Disease Management

TCM Management of Gum Disease

Our mouths are teeming with germs, but most of them are harmless. Good germs help with digesting food, controlling bad breath, and protecting against oral problems, while bad germs can lead to issues like mouth sores, tooth decay, and gum disease. These germs coexist in harmony, forming a community in the oral cavity. Maintaining a balance between these germs is crucial. When this balance is disturbed by factors such as a poor diet, improper oral hygiene, or other health issues, oral problems are likely to occur.

The gums form a tight seal around the teeth to keep them in place and provide a barrier against germs. However, plaque build-up and the body's immune reactions can damage the gums and dental tissues. Gum disease progresses slowly, often starting as gingivitis, where plaque accumulates around the teeth, causing the gums to become red, swollen, and tender. If untreated, it can advance to periodontitis, where the gums and bones pull away from the teeth, forming pockets. Common signs of periodontitis include red, swollen, or bleeding gums, bad breath, pain and weakness when chewing, sensitive or loose teeth, receding gums, and pockets with hard tartar between the teeth and gums.

gum diseases

Although poor oral hygiene is a primary cause of gum disease, internal factors also play a significant role. It's common to see gum problems during puberty and pregnancy, reflecting the influence of hormonal changes on gum health.

According to the holistic view of traditional Chinese medicine (TCM), the mouth has extensively connections with the internal body. The oral cavity is considered the external opening of the spleen, so oral problems are often associated with spleen issues. The heart opens up through the tongue, linking tongue problems to the heart. Teeth and bones share the same source, both nourished by kidney essence , so tooth and bone problems are associated with kidney functioning. The stomach and large intestine meridians pass through the upper and lower tooth beds, respectively, supplying and distributing blood and qi (vital energy) to these regions. Therefore, tooth and gum conditions are linked to the functional states of the kidney, stomach, or large intestine, and gum disease should be considered in the context of internal disharmony.

Chinese Herbal Prescriptions for Gum Disease

Instead of applying local treatments for gum disease, TCM focuses on restoring internal harmony. As the development of gum disease is associated with the internal functioning of the kidney, spleen, stomach, and large intestine, physicians will evaluate the overall manifestations of individuals. They then identify the internal disharmony pattern and its involved organs for designing a herbal prescription. In most cases, individuals tend to have weakened kidney function and an overactive stomach.

Below are common disharmony patterns of gum disease and their prescriptions:

Stomach fire stirring up

The gums look bright red, swollen, painful and bleeding, even pus-forming inside the pockets. Individuals may also be accompanied by mouth dryness, thirsting for cold drinks, feeling hungry easily, abdominal discomfort, bad breath, constipation and yellowish urine. On examination, the tongue is red and covered by yellow and thick coating, the pulse is rolling and rapid. The individuals are likely have an unhealthy diet, such as overeating deep fried, heavily spicy or greasy foods, or drinking too much, that damages the stomach and spleen and generates excess fire. Then the fire pathogens travel along the stomach meridian and reaches the gums, causing damage. Also, poor oral hygiene leads to bad germs overgrowth inside the oral cavity that further damage dental tissues.

The herbal remedy should aim to clear the stomach, purge fire, resolve swelling and pain.

A sample herbal prescription is Clear Stomach Powder .

Kidney yin depletion

The gums look dusky red or purplish color, the gumline is receded and bleeding, and there are loose or shifting teeth, painful and weak chewing. Individuals may also be accompanied by dizziness, ear ringing, lumbar soreness, and warm palms and soles. On examination, the tongue is slight red with little coating, the pulse is thready and rapid. This is due to kidney weakness that fails to provide essence to nourish the dental tissues, or yin deficiency leads to virtual fire irritating the gums and teeth. Individuals are usually older aged, having other health problems, or having an unbalanced lifestyle such as physically overstrain or staying up late for a long time.

The remedy should aim to nourish yin, invigorate kidney, replenish essence and consolidate teeth.

A sample herbal prescription is Six-ingredient Rehmannia Decoction .

Blood and qi insufficiency

Receding and bleeding gums, and in pale color, spitting out blood when brushing or flossing teeth, loose teeth, painful and weak chewing. Individuals may also accompany with paleness, sensitive to low temperatures, fatigue, dizziness, blurred vision, insomnia or dream-disturbed sleep, a poor appetite, breath shortness and palpitations. On examination, the tongue is pale, and the pulse is deep and thready. This is due to a weak body or chronic illness that fails to produce sufficient blood and qi for supporting the gums and teeth, while pathogens (bad germs in mouth) take advantage to become overwhelmed.

