CATEGORY 66 AUSTRALASIAN DENTIST I have now spent over 40 years, removing white supra gingival scale, black subgingival scale, plaque, and extrinsic tar, tannin and stains. I was taught that “Periodontal disease“ was a microbe infection / host defence immune mediated disease. Prof Seymour, Uni of Qld early 1980s, was looking at pathogens from swabs of periodontal pockets under dark field microscopy. We have since learned about spirochytes, and anaerobes like P. Gingivalis. I have heard and read that Universities are now teaching that “Periodontal disease” can only be managed. There is no Cure. If we think of Disease as an equation, Disease requires Infection. And our modern understanding of Biofilms, shows us that imbalance leads to dysbiosis and disease. Disease occurs when the healthy biofilm is disrupted, and the Host is not able to resist damage from the pathogens. Disease = Virulence x Quantity / Host Resistance x Immune Function Using this equation, we can break down Periodontal Disease and our Therapy into meaningful intervention. I remember reading a study that showed that “unless you have marginal gingivitis, the anaerobes cant get under your gums”, which is why good supragingival plaque removal, and preventing marginal gingivitis is so important Gingivitis is inflammation of the gums, usually due to bacteria aka carbohydrate driven plaque, or some other factors like SLS, dry mouth (acidic saliva), Candida, and some medications that produce an exacerbated immune response (like the contraceptive pill or its modern hormone regulating equivalents). Gingivitis is considered “reversible”, but only if the root cause of the inflammation is addressed. Sometimes, this means thinking beyond “plaque control“. “Gum Disease” as the general public knows it is a disease that destroys the Bone around the teeth. So, “Periodontal disease” is a disease that directly destroys the Periodontal ligament and the Alveolar bone, primarily due to Infection by anaerobes. It’s basically a “biofilm disease“. If our Profession is ever going to get on top of this awful disease: First step is STOP calling the destruction “Pockets“. The words we use have an important impact on the Patient. The term “Pockets” does not convey that this disease is Serious! If you have “Perio”, you have a chronically infected wound with a surface area affecting Bone, the size of the palm of your hand. DIRECT to BONE !!! We know that the Perio germs (P Gingivalis and its friends) are anaerobic acidophilic germs that eat blood products, absorb calcium, and make a “deathstar” of tartar/calculus/scale deposit on the side of the root, under the gum line. P. Gingivalis has been found in the heart atheroslerosis in heart attack victims. P. Gingivalis has been found in the brain plaques of Alzhiemers suffers. So, it is not just GUM Disease. We know it is affecting the whole body, the Cardiologists know it is affecting the whole body, the Research has always shown that periodontal disease is linked to low birth weight babies, so lets START calling it. “You have a huge wound, around every tooth, bacteria are infecting your bone, and getting into your blood stream”. “I can Help You”. Using the Disease equation, we have 4 points of intervention. Let’s see how the Profession is doing at addressing this awful disease. Disease = Infection + Dysbiosis #1 Virulence #2 Quantity #3 Host Resistance #4 Immune Function Interventions: 1. Decrease the bulk of the pathogens, u Professional removal of all plaque and scale. This addresses #2 2. Post-operatively provide a “reduce virulence” protocol. u Professional application of antimicrobials INTO the wounds/pockets aka introducing Chlorhex into the defect. A good idea, but rarely done. LANAP perhaps provides this. This addresses #1 3. Educate and Provide “Home Care“ methods for the Patient to debride, and to reduce Quantity. u Brushing, flossing, interdental brushing, Waterjet type pressure cleaners This addresses #2 4. Educate and Provide “Home Care“ methods for the Patient to reduce VIRULENCE. u Some kind of toothpaste or mouth rinse with anti-microbials. Like Chlorhexidine Mouth wash. Curasept Chlorhex gel, PDS ChloroFluor Gel, Hydrogen Peroxide mouth rinse or gel (Carbomide Peroxide). This addresses #1 5. Educate and Provide “Home Care“ methods for the Patient to alter their oral bioflim environment, back towards a healthy Alkaline Saliva rich environment = Hydration. u Provide some kind of advice about HYDRATION. Most people with “Perio” have acidic saliva. Do a Physician of the Mouth, Part 3 Oil Pulling, Gum Disease, and Vit D3 and Vit K2 By Dr David Stephenson CLINICAL Dr David Stephenson
RkJQdWJsaXNoZXIy MTc3NDk3Mw==