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.

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.