According to functional medicine, the gut is at the center of autoimmune disease. This is why there’s often a focus on symptoms of intestinal permeability (leaky gut) and other digestive distress as possible indicators of autoimmunity.
What most people don’t realize, though, is that the gut isn’t just the stomach and intestines but the mouth, too. When we consider the many potential triggers of autoimmune thyroid disease, we have to think about our mouths—especially the teeth and gums.
An abscess, infection, root canal, dental surgery, dental X-ray, fluoridation procedure, amalgam fillings…all are possible igniters of autoimmune disease. Could an unknown or unaddressed dental issue have triggered your thyroid condition?
I recommend beginning to think about your dental timeline to see if you can trace any decline in your health to a dental procedure. In the meantime, let’s look at some of the potential dental triggers of Hashimoto’s and how you might address them so that complete healing can happen.
Trigger #1: Infections and Inflammation in the Mouth
There are several potential causes of inflammation in the mouth—all of which will need to be resolved before you can recover fully from Hashimoto’s.
Impacted teeth. Impacted teeth can create inflammation around the root of the other teeth and can lead to gingival inflammation, periodontitis, and tooth decay. If you’ve been eating a “modern” diet containing flour, sugar, and processed vegetable fats, developing tooth decay is more likely, and adopting a more ancestral diet may help with preventing new onset tooth decay.
Mouth bacteria and dental infections. Mouth bacteria, abscesses in the mouth, and even hidden infections can lead to gut dysfunction and trigger autoimmune disease.
A dental abscess is a collection of bacteria usually present in the gums surrounding the teeth. An abscess usually looks like a boil on the surface of the gums and is very painful. The bacteria from the abscess can stimulate our immune systems and drain into the gut creating digestive symptoms.
You can often prevent dental infections through the use of oral self-care, but in many cases, the infections will need additional interventions from the dentist, such as antibiotics, draining, or even surgical intervention.
Symptoms may include dental abscess, jaw pain, and/or headaches.
Recommended Treatment Plan:
If you have not had a dental X-ray or dental exam in over a year, or currently have a dental issue, be sure to make an appointment with your dentist ASAP. Some dental infections may be “silent” and only a dental exam will reveal their presence—this means even if you don’t have obvious signs or symptoms of a dental infection, it’s a good idea to get an exam if it’s been over a year.
Trigger #2: Periodontitis
While periodontitis is also related to inflammation, specifically inflammation of the gums, I’ve separated it out from the triggers above because it’s often found in Hashimoto’s patients. Pathogens in our mouths that cause periodontitis have been suggested to contribute to rheumatoid arthritis and Hashimoto’s by activating an inflammatory response. (1-7)
Periodontitis can lead to receding of the gums, loose teeth, and eventually tooth loss, and can be worsened by fluoride—the very substance added to our water and toothpaste to prevent tooth decay!
Symptoms may include bleeding gums (especially with brushing or flossing), puffy gums, receding gums, plaque buildup on teeth, loose teeth, bone loss in the jaw, and bad breath.
Recommended Treatment Plan:
Periodontitis has been connected to dental dysbiosis or an imbalance of bacteria in the mouth.
The conventional dental approach to periodontitis may involve scaling and root planing, where the roots of the teeth are scraped and cleared out to allow for better gum reattachment, surgery and gum grafts, as well as utilizing the antibiotic doxycycline to restore a better bacterial balance. Doxycycline penetrates the gums 7-20 times more effectively than other drugs, which means it can get to those deeper gingival crevices where pathogens can hide.
While previous research implicated oral bacteria in triggering periodontitis, I was excited to learn that French-Canadian dentist Dr. Mark Bonner has found that most cases of periodontitis are caused by two parasitic infections of the gums: Entamoeba gingivalis and Trichomonas tenax. Entamoeba gingivalis was found in 69 percent of diseased gingival pockets but was absent in healthy gum tissue. This bug is transferred from person to person through kissing and may also be present in dogs, cats, and horses. The parasite Trichomonas tenax may be found in another 5 to 20 percent of periodontitis cases and is also found in people, cats, and dogs.
