Dr John van Limburg Stirum
Dr. John van Limburg Stirum, after having lived in the USA as well as in Holland moved to Switzerland in 1967. He completed his medical education at the University of Zurich in 1981 and received his doctorate in 1983. Internship in the fields of anesthesia, orthopedics, rheumatology, gynecology, obstetrics and internal medicine. General practice since 1985 with specialization in Phlebology. In subsequent years, intense and international edification in functional medicine and applied biochemistry. Since 1990 focused activity in the area of science-based integrative medicine. As of 1997 head of the Lake Garden Medical Center in Kilchberg near Zurich, Switzerland. Since 2000 president of the Swiss Medical Society for Nutritional Medicine. Further interests in dental and environmental medicine as well as in eastern medical paradigms. Research and international lecturer activity in applied biochemistry, particularly redox and acid base medicine. Scientific and medical contributions in journals, magazines, radio, television and literature. In 2008 he published the textbook: "Modern Acid Base Medicine", Hippocrates, Stuttgart.

2012 - Antiaging begins in your mouth.

Background
A growing body of evidence strongly supports a link between periodontal disease and systemic illness, including cardiovascular disease, diabetes, and stroke.  Patients with periodontal disease have a 1.5-4.0 times greater risk of developing CHD or stroke.[1-8]  Periodontal disease is considered the sixth most common complication of diabetes and evidence supports the concept that the presence of periodontal disease influences the control of diabetes.[9] Patients with periodontal disease have a 1.5 times greater risk of Chronic Obstructive Pulmonary Disease (COPD) and pregnant women with periodontal disease are 7 times more likely to have a baby of low birth weight or that is premature. Emerging dentistry and medical professionals seek to further define these interrelationships through scientific inquiry. Ultimately, this new knowledge may prove useful in intervention strategies to reduce patient risks and prevent systemic disease outcomes.

Science
There are two main sources of oral toxicity. First, heavy metal-containing dental fillings, second substances produced by anaerobic bacteria and other microbes in periodontal disease and infected teeth. The main toxin from heavy metals is mercury vapor from amalgams. The best known toxic substances in the context of periodontal disease are reactive thiol compounds such as hydrogen sulfide (H2S) and methyl mercaptane (CH3SH). Mercury is a well-documented neurotoxin and a large part of the latest scientific publications has now gone on periodontal disease as a major risk factor for cerebrovascular incidents, cardiovascular disease, low birth weight and other systemic illnesses.

 For this reason it is important to understand the mechanisms of toxicity. Mercury reacts with many enzymes by covalent binding with sulfhydryl groups (SH-E => ES-HgX). In this case, X may be a halide or a sulfhydryl group. H2S and CH3SH are, due to their gaseous and hydrophobic properties, most likely capable of tearing disulfide bonds (RS-SR) of complex protein structures apart and thus inactivate enzymes. An example of the medical significance of the inhibition of enzymes with reactive SH groups is found in the pathogenesis of Alzheimer's disease, where such proteins as tubulin and creatine kinase are shown to be strongly restricted in their activity compared with non-demented matched controls. The same enzymes are inhibited by mercury and toxins from periodontal foci and non-vital teeth. The research by Prof. Boyd Haley demonstrated a wide variability in the toxicity of non-vital teeth extracted from different patients.

 In chemical terms, mercury vapor from amalgams are in a position to enter into metabolic products of periodontal diseases to form compounds that are potentially toxic. An example is the "amalgam tattoo", a dark purple discoloration of the mucous membrane from the reaction of mercury and H2S with the formation of insoluble HgS (mercury sulfide). Also CH3SH will respond rapidly with mercury and produce mercury-methylthiol (CH3S-HgX) or dimethylthiol-mercury (CH3S-Hg-SCH3). Both of these thiolorganic mercury compounds are very hydrophobic and therefore extremely toxic and are therefore declared oral "super-toxins". They can always be detected in cumulation of amalgams and periodontal diseases. This is another factor indicating the importance of toxicity assessment and treatment in case of chronic systemic diseases as well as in prevention.

 Despite the high impact of dental health on our wellbeing, this aspect is being completely neglected by practitioners, also those in the field of antiaging medicine. Dentist - by means of their education - do not take systemic dental effects into their consideration and the practitioner neglects the teeth as well, believing that this aspect is covered by dental medicine. Therefore the systemic approach to dental health has so far been banned into a medicinal "No Mans Land".

 Based on a multitude of scientific research and clinical data, it is mandatory in the medical and dental marketplace to continue to understand and establish the periodontal disease - systemic health connection.[13-14] Until several years ago there has been no known diagnostic tool to directly access this interdisciplinary aspect of dental and systemic health. Now this gap has  been closed by the OroTox Assessment, as a spin off after 35 years of research in this field by Prof. Boyd Haley of the University of Lexington Kentucky.

 OroTox
The OroTox is a rapid and simple chair side method used to determine the amount of anaerobic bacterial toxins and inflammatory proteins in gingival crevicular fluid. OroTox provides site-specific levels of toxins and proteins in periodontal pockets which may aid in the early and present determination of periodontal disease.  Traditionally, presence of infection is noted by simple observation, probing or bacterial cultures without a method of quantification. OroTox can be used as an early screening tool that can provide quantitative baseline levels of toxins and protein levels and may monitor efficacy of recommended treatment regimens over time. OroTox is considered a chair-side patient compliance tool confirming dental observations increasing patient as well as dental awareness and compliance.

