Champion of the smile

Iranian periodontologist Prof. Hessam Nowzari, describes simple way to prevent aggressive juvenile gum disease.

PROF. HESSAM NOWZARI 370 (photo credit: Courtesy)
(photo credit: Courtesy)
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 said.
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 said.
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 traditions.
He threw away the notes for his lecture on esthetic dentistry and decided to change the subject, to juvenile periodontitis.
“Little 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.”
The focus on dental cavities in the 20th century, he continued, overshadowed important information regarding the impact of periodontal disease on the global population.
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 teachers.”
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.”
Nowzari 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.
Unlike 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.
“When a 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.”
The salt 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.
“I did not invent unprocessed salt as a solution,” Nowzari told The Jerusalem Post.
“The effectiveness of sea salt has been mentioned in ancient manuscripts.”
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 disease.”
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.
Alpha 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 the participants.
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 eight incisors.
The researchers concluded that the soldiers had a relatively high prevalence of aggressive periodontitis.
Dental hygienists 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?”