Monday, June 24, 2013
The Less I See You, The Better!
Maintenance or hygiene visits are all about risk management. Most patients have a measurable amount of risk for tooth decay and periodontal disease. If you have had a history of tooth decay, for example, that's a standard that holds true in evidence-based literature: You are susceptible to decay, therefore, you should have an inspection done every 6 months.There's a lot of risk factors to consider. But your dentist can help you understand what those are. Here at our office, we issue a risk management sheet explaining your factors for decay and how to treat those risks.
Periodontal disease is similar, but there are different factors to consider. If you are a smoker, a diabetic, or have a history of gum and bone damage from an infection, you should see the dentist at least twice a year. For some people, those factors don't exist. If you don't have any risk of decay, and you don't have a history of gum disease, you probably don't need to see me so much. That's why it's not necessary to see all patients twice a year. Some patients only need to be seen once annually for examination. The cliche still holds true: Flossing Each Day Keeps the Doctor Away.
Monday, April 22, 2013
Putting A Spare on a Bad Axle?
One example of this occurred this morning. A patient called this morning complaining of continued pain with his severe periodontal disease after we began non-surgical treatment. He elected to retain a poor tooth instead of removing it, and now I'm guessing he is hurting because the continued infection has flared up. And he prefers to have me call his pharmacist to treat his pain and infection. When I reviewed his case, I noted that the area where he was complaining has truly severe bone and tissue infection with little hope for medication to solve. In addition, he plans to transfer his care to another provider.
When your car has a problem, like a bad axle or suspension, it's tough to call the mechanic and have them send out a tow truck to put the spare tire on. Furthermore, your mechanic will have a tough time assessing the extent of the current damage without having your car up on the lift in the garage.
The same holds true for a change in conditions in the mouth. Even from week to week, periodontal disease and failing teeth are in flux. A prescription for pain control may be a poor choice for a number of reasons, both medical and dental. Some issues can't be resolved with prescriptions. Narcotic medication management is something we take seriously, and we do not provide narcotic medications without seeing patients directly. And from the medical-legal standpoint, making an assessment and treatment over the phone is risky for patients and providers.
Thanks for understanding we dentist types want the best for your your medical health, your teeth. And your cars.
Thursday, February 28, 2013
Battling The Banes Of Our Existence: Inflammation AND Big Pharma
One of the most influential drugs in the battle against periodontal disease is doxycycline. The popular brand name of this drug is called Periostat. But it is available in generic formulations. It is an antibiotic by design. But instead of using heavy-duty doses to kill bacteria associated with periodontitis, the drug has been wielded by researchers and clinicians in small amounts to suppress the body's inflammatory process, which is actually a reaction to bacterial toxins.
When the inflammatory process begins in periodontal disease, it is not the bacteria that create tissue destruction. It is the body's reaction to the toxins that trigger enzymes and bone- and gum-killing proteins to surge. So the low-levels of doxycycline suppress the enzymes released during inflammation, and the tissues are not destroyed as readily over time. The concept is called host modulation therapy.
Patients occasionally pipe up with concerns that they will not use the drug because they fear it will promote a bacterial super-infection when using doxycycline. But frankly, the doses are so small that they don't even kill bacteria, and do not promote the mutations responsible for bacteria to become more resistant to treatment. My opinion is that it should just be added to the water supply based on how effective it is for some patients with highly sensitive inflammatory reactions. It's one of the only good weapons I have seen sensitive patients use with success beyond good self-care to avoid surgical treatment and minimize the impact of periodontitis.
But there is now a greater challenge for patients to get access to this drug because of the decisions pharmaceutical companies and medical insurance companies are making. Not only are many drugs being taken off the shelf due to discontinuation of drug manufacturing, but insurers are also implementing increases in co-payments for patients who want to use drugs that are in short supply. So if you or others want to know the status of your drug of choice in the marketplace, go to the site managed by the American Society of Health Pharmacists.
Thursday, December 20, 2012
Reduce your Medical Costs By Seeing Me
Periodontal disease and diabetes are inextricably linked. The nature of the inflammatory pathways in gum is to disrupt the body's ability to manage the processes of glucose control, insulin and glucagon production, and metabolism of sugars. Chronic inflammation from any infection also inhibits the ability for a body to heal or perform optimally in countless ways.