Dr. Bonner has created a protocol that involves the use of pharmaceuticals (antiparasitics, antifungals, antibiotics) and advanced dental cleaning methods and testing of the periodontal pockets to ensure eradication of Entamoeba gingivalis and Trichomonas tenax and a return of healthy gum flora. He reports that this method is a cure for periodontitis and has trained over six hundred dentists on the method. For more information on Dr. Bonner’s protocol and additional dental guidance, I recommend his book To Kiss or Not To Kiss. (8,9)
While Dr. Bonner has trained over 600 dentists worldwide on his protocol, the majority of trained dentists are in French-speaking countries. He has started to host seminars in English, and dentists in the US are beginning to take notice as well.
Overall, I’ve noticed reduced gum inflammation in Hashimoto’s patients after using gut balancing herbal protocols (such as the ones in my book Hashimoto’s Protocol) and prescription antiprotozoal agents, such as metronidazole (Flagyl) and Nitazoxanide (Alinia), which have activity against amoeba. However, herbs and prescription medications without the dental cleaning methods may not be able to penetrate the gingival pockets deeply enough to get to all the organisms.
Another consideration is that this amoeba is passed through person-to-person kissing, so you may also want to make sure your kissing partners are treated accordingly.
Trigger #3: Dental Procedures
Dental procedures, such as a tooth extraction or root canal, can lead to less-than-obvious infections which must be resolved if you want to feel completely better.
Tooth extraction (that leads to cavitation). When you have a tooth or teeth extracted, there is a risk for a cavitation to occur. A cavitation is a hole in the jaw that can collect bacteria while open, and then as the jaw heals over it, bacteria is trapped inside and ultimately leads to infection.
Root canals. Root canals are dental procedures that are done when the root, or inside of the tooth, becomes infected. During this procedure, the tooth is cleaned out and the nerves and insides of the tooth are removed, but the root and tooth are left in the mouth—essentially leaving a “dead tooth.” Many of these teeth can harbor infections and when the nerve of the tooth is removed, we are less likely to sense them.
Symptoms may include deep jaw pain, sensitivity to hot and cold, headaches and/or migraines.
Recommended Treatment Plan:
For cavitation as caused by tooth extraction: If your symptoms started post wisdom tooth removal, you may want to work with a biological dentist to rule out this type of infection. The cavitation can be drained and cleaned out by this type of dental professional.
For root canals: If your symptoms began after a root canal procedure, it may need to be cleaned out surgically by a dental specialist or have the tooth removed. Unfortunately, these infections are more likely to be inaccessible to antibiotics.
Trigger #4: Amalgam Fillings
Amalgam fillings, called “silver” fillings, contain 50% of mercury by weight. They also contain small amounts of silver, tin, copper, and zinc. Amalgams are a major source of mercury exposure in the general population, accounting for two-thirds of human mercury exposure.
Mercury is continuously released from the fillings—every time a person chews—as mercury vapor is not a chemically stable compound. Rates of absorbed mercury from amalgam fillings range from 9 to 17 mcg/d, with an uptake estimate of 12 mcg/d.
Research has shown that mercury from amalgams does accumulate in thyroid tissue. The more mercury fillings a person had, the higher amount of mercury was deposited in their thyroid gland.
Symptoms may include digestive issues, joint pain, fatigue, brain fog/trouble concentrating, and hair loss. Many of the symptoms related to mercury exposure overlap with those seen in Hashimoto’s. (Read what Carrie experienced with amalgam fillings.)
Recommended Treatment Plan:
If you have Hashimoto’s and amalgam fillings, I encourage you to have the MELISA (Memory Lymphocyte Immunostimulation Assay) test. This test can detect hypersensitivity to metals and environmental toxins and help you determine whether removing your fillings should be a priority. (10,11)
If you do need to have your amalgam filling removed, it’s critical that you have them removed safely. When done improperly, the process can cause you to breathe in additional, possibly large doses of mercury vapor—a big problem if you have the MTHFR gene mutation and intestinal permeability (an excess of mercury exposure all at once can overburden your detox pathways).
