Th New Paradigm for Periodontal Disease Control, Part 3

Dentistry has found ways to manage these infections beyond cleaning up the biofilms in the past 10 years. Routinely altering the patient's susceptibility (shifting it towards being more resistant to disease) helps them keep their teeth longer.

Shifting a patient's inflammatory response can be done with unique medications (Periostat, Oracea). These medications suppress an enzyme that is critical in creating inflammation.

Probiotics like Evora Plus have been engineered to displace the bad bugs in the biofilms with a specific group of bacterial species. Just as we see Activia yogurt commercials showing how we can add good bugs to our gut, we now see how oral probiotics shift the prevalence of oral bacteria that promote periodontal disease. 

Achieving excellent diabetic control is another way to improve a patient's threshold for infection.

Autoimmune disorders, such as diabetes, are complex and numerous. Rheumatoid arthritis, lupus, HIV--just to name a few--are all diseases that, when well-controlled, influence the outcome of teeth in periodontal disease patients.

Smoking cessation, stress reduction, creating healthy work environments, behavioral therapy, proper diet and managing alcohol intake, consistent exercise--all of these are lifestyle changes that make a difference.

Most people don't realize that periodontal disease is a bug problem AND a bite problem. Balancing a bite with orthodontics, wearing bite guards, and anchoring or stabilizing teeth are dental solutions to treating periodontal disease. And the last resort, of course, is to remove teeth that have contributed to the constant pileup of biofilms.

A Unique Way To Connect With Consumers

I just discovered a company called Thumbtack. It is a service that allows consumers to initiate a request for services. A bit of proprietary software connects consumers with service providers for any need. Thumbtack notifies any local service providers and asks them to present a quote for their services. It seems like this concept could make an impact on people who are searching fro more than just a grocery store item or a pair of shoes. Angie's List made some headway to review service providers, but Thumbtack appears to link both reviews and the all-important connection between consumers and services: the handshake to create service for an agreed price.

I was notified today that a prospective patient wanted to have a mouthguard made, and I was asked to present a quote for the service. I will keep you posted on how the service works. Until then, you can see our Thumbtack listing by clicking this link.

Sugar For Kids = Tooth Decay, Obesity, Apnea, Etc.

Yet another recent study connecting childhood obesity to sugar-containing beverages has been released.

I established how detrimental sugar is in a previous post.  But what stems from sugar beverages goes beyond tooth decay for me.  My experience with overweight kids is that they are significantly more likely to develop obstructive breathing disorder, or apnea. This breathing disease is likely to occur before adulthood in moderate to morbidly obese kids.  The Academy for Dental Sleep Medicine has really opened my eyes to the global significance of pediatric apnea.

When I see apneic patients, I almost always witness some element of tooth grinding or TMJ problem.  It's not consistently problematic in all apneic kids or adults, but there is usually one or more of the following issues we see: uncommonly sore jaw and head muscles, abnormal tooth wear, and sometimes TMJ joint pain. None of those things are common problems for children. ANd they are simply abnormal signs for people in general.

The literature has conflicted over the years about the connections between apnea and tooth grinding (also known as bruxism), but I know there is a relationship between obesity and tooth grinding.  And the sleep study summaries come back on these teeth grinders describing obstructive apnea.

But the main point of this post is this: Don't let your kids become obese.  There are a number of different diseases that will stem from a poorly governed diet and lifestyle for your kids.

If you have questions about managing childhood obesity, pediatric apnea, tooth decay, or nutritional choices for your children, please do not wait for a pediatric medical clinic visit. Call us for a consultation.

The New Paradigm In Periodontal Disease Control, Part 2

Last entry discussed how biofilm is constantly occurring and attacking at-risk patients. So this entry will focus on how a patient has to be susceptible to inflammatory problems like periodontitis. There are genetic, dental, and medical reasons that influence how a patient contracts the disease.
  
Biofilms affect all of us, but they affect each of us differently. In fact, about two-thirds of patients who have periodontal disease only contract a mild form of it. The other third have serious and complex infections. There are things in people's lives that tip the scales in the direction of severe disease. Patients' genetics, lifestyle, and medical health influence their thresholds for infection and damage. The big categories are:

1) Genes for highly sensitive inflammatory response, or a family history of the disease.
2) Medical conditions that alter the immune response or inflammatory response.
3) Smoking habit.
4) Chronic stress in any form.
5) Bite problems, including clenching, grinding, or unbalanced bites.

Even if we remove biofilm when patients have infections, they may still get recurrent infections because of the above factors. Since biofilms never take a day off, patients with one or more of these above risk factors need to constantly manage their disease issues with their dentists and specialists. Shifting the patients' responses to inflammation means getting rid of biofilm regularly, but also treating  the risk factors. Until the those are managed the right way, the periodontal disease will hang around, and the chances of losing teeth go up.

Diabetes, heart disease, chronic inflammatory lung diseases, apnea, autoimmune disorders, obesity --these are all disorders that raise the level of body-wide inflammation and reduce the body's ability to heal.And periodontitis works to complicate these diseases too.

Smoking introduces toxins that depress the immune system's ability to fight infection, and also stimulates the release of a number of inflammatory proteins in the body.

Chronic stress, be it physical or psychological, will alter the body's threshold to infection. Chronic pain induces the same inflammatory proteins as smoking in some cases. Depression has been shown to alter physical health and immune response.

