while IgG levels increased significantly after six months. Two studies suddenly moved from systemic to topical administration of CoQ10 for improving periodontitis. The results of the former suggested a very limited effect after CoQ10 administration, while the results of the latter were inconclusive.^[7]

Dosing and Duration of Response

With such varied results from the studies assessed, it is impossible to determine an appropriate dose. The optimal dose of coenzyme Q10 is not known, but it may vary with the severity of the condition being treated. The oral dose used in the RCTs was not stated in most reviews, while in others it ranged from 50 mg/d (being the most common) to 65 mg bid. Likewise, the duration of response cannot be specified, as the very existence of this response is still under investigation; most commonly, however, treatment was based on three to four weeks for oral supplementation and six to eight weeks for topical application.

Safety: Adverse Reactions and Contraindications

CoQ10 has an excellent safety record. The safety of high doses of orally ingested CoQ10 over long periods is well-documented in human subjects, and also by chronic toxicity studies in animals. The side effects reported in human studies are generally limited to mild gastrointestinal symptoms such as nausea and stomach upset, seen in a small number of subjects. No adverse effects were observed within and of the studies reviewed.^[8]

Treatment Versus Prevention

Although this paper focused on the treatment of gingivitis and periodontal disease, it should be noted that many dental hygiene products claim that CoQ10 has strong positive effects for prevention.^[4] With no response after contacting the company inquiring the basis of their claims (“CoQ10 has powerful proven healing properties for the gums”) ^[4] and few results in scholarly searches, one could question how much truth this statement holds. Perhaps just the act of brushing daily and flossing is preventing the periodontal disease, and not the type of toothpaste ingredients—but that is another article in itself!