Many of my clients have reported an onset or increase in Hashimoto’s symptoms after improper amalgam removal. Proper precautions for safe removal of dental amalgams (to prevent the absorption of mercury vapor into your body) include the use of the following:
- rubber dams
- oxygen mask and skin cover (for you)
- extra suction to help evacuate the vapors away from you
- activated charcoal rinse after the procedure, which can bind up residues
- N-acetyl cysteine (NAC) or other liver support supplement before/during/after your amalgam removal (very helpful)
- Liposomal Glutathione – At my recent book signing in Chicago, one of my readers, a biological dentist, mentioned remarkable improvements in people with mercury toxicity through the use of Liposomal Glutathione. I’ve also had clients and readers report huge benefits with this product, however, I have one hesitation in recommending it—it does have soy, so it’s not appropriate for people who are soy sensitive (60-70% of people with Hashimoto’s).
For best results, before undertaking the removal of dental fillings, I recommend building up your resilience by completing my Fundamental Protocols, the Liver Support Protocol, Adrenal Balancing Protocol, and the Gut Balancing Protocol, before getting amalgam fillings replaced.
The success of removing amalgam fillings is highly dependent on your body’s ability to clear toxins. Most people with Hashimoto’s already have a toxic backlog, and as the body’s primary detox organs are the liver, skin, and gut, the Fundamental Protocols will give your detox capabilities extra support. The protocols can also be done afterwards.
[Check out my newest book Hashimoto’s Protocol: A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back for the comprehensive Liver Support and Gut Balancing Protocols.]
Trigger # 5: Incompatible Dental Materials
Fillings, onlays, bridges, braces, plastic aligners (like Invisalign), and other types of materials used for dental work may trigger an immune response in some individuals. This is a sign that the materials used may be incompatible with your own unique biochemical makeup.
Again, what’s important here is that you become familiar with your dental timeline—can you trace your symptoms back to the introduction of any of the materials or dental alignment tools mentioned above?
Even “tooth-colored fillings,” referred to as dental composites, can be an issue for some people who may be sensitive. Some composites contain BPA, a known thyroid toxin, which can be released from dental materials and potentially cause symptoms to develop.
Recommended Treatment Plan:
If you want to determine if you are sensitive to the chemical and materials in your dental work, I recommend seeking out a biological dentist.
With the exception of Invisalign, it may not be feasible to remove materials used in dental work. It may also not be entirely necessary. Before going to extreme measures, I recommend that you introduce protocols into your life that can boost your detox abilities and substance tolerance.
It’s also important that you—and anyone else with an autoimmune condition—start working with a biologic dentist to get tested for biocompatibility. Going to a biological dentist will help ensure that any future dental work will be done using only the safest materials for your distinct biochemistry.
Trigger #6: Dental X-Rays
Even small amounts of radiation have been found to be of detriment to the thyroid gland, so it’s wise to limit your exposure to radiation.
Recommended Treatment Plan:
For this potential trigger, it’s not so much about a treatment plan, but a strategy for minimizing your exposure in the future. Here are two things you can do:
- Get digital X-rays rather than film x-rays because they are safer overall and provide less radiation.
- Use a thyroid shield/guard. A lot of dental assistants may only give you a chest guard, but don’t let them pressure you into doing the X-rays without properly protecting your thyroid gland. You can also purchase your own thyroid guard to bring to appointments with you.
Trigger #7: Fluoride
Fluoride is a substance commonly used in dental treatments, but what many don’t realize is that this ubiquitous chemical is directly toxic to thyroid function. In fact, fluoride used to be prescribed to treat hyperthyroidism up until the 1950s because of its thyroid-suppressing activity. (13-26)
Most adults in fluoridated communities are ingesting between 1.6 and 6.6 mg of fluoride per day from water, which is more than enough to suppress thyroid function. Fluoride may act as a trigger in inducing thyroid cell death and inflammation and lead to the development of thyroiditis/autoimmune thyroiditis. (13-26)
To remove fluoride, you have to know where to find it, and you’ll probably be surprised by some of the sources: dental treatments, certain medications, supplements, bottled beverages, teas (especially the red and black varieties), canned food items, chewing tobacco, toothpaste, and water (in fluoridated communities) can all contain fluoride.
Recommended Treatment Plan:
Some people have reported improvement in thyroid symptoms and thyroid function tests following removing fluoride from their lifestyle.
You can only remove fluoride from water by distilling it, using reverse osmosis filtration systems, or activated alumina defluoridation filters. Most other filters do not remove fluoride.