With the constantly evolving demands of patient access to care, the model of caring for your mouth to care for your body really means more. There's only so many medical facilities to supply the ever-expanding demand for a clinic when patients need it. So if seeing a dentist can reduce medical visits, it ultimately creates a win-win-win: Win 1: patients can be healthier. Win 2: doctors and hospitals can reduce their labor and equipment costs. Win 3: medical insurers could potentially reduce policy premiums as healthcare utilization is reduced, and policy holders benefit.
SO, I say call our office and get an appointment reserved today!
Tuesday, September 25, 2012
Th New Paradigm for Periodontal Disease Control, Part 3
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.
Thursday, September 20, 2012
The New Paradigm In Periodontal Disease Control, Part 2
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 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.
Monday, January 23, 2012
February is Heart Health Month!
February is American Heart Health Month. Throughout the month, we are educating patients and bringing attention to the health link of oral disease and heart disease. We know that this is an important concept in your wellness, so we invite you to share in this opportunity.
We are proud of our education and experience over the last 12 years in treating the entire spectrum of periodontal disease patients, from non-surgical disinfection to surgical debridement and tissue regeneration. We have information about how we recognize and treat the disease at our website.
We encourage you to review the enclosed web links that share research on the subject of the oral-systemic link between plaque build-up in the mouth and the effect on the heart. We also encourage you to share any research on this subject with us.
http://www.perio.org/consumer/perio_cardio.htm
http://www.joponline.org/toc/jop/79/8s
http://dentistryhasaheart.com/articles.html
Many patients don’t know they are at risk. A self-assessment tool for you to use is at www.mydentalscore.com. It takes two minutes to assess your risk for disease. If you find you're at risk for heart disease or periodontal disease, we invite you to our office during the month of February for a periodontal disease screening at no cost to you.
Thanks for having a heart!
Tuesday, December 13, 2011
Diabetes Testing--in a Dentist's Office?
It is rare that a patient comes to us being fully aware of a diagnosis for periodontal disease. WHen we diagnose the disease, we make sure we have discussed how influential diabetes can be in the process. If a patient has a family history of diabetes or cardiac disease, is overweight, has cardiovascular disease, hypertension, or all of the above, we are concerned that they do not suffer diabetes themselves.
Part of our dental examination may include a preliminary screening for blood glucose imbalance. A simple test can be done in our office to measure blood glucose and better inform the patient about a larger risk for diabetes. The test includes a tiny prick on the finger to acquire a drop of blood to place on a test strip that can be analyzed for blood glucose. If it is out of balance, we can then refer patients for proper diagnosis of blood glucose disorders like diabetes.
Performing this test in our office can not only help save a patients teeth, but it may lead to successfully managing undiagnosed diabetes. That alone can save lives.
Monday, March 22, 2010
Periodontal Disease is a dangerous medical condition!
The good news? We developed a successful program several years ago for treating periodontal disease. We work with your physicians and medical specialists to make sure this disease is managed the right way.
Periodontal disease is also a chronic inflammatory disease. And inflammatory diseases can complicate several other diseases, including chronic pulmonary disease, arthritis, pneumonia, and diabetes. Not only is periodontal disease a confirmed factor in these problems, but there is current research being conducted to prove how it can trigger or influence more diseases, like pancreatic cancer and Alzheimer's.
This problem is a double-edged sword--problems with oral health can create problems with your medical health, and vice-versa. But we have experience solving these issues directly with your physician. And that results in reducing your risk.
Open this link for more information on the medical importance of good oral health. Contact us for an appointment today!
Monday, February 1, 2010
Stabilizing Loose Teeth
We can stabilize teeth and increase their lifespan. If we can anchor loose teeth successfully, and treat the source of the loose teeth, those questionable teeth can survive longer.
One method is splinting. We can unite or bond several teeth together. We can use metal wires or non-metallic fibers to unite the teeth with adhesive dentistry.
We also make clear acrylic splints called biteguards so you can reduce the traumatic forces of grinding.Combining splinting with treatments for bite problems or treating periodontal disease can prevent premature tooth loss.