Parents and grandparents – especially mothers and grandmothers – are largely but
unknowingly responsible for a global epidemic of dental disease in young people
that doesn’t create cavities but causes their teeth to wobble and fall out. And
these same caregivers have the opportunity to treat and even prevent it, simply
using a clean finger or toothbrush, a cup of water and a teaspoon of “kosher
salt” or sea salt.
The disease – prevalent from Colombia in Latin America
to Israel, Uganda, Morocco, India, Malaysia, Japan and China – is aggressive
juvenile periodontitis, and the villains are bacteria called Aggregatibacter
actinomycetemcomitans and Porphyromonas gingivalis, and few others. It is a
silent disease with millions of victims. In China alone, some 100 million people
carry the bacteria in their mouths.
The hero is Prof. Hessam Nowzari, an
Iranian researcher and periodontologist, who at a recent Jerusalem dental
conference was introduced as a University of Belgium and University of Southern
California graduate with a doctorate in biology and health sciences, “an opinion
leader and a peacemaker.”
He was born in Shiraz, Iran, where he said
Queen Esther is buried and celebrated by the Persian youth. “The Jewish nation
represents, besides the Persians, the oldest nation in Persia,” he
Nowzari recently attended a conference organized by the Hebrew
University-Hadassah School of Dental Medicine. He told the Jerusalem conference:
“I would never hesitate to come here. I thank you for inviting a Persian, an
Iranian, to your country. There has never been anything but friendship and love
between us. I have no ambition; it comes from my heart,” Nowzari
Many years ago, Nowzari visited Casablanca, Morocco, to speak about
esthetic dentistry and was shocked to see young people in their 20s and even in
their teens with obtruding teeth showing their roots instead of healthy gums,
wobbly teeth and missing ones.
Checking their mouths, he noticed that
they had no cavities, but their mouths were clearly diseased. He realized that
the young people had developed gingivitis, which is a gum infection at a stage
when it can be treated with removal of bacteria-infested plaque; this had
developed into chronic periodontitis, which caused many to speak with their hand
over the mouth out of embarrassment – and not just from modesty or cultural
He threw away the notes for his lecture on esthetic dentistry
and decided to change the subject, to juvenile periodontitis.
attention,” said Nowzari, “has been directed toward evidence that an
early-in-life oral infection with the potential to reach epidemic proportions is
threatening the health of our youth around the world. Health professionals and
the public seem unaware that the silent disease process of early-in-life
periodontal infection is targeting thousands of children and young adults, their
smiles and, consequently, their emotional and psychological lives.”
focus on dental cavities in the 20th century, he continued, overshadowed
important information regarding the impact of periodontal disease on the global
To date, little attention has been given to the psychological
and emotional impact of early-in-life periodontal infection. Yet increasing
numbers of children are being affected.
“How are these children giving a
meaning to what is happening to them? How do affected adolescents face personal
challenges and social difficulties associated with their facial appearance? How
do young adults relate to each other? How are relationships influenced by the
facial appearance of the smile or speech problems that can result from loss of
teeth?” Modern society places significant emphasis on facial expression, wrote
Nowzari in a journal article, “and, consequently, facial expression plays an
important role in human interactions.
The smile has a significant effect
on first impressions that can dictate the way others respond to children or
adolescents. Unfortunately, reactions eagerly anticipated by the smiling child
with missing teeth and inflamed gingiva may not be forthcoming from others. The
permanent loss of maxillary incisors can result in learning problems at school
and social inhibition caused by self-consciousness about appearance. Children may
show dependent behavior or regress to behaviors appropriate to a much younger
child. Therefore, school-age children affected by destructive early-in-life
periodontal diseases may be at risk for delayed educational development because
of poor social interactions and responses from the public, peers, parents and
In India, children don’t have many cavities, but there is a
high prevalence of periodontitis.
“You see used dentures on the ground
that had been thrown out by adults. Young men or women missing teeth try to fit
them into their mouths. I estimate that two percent of the billion people of
India suffer from this disease. At first, you may think that children with
crooked teeth have orthodontic problems, but as we studied the matter, we
realized they had severe bone loss due to periodontitis.”
recommends that a parent not to share a spoon or food with a child to avoid
“vertical transfer” of the bacteria.