One of the most convenient and cost-effective reverse osmosis water filters out there is AquaTru’s countertop filter. I have one in my bathroom that I use on a daily basis! It’s super easy to setup (no plumber required!), and I feel better knowing that I’m brushing my teeth and washing my hands with purified water. This is also a great option for apartments or other places where you can’t adjust the plumbing. Plus, the wonderful people at AquaTru have been so generous to offer my readers a discount!
Another option is having a plumber or handyman install an under the sink reverse osmosis unit. These typically cost around $200 and provide a consistent, daily source of water without fluoride. I recommend that you use the fluoride-free water for cooking and drinking, for your pets, and family.
It should be noted that boiling water concentrates the fluoride instead of getting rid of it, while freezing the water does not affect the concentration of fluoride. Bottled water isn’t a safe go-to either since some contain fluoride (see http://fluoridealert.org/content/bottled-water/ for more information). (27)
Water delivery services will deliver fluoride-free water to your home or office, if installing your own filter isn’t an option.
If you want to get more involved, join the Fluoride Action Network (http://fluoridealert.org/), an advocacy organization dedicated to broadening the awareness of fluoride toxicity. (28)
In addition to removing fluoride from your day to day life, you can also utilize supplements to help you recover from long term fluoride use. A recent study done in rats has shown that taurine, a major constituent of bile, can partially alleviate thyroid dysfunction caused by fluoride! Taurine and other bile boosting ingredients can be found in the Rootcology Liver & Gallbladder Support. (29)
Getting Better Dental Care
I’ve mentioned the term “biological dentistry” here a few times, and I want to give you a better understanding of what this is exactly because I truly believe it to be a safer way to maintain a healthy mouth—something we’ve established is important to your overall health—especially if you have Hashimoto’s or other autoimmune disease.
Biological dentistry is a branch of dentistry that looks at the connection between oral care and the health status of the rest of the body. While most traditional dentists focus only on “rescue care” rather than prevention, biological dentists try to prevent health problems that may originate from exposure to certain procedures and materials.
Biological dentists have advanced training in using biocompatible materials in dental procedures and in the removal of amalgam fillings (which can sometimes be a trigger of Hashimoto’s).
To find a biological dentist in your area, visit the International Academy of Oral Medicine & Toxicology’s website at www.iaomt.org for a listing. If you find a dentist in your area, I suggest you call and “interview” the biological dentist in advance of scheduling an appointment. Here are the questions you should ask:
- Do you use a thyroid shield for X-rays?
- Do you use a rubber dam for removing mercury fillings?
- Do you perform the MELISA test?
What You Can Do at Home: Recommended Self-Care Steps for Better Dental Health
Of course, one of the most vital factors in maintaining healthy gums, teeth, and mouth is our own self-care practices. Some consistent, focused effort here can minimize the need for invasive dental work (anything beyond a cleaning) and reduce inflammation.
Let’s look at a few strategies you can implement on an ongoing basis that will help improve and maintain oral health.
Create an alkaline environment
Dental cavities are related to the pH of our mouth, which allows for specific bacterial species to proliferate, as well as the nutrition we take in. Cutting back on sweets, soda, tea, and coffee, and following any of my Root Cause-approved diets, can help reduce the acidity in the mouth.
You can also try brushing your teeth with baking soda for one week to help create an alkaline environment in the mouth, making it more difficult for the pathogenic bacteria to survive.
Use a proper tooth-brushing method
Many of us are not familiar with proper brushing techniques. While brushing your teeth, aim at the gum line, as that’s where most of the pathogenic bacteria live. You can do this by angling your toothbrush up to reach upper teeth and angling it down to reach lower teeth.
The most helpful way to brush is through applying gentle pressure and a jiggling motion; Sonic toothbrushes can do the work for you. Flossing is also an important daily habit to start as this will help to dislodge food particles (aka, food for the pathogenic bacteria).
Eliminate pathogenic mouth bacteria
Eliminating pathogenic mouth bacteria can be challenging as the mouth bacteria form biofilms, also knows as dental plaques, that protect them from the usual methods of removal. Some strategies that may help eliminate bacteria are:
Water picking: Using a waterpik may be helpful in displacing pathogenic bacteria, allowing for their removal.