The remedy should aim to replenish qi, enrich blood, rebuild gums and consolidate teeth.

A sample herbal prescription is Eight Treasures Decoction .

In TCM experiences, the disharmony patterns of gum disease are more complicated than the above, as individuals are likely to present in a mixed type. It is necessary to diagnosis properly in order to get the desirable results. TCM herbal therapy is effective for gum management, as they are flexible to treat the specific need of each situation. For example:

If gum bleeding is serious, extra herbs like donkey-hide gelatin, carbonized hair and lotus root node (carbonized) can be selected to arrest bleeding.
If gum swelling is serious, extra herbs like dandelion, great burdock fruit, and gardenia fruit can be selected to resolve the inflammation.
If gumline receding and teeth loose are serious, extra herbs like wolfberry, dodder seed and tortoise shell glue can be selected to nourish the kidney and consolidate teeth.
For other symptoms like bad breath, tooth pain, mouth dryness and oral sores, extra herbs like gypsum, processed rhemannia rhizome and anemarrhena rhizome can be selected to target the problems specifically.


great burdock fruits	gardenia fruits	donkey-hide gelatin

Acupuncture Therapy for Gum Disease

Needling stimulations regulate blood and qi activities and enhance the body’s self-healing power, that are able to create a positive change for the body. For gum disease, the body points selections are below:

Major acupoints: he gu (Li4), nei ting (St44), jia che (St6) & xia guan (St7);
Assist acupoints: er jian (Li2), qu chi (Li11), & zu san li (St36).

The acupoint are mostly selected along the stomach meridian (St), and the large intestine meridian (Li), that can work on the upper and lower tooth beds directly. For example, the points of St44 & Li4 are often used for gum disease. Points along the other meridians will also selected for the purposes of replenishing blood and qi, and invigorating kidney.

For stomach fire cases, a reducing stimulation technique should be applied, while for other two disharmonies, an even stimulation technique is applied.

Stomach and Large Intestine Meridians — Large Intestine and Stomach Meridians

Herbal Mouth Washes for Gum Disease

TCM has a long history of using mouth washes for oral and throat diseases, some early applications can be found in famous TCM classics. Since mouth washes work on the lesions directly, individuals can attain a faster and more favorable result than oral decoctions. They can also avoid unnecessary drug stimulations to the gastrointestinal tract. In TCM, mouth washes are usually prescribed for conditions like pharyngitis, tonsillitis, periodontitis, toothache and mouth sores.

Physicians usually prescribe according to individual conditions. The prepared solution is used to gargle in the mouth for 1~2 minutes each time. There is no need to rinse with water afterwards and remember not to eat immediately. Do this 3~5 times a day, it is better to brushing or flossing teeth before doing this. Some herbal remedies that are suitable for making mouth washes to promote gum health are:

Manchurian wildginger (3g), Dahurian angelica root (10g), borneol (0.5g), figwort root (30g), honeysuckle flower (30g), and liquorice root (5g);
Baical skullcap root (10g), bamboo leaf (10g) & dictamnus root bark (30g);
Unprocessed gypsum, baical skullcap root, Chinese rhubarb, figwort root, Tokyo violet herb and rehmannia root, prepare in equal amount for each ingredient.

*Every day, boil the herbs with water for 20 minutes to prepare about 150ml of solution.

Herbal Pastes for Brushing Teeth and Massaging Gums

At home, individuals can also prepare an herbal paste to brush the teeth, or cover on the gums for massaging.

Prepare equal amount of unprocessed gypsum, salt (fried), Fortune's drynaria rhizome, peppermint, Dahurian angelica root, yerbadetajo herb, and pagoda tree flower; grind into powder, mix with honey, and store in a container.
Prepare equal amount of honeysuckle flower (30h) and Fortune's drynaria rhizome (30g); grind into powder, mix with honey (30g), and store in a container.
Prepare carbonized hair (1.5g) and borneol (0.5g); grind into powder, mix with honey (30g), and store in a container. This is suitable for gum disease with frequent bleeding.
Gallnet of Chinese sumac (30g), dried earthworms (30g) and salt (1g); grind into powder, mix with honey, and store in a container. This is suitable for gum disease with kidney deficiency.
Prepare equal amount of yerbadetajo herb, Fortune's drynaria rhizome and salt; grind into powder, mix with honey and store in a container.