 Principles of Detection
Anaerobic bacteria found especially in the gingival crevicular region produce metabolic by-products containing sulfur and polyamine based compounds. Up to 350 different species of anaerobic microbes have been classified in marginal periodontal infections, thus making it impossible to identify these pathogens in a single cost-effective test. Also, their mere detection must not be related to the observed pathology. However, quantification of toxic by-products as well as bacterial and inflammatory proteins can be critically important in the judgment of periodontal disease independent of the bacteria actually involved. The first step of the OroTox is designed to measure the level of thiols such as hydrogen sulfide and methylmercaptan, the two major volatile compounds produced by anaerobic bacteria.15 In a second step the OroTox detects the quantity of inflammatory proteins in the gingival crevicular fluid, as a tissue response to the local bacterial and toxic burden. The OroTox is therefor a simple chair-side test delivering significant information within minutes, enabling health care professional to easily make clinical judgment and follow the progression of disease as well as the effects of any subsequent treatment over time.

 Clinical Experience
Female, born 1967, suffered from repeating pneumonia and COPD, fever episodes, chronic fatigue as well as rheumatism for years. The OroTox detected two of three root canals delivering elevated levels of bacterial by-products and inflammatory proteins. Consequently the teeth were extracted and as a result the patient permanently lost her symptoms.

 Female, born 1939, with diabetes and rheumatism. It was planned to put her on insulin as her blood glucose levels were unsatisfactory under oral antidiabetics. She demonstrated 4 root canal teeth. Of these 4 teeth one was shown very toxic in the OroTox. This one tooth was then extracted which resulted in immediate relief of her rheumatism. Excited about the results she also had her other root canal teeth removed that showed moderate values in the OroTox. After having done so her blood sugar levels declined to a level, where insulin was no longer indicated.

 Female, born 1947, with a chronic angular conjunctivitis of her left eye. She carried three root canals of which one was toxic and inflamed as demonstrated with the OroTox; no abnormalities were seen on the x-ray. The extraction of this tooth resulted in immediate relief and whitening of the sclera.

 A married young lady, born 1968, tried to get pregnant for 6 years. She also suffered from body malodor. She had 3 root canals. Of these three root canal teeth, the OroTox showed that two of them were toxic. She had exactly these two teeth removed. One month later she became pregnant (!) and she lost her body odor as well.

 Female, born 1940, suffered from chronic hives for more than 10 years. Only cortisone and antihistamines granted temporary relief. For quite some time she felt a pain in her lower left jaw in the vicinity of the mandibular left first molar. The tooth, not having been endodontically treated was estimated healthy by several consulted dentists based on the x-ray and clinical appearance. Never the less, the OroTox resulted in a high toxic and protein reading. Driven by her distress the patient had the tooth drawn without delay. Her rash disappeared immediately and has not reoccurred any more as confirmed in a follow up 6 years later. The histological diagnosis revealed a "chronic nonsuppurative osteomyelitis with ischemic damage."

 Conclusion
With increasing knowledge of oral disease patterns and treatment options as well as the knowledge of "dental infections ranking as the most universal affliction of humankind. The discomfort caused by these infections and their enormous cost (dental infections rank third in medical costs, behind heart disease and cancer, in the US) gives dental diseases prominence..."[16] it is expected that future clinical practice will incorporate diagnostic based data into treatment plans along with prognosis for dental treatment. Value added diagnostic aids in total patient care may also extend interdisciplinary communication. The OroTox may be regarded as the diagnostic link between dental and medical professionals through prescreening referral patterns, disease state management and quality assurance programs within health care plans.

References
[1] Mattila KJ, Valtonen VV, et al. Dental infection and the risk of new coronary events: prospective study of patients with documented coronary artery disease. Clin Infect Dis 1995;20:588-92.
[2] DeStefano F, Anda RF, et al. Dental disease and risk of coronary heart disease and mortality. Br Med J 1993;306:688-91.
[3] Joshipura KF, Rimm EB, et al. Poor oral health and coronary heart disease.  J Dent Tes 1996;75:1631-6.
[4] Beck JD, Garcia R, et al. Periodontal disease and cardiovascular disease. J Periodontal 1996;67(suppl):1123-37
[5] Morrison H, Ellison L, et al. Periodontal disease and risk of fatal coronary heart and cerebrovascular diseases. J Cardiovasc Risk 1999;6(7):7-11.
[6] Wu T, Trevisan M, et al. Periodontal disease and risk of cerebrovascular disease: the first National Health and Nutrition Examination Survey and its follow-up study. Arch Intern Med 2000;160:2749-55.
[7] Grau AJ, Becher H, et al. Periodontal disease as a risk factor for ischemic stroke. Stroke 2004;35:496-501.
[8] Rosenberg HM, Ventura SJ, et al. Monthly vital statistics report 1996; 45(3):31.
[9] Matthews DC. The relationship between diabetes and periodontal disease. J Can Dent Assoc 2002;68(3):161-4.
[10] Yaegaki and Sanada, J. Periodont. Res. Volatile Sulfur Compounds in Mouth Air from Clinically Healthy Subjects and Patients with Periodontal Disease. 1992;27:233-278.
[11] Walters et al., Relationship of Human Gingival Crevicular Fluid Polyamine Concentrations to the Percentage of Spirochaetes in Subgingival Dental Plaque. Archs Oral Biol. 34(5): 373-375.
[12] Makela et al. Scand. J. Dent. Res. Protein Composition of Crevicular Fluid Before and After Treatment. 1991; 99:413-23.
[13] Future of Denistry-Executive Summary. Chicago; American Dental Association, Health Policy Resources Center;2002
[14] ADA.org
[15] Moita, M. and Wang H.L.  Relationship of sulcular sulphide level to severity of periodontal disease and BANA test.  J. Periodontal 2001 Jan:72(1): 74-8.
[16] Walter J. Loesche DMD, PhD, School of Dentistry and Department of Microbiology and Immunology, School of Medicine, University of Michigan, Ann Arbor, Michigan