Oil pulling: Oil pulling is an old Ayurvedic remedy of swishing around sesame oil or coconut oil in the mouth and between the teeth.
To try: First thing in the morning, put one tablespoon of either sesame or coconut oil in the mouth and swish around for 5-20 minutes until the oil turns white. Then, the oil is spat out along with the toxins in it.
In theory, this method helps to break down the “homes” of bacteria, which are usually made of microcapsules of oil. While water won’t penetrate those microcapsules, sesame oil can, and mixes readily with the bacteria and becomes white in color.
Cranberry juice: Cranberry juice has been found to have anti-adhesion properties which prevent the attachment of the bacteria to our body’s surfaces and may also help to dissolve the protective coats that store the bacteria.
Oral probiotics: Oral probiotics are an accelerated way of getting beneficial bacteria into our mouths so that they can displace pathogenic bacteria and reduce inflammation in the mouth.
Dr. Jeffrey D. Hillman was able to identify strains of probiotic bacteria from volunteers with healthy teeth and gums. He isolated these bacteria and put them together in a probiotic mix called ProBiora3, which can be found in these mints.
This type of bacterial mix works to crowd out the pathogenic bacteria and has been reported to whiten teeth, reduce gum bleeding, inflammation, and biofilms of pathogenic bacteria. The probiotics are available as orally dissolvable mints that are to be taken twice per day for 30-90 days.
You can also try a probiotic toothpaste. Designs for Health makes PerioBiotic toothpaste, a special probiotic toothpaste that is free of fluoride and triclosan and packed with probiotics.
The key to getting the most benefit from this toothpaste is to forgo rinsing your mouth after brushing your teeth, allowing the beneficial bacteria to stay in your mouth longer. It feels strange and first, but eventually, you will get used to it.
I recommend trying and continuing with some of the self-care steps I’ve introduced here. If you find you want a more comprehensive routine, visit page 326 of Hashimoto’s Protocol for the Root Cause Basic Dental Protocol.
Dental triggers of Hashimoto’s are frequently overlooked, but you now know that dental history must be considered when thinking about potential igniters of autoimmunity.
Have any of the triggers outlined here sparked an aha moment for you? Have you addressed a dental trigger and noticed that it helped resolve any Hashimoto’s symptoms or just made you feel better in general?
I hope this information will help you on your journey!
1) The Cranberry Institute – Dedicated to supporting research and increasing awareness about the health benefits of the cranberry. Cranberryinstituteorg. 2017. Available at: http://www.cranberryinstitute.org/. Accessed June 22, 2017.
2) Patil B, Gururaj T, Patil S. Probable autoimmune causal relationship between periodontitis and Hashimotos thyroidits: A systemic review. Nigerian Journal of Clinical Practice. 2011;14(3):253. doi:10.4103/1119-3077.86763.
3) Fluoride Linked To Gum Disease. Medical News Today. 2017. Available at: http://www.medicalnewstoday.com/releases/71584.php. Accessed June 22, 2017.
4) Vandana K, Sesha Reddy M. Assessment of periodontal status in dental fluorosis subjects using community periodontal index of treatment needs. Indian Journal of Dental Research. 2007;18(2):67. doi:10.4103/0970-9290.32423.
5) Dittmann R. Brighton Baby: A Revolutionary Organic Approach To Having An Extraordinary Child. Bloomington, IN: Balboa Press; 2012.
6) Diabetes Self-Management – Diabetes Articles and Recipes. Diabetes Self-Management. 2017. Available at: https://www.diabetesselfmanagement.com. Accessed June 22, 2017.
7) Foundation A, Price A, Directors B et al. Home – The Weston A. Price Foundation. The Weston A Price Foundation. 2017. Available at: http://Westonaprice.org. Accessed June 22, 2017.
8) Bonner M. To Kiss Or Not To Kiss. A Cure For Gum Disease. Editions AMYRIS; 2013.
9) Bonner M, Amard V, Bar-Pinatel C et al. Detection of the amoeba Entamoeba gingivalisin periodontal pockets. Parasite. 2014;21:30. doi:10.1051/parasite/2014029.
10) Mercury allergy – MELISA. Melisaorg. 2017. Available at: http://www.melisa.org/mercury/. Accessed June 22, 2017.