The New Paradigm in Periodontal Disease Control, Part 1

I woke up this morning thinking about one patient who saw me several months ago for non-surgical treatment of his periodontal disease. He had been surprised about how it did not take multiple visits, nor did it require the scraping of hand instruments to treat his infection.  And it makes sense that he would question our standards and practices; he had a history of treatment for the disease, as well as a decent clinical concept of how to treat it. His wife was a hygienist who dedicated her life to treating periodontal disease based on the most ideal knowledge base, instruments, and protocols available at that time in her career. He questioned the value of the treatment based on the shorter treatment times and lack of "hand scraping."

I realized there was a lot of things that have changed about how we recognize, treat, and manage periodontal disease that I may not have expressed to him. So I decided to drill down into the deep pile of knowledge we have accumulated over the past 10 years of clinical and scientific research. I want to do a better job of explaining the two different paradigms of treatment for periodontal disease. I want to help my patient as well as our readers understand there was a previously practiced "old-school" paradigm and a solidly established "new-school" paradigm that drives how we treat our patients today.

The new paradigm is focused on how practitioners manage the infection threshold for patients susceptible to periodontitis. Long ago, it was thought that periodontal disease was a bacterial disease; although some patients had more severe disease, and some patients less, bacteria was primarily responsible for tooth loss associated with the disease. But today, we realize three important concepts hold true for periodontal patients: 1) biofilm (the bacterial sludge) has to find a home around and between teeth, 2) the patient has to be susceptible to inflammatory disease like periodontitis(genetically and medically driven reasons for that), and 3) routinely altering the patient's susceptibility (shifting it towards being more resistant to disease) helps them keep their teeth longer. This newer model of management uses progressive technology to better mange the disease. Management is also more medically driven than it is dentally driven; heavy tartar or lots of bugs are not the sole focus for eliminating disease. That means we take a different approach to measuring, analyzing, and directing other treatments for the disease then we ever did before.

So biofilm piles up around and in between teeth like a bad TV rerun. It's episodic. And there's some nasty strains of bugs in there. Certain strains of the bugs are more aggressive and more resistant to treatment. So if doctors or hygienists try to simply hand scrape the bugs off the teeth, they just smear it around if it's not present in hard tartar. The bugs have also evolved ways to reside in the soft tissues. The new paradigm involves sonic or mechanical instruments to not only remove the biofilm from the teeth, but also irrigate or flush the biofilm from the holes in which they live. And research shows it eliminates the bugs. And sonic instruments can remove some inflamed soft tissue with less trauma than hand scraping. Lasers are also more effective: vaporizing biofilm and soft tissue where the bugs live has shown dramatic results in disinfection and healing of tissues. And research studies have shown how mechanical instrumentation is as good or better than hand instrumentation.We've traded muscles for technology: we have more effective and more efficient tools to treat the disease.We have seen patient outcomes with the new paradigm of  that are as good or better than the old-school equipment and practices.

In my next blog, I'll discuss how controlling biofilms requires attention to follow-up visits and assessing the medical profile of every patient.

We have information available about periodontal disease on our website. Call us to set up a consultation about your health today.

Bone Grafting--Science, Uses, and Safety

It has been some time since I discussed bone grafting and why it is essential in today's dentistry. So I thought I would provide general explanations about how it works, how we use the science, and how we keep the grafting procedures safe for our patients.

When a tooth is removed, the supporting bone will atrophy in that area. It's similar to how bodybuilders' muscles can atrophy if they stop going to the gym. Bone atrophy can affect the missing tooth space as well as adjacent teeth. Bone needs teeth in order for bone to stick around. Up to 60% of the bony volume is lost in the first 6 months following a tooth removal. So maintaining bone is a good solution if you want to replace a tooth or prevent bone loss.

We routinely place preservation bone grafts; those are to preserve bone in an area where a patient intends to replace a tooth. The components of the donor bone stimulate your body to grow new bone cells (called osteoinduction). Some graft components serve as a foundation or latticework to allow your body's bone cells to grow on the graft (called osteoconduction). When we replace teeth with implants, we typically use a combination of the two processes to grow your bone. We typically use a particulate (ground-up) bone graft. Some grafts are block bone grafts, which are used in conjunction with particulate bone to rebuild larger areas of bone loss.

The type of bone growth you need depends on your goals. Some grafts resorb, some grafts remain in the area. We will explain what type of bone growth is best for your needs when you contact us for an appointment. 

Many patients ask me about what is in the graft, where does it come from, and is it safe? The donor tissue is usually bone from human cadavers that have been put though a lengthy process to prepare it for safe use. Below are the steps taken to ensure safety:

1) Donation Process
    • Tissue is donated through a certified Organ Procurement Organization (OPO).
    • Strict screening of donors and donated tissue includes in depth review of donors’ medical
    history and extensive serological and microbiological testing of the donated tissue.
2) Tissue Selection
    • Each lot of processed tissue is from a single donor.
    • The tissue undergoes physical inspection prior to any processing. The tissue then undergoes
    debridement process in ISO class clean rooms.
3) Preparation for Cleaning Process
    • Tissue is carefully weighed and then subjected to a proprietary combination of cleansing and reagents.
4) Cleaning Process
    • Tissue is subjected to a deep penetrating cleaning process that relies on cleansing reagents with computer-controlled mechanical processes.          
5) Post Treatment
    • Tissue undergoes additional microbial inspections and then is terminally sterilized
     through the use of low dosage gamma radiation.