For the past decade, Nowzari, who
has been the director of advanced periodontics at the University of Southern
California from 1995 to 2012, came upon a cheap, easy solution against the
infections in children.
The earlier it is used, the better, as it cannot
halt or prevent the infection in adults.
Just rub the gums of an infant
or child twice a day with the sea salt/kosher salt solution.
ordinary table salt, this natural salt contains minerals and iodine not lost
during processing. The salt interferes with the metabolism of the virulent
bacteria. He claims that if mothers rub a saltwater solution on their very young
children’s mouth for a period of time, the bacterium can be eradicated and
replaced by gram-positive bacteria that will inhibit the return of the microbes.
Jean François Michel, Marie Graçe Michel and Nowzari have reported a high
success rate among 625 participants from a particular population.
mother performs this act of hygiene, there is less resistance on the part of the
child. There is more trust between mother and child. Assuming that periodontal
herpes viruses can reside in inflammatory cells, a reduction of gingival
inflammation reduces periodontal viruses counts as well.”
technique has a high degree of efficacy and tolerability and can be implemented
in virtually all parts of the world using low-cost resources, he said.
did not invent unprocessed salt as a solution,” Nowzari told The Jerusalem
“The effectiveness of sea salt has been mentioned in ancient
In Manila, where orphaned or abandoned children five or
eight years old live in the street, “we showed them how to brush using sea salt.
French volunteers helped and tested them for gum pockets that are a sign of gum
Nowzari has published numerous dental journal articles and
spoken at conferences around the world. Nowzari made a nonprofit educational
film called The Enemy of the Smile about the bacteria.
“I contacted Prof.
Moshe Goldstein of the Hebrew University-Hadassah School of Dentistry, whom I
know, and contacted the school’s dean, Prof. Adam Stabholz, to join me in making
the film. I had never met Adam before.”
By the time the two met, the film
was already made.
“In December 2010, I was invited to give a talk on ‘The
Enemy of the Smile’ before the Alpha Omega International Convention in San
Diego, and I presented the film. Suddenly, Adam – who was there – stood and
introduced himself: ‘Here I am, Hessam,’ he said.
I went into the
audience, and we hugged each other.”
The first version of the film
received an award as the best short educational film in California.
Omega raised funds for the D. Walter Cohen Center at the Jerusalem dental school
where Stabholz and Goldstein are developing a program for the treatment of the
aggressive periodontitis in children to become a model and template for other
universities and countries around the globe.
A few weeks ago, Nowzari was
invited to speak in Jedda, the second largest city in Saudi Arabia and the
largest seaport on the Red Sea. The film, which included Stabholz giving a
greeting, was presented there. The Israeli dental school dean said: “Hello from
Jerusalem. I am dean of the Hebrew University- Hadassah Dental School.” Although
these were forbidden words, and an Israeli was speaking through the film, there
was no protest, as the subject of preventing aggressive periodontitis enthralled
Israel is not immune from aggressive periodontitis even
though has thousands of dentists and subsidized dental care for children until
age 12. In the August 2006 issue of the Journal of Periodontology, Stabholz and
dental researchers at Tel Aviv University wrote about aggressive periodontitis
among young Israel Defense Forces personnel.
They studied 642 army
recruits (562 men and 80 women) aged 18 to 30 years who arrived at a military
dental clinic for dental examinations. The soldiers filled out questionnaires
about their ethnic origin and family periodontal history, followed by
radiographs and a clinical periodontal examination of four first molars and
The researchers concluded that the soldiers had a
relatively high prevalence of aggressive periodontitis.
in Israel would be natural partners with dentists to teach parents and children
the salt treatment for aggressive periodontitis. But because of the Health
Ministry’s dental care for the young, the health funds that provide the service
per young patient have no incentive to employ them as they are paid per patient
and not per hour.
“To empower millions of children affected by this
disease, scientists and researchers from Iran and Israel have the responsibility
to collaborate with each other and learn from each other,” Nowzari concluded.
“The 4,000-year-old collaboration between the two exceptional cultures will one
more time produce a positive outcome; this time young people around the globe.
If Persian and Israeli scientists don’t lead the project this time, who else has
the experience, knowledge, capability and willingness to do so?”