11) Sterzl I, Prochazkova J, Hrda P et al. Removal of dental amalgam decreases anti-TPO and anti-Tg autoantibodies in patients with autoimmune thyroiditis. . 2006. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16804512.
12) Welcome to Clifford Consulting & Research Online – North American English version. Ccrlabcom. 2017. Available at: http://www.ccrlab.com. Accessed June 22, 2017.
13) Fluoride Linked To Gum Disease. Medical News Today. 2017. Available at: http://www.medicalnewstoday.com/releases/71584.php. Accessed June 22, 2017.
14) Easy Ways To Remove Fluoride from Tap Water. ThoughtCo. 2017. Available at: http://chemistry.about.com/od/chemistryhowtoguide/a/removefluoride.htm. Accessed June 22, 2017.
15) Choi A, Sun G, Zhang Y, Grandjean P. Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environmental Health Perspectives. 2012;120(10):1362-1368. doi:10.1289/ehp.1104912.
16) Fa-Fu L et al.The Relationship of a Low-Iodine and High-Fluoride Environment to Subclinical Cretinism in Xinjiang. Slweborg. 2017. Available at: http://www.slweb.org/IDD.html. Accessed June 22, 2017.
17) Fluoride Action Network | Mikhailets (1996): Functional state of thyroid under extended exposure to fluorides. Fluoridealertorg. 2017. Available at: https://fluoridealert.org/studies/mikhailets-1996/. Accessed June 22, 2017.
18) Water C, Council N. Fluoride In Drinking Water. Washington: National Academies Press; 2006.
19) Susheela A, Bhatnagar M. Excess Fluoride Ingestion and Thyroid Hormone Derangements in Children Living in Delhi, India. The International Society for Fluoride Research. 2005. Available at: http://www.fluorideresearch.org/382/files/38298-108.pdf. Accessed June 22, 2017.
20) Fluoride Action Network | Thyroid. Fluoridealertorg. 2017. Available at: http://www.fluoridealert.org/issues/health/thyroid/. Accessed June 22, 2017.
21) Basha P, Rai P, Begum S. Fluoride Toxicity and Status of Serum Thyroid Hormones, Brain Histopathology, and Learning Memory in Rats: A Multigenerational Assessment. Biological Trace Element Research. 2011;144(1-3):1083-1094. doi:10.1007/s12011-011-9137-3.
22) Zeng Q, Qui Y et al. Studies of fluoride on the thyroid cell apoptosis and mechanism. Neuro Endocrinol Lett.2012. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22800594. 2012.
23) The Controversial Link Between Fluoride and Thyroid Disease. Verywell. 2017. Available at: http://thyroid.about.com/od/drsrichkarileeshames/a/fluoride2006.htm. Accessed June 22, 2017.
24) Nabrzyski M, Gajewska R. Aluminium and fluoride in hospital daily diets and in teas. Zeitschrift für Lebensmittel-Untersuchung und -Forschung. 1995;201(4):307-310. doi:10.1007/bf01192722.
25) Fluoride Action Network | F.A.Q. Fluoridealertorg. 2017. Available at: http://www.fluoridealert.org/faq/. Accessed June 22, 2017.
26) Fluoride Action Network | Considerations When Buying a Water Filter. Fluoridealertorg. 2017. Available at: http://www.fluoridealert.org/content/water_filters/. Accessed June 22, 2017.
27) Fluoride Action Network | Fluoride Content of Bottled Water. Fluoridealertorg. 2017. Available at: http://fluoridealert.org/content/bottled-water/. Accessed June 22, 2017.
28) Fluoride Action Network | Broadening Public Awareness on Fluoride. Fluoridealertorg. 2017. Available at: http://fluoridealert.org/. Accessed June 22, 2017.
29) Adedara I, Ojuade T, Olabiyi B et al. Taurine Ameliorates Renal Oxidative Damage and Thyroid Dysfunction in Rats Chronically Exposed to Fluoride. Biological Trace Element Research. 2016;175(2):388-395. doi:10.1007/s12011-016-0784-2.
30) Yang H, Xing R, Liu S, Yu H, Li P. γ-Aminobutyric acid ameliorates fluoride-induced hypothyroidism in male Kunming mice. Life Sciences. 2016;146:1-7. doi:10.1016/j.lfs.2015.12.041.