The Secret KILLER? Periodontal Disease and the link to:
American Heart Association Recommendations - Premeds
Links And Information From The Academy Of Periodontology.
Non Surgical Treatment of Periodontal Disease.
Treatment Options Surgical And Non Surgical.
Soft Tissue Lasers
Lasers have become part of our daily lives. They're in our computers, and we see them in the grocery store when we buy
our food. Now, with new advancements in technology, lasers have become an
important part of dentistry as well.
The benefits of using
lasers in dentistry
A number of different kinds of lasers
are used in dentistry, and they are particularly useful for treating the gums
and soft tissue problems. The benefits of laser treatment include:
·
Faster healing
How we use lasers
Before using the laser, we provide you
with special protective glasses, and then we may numb the area we'll work on. We
then sweep the gentle beam over the affected area.
The narrow beam removes only a specific number of cell layers on each pass, so
we have precise control over the procedure.
Lasers can be used in a wide range
of procedures, including:
·
Esthetic gum recontouring
Dental lasers are an effective new technology that allows us to work faster and exercise more precise control over procedures. The result is faster healing and less pain for you when compared to conventional surgical techniques.
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Note: to follow the links (red print) from this page go to:
Periodontal
Disease
In
the mildest form of the disease, gingivitis, the gums redden, swell and bleed
easily. There is usually little or no discomfort. Gingivitis is often caused by
inadequate oral hygiene. Gingivitis is reversible with professional treatment
and good oral home care.
Untreated
gingivitis can advance to periodontitis. With time, plaque can spread and grow
below the gum line. Toxins produced by the bacteria in plaque irritate the gums.
The toxins stimulate a chronic inflammatory response in which the body in
essence turns on itself, and the tissues and bone that support the teeth are
broken down and destroyed. Gums separate from the teeth, forming pockets
(spaces between the teeth and gums) that become infected. As the disease
progresses, the pockets deepen and more gum tissue and bone are destroyed.
Often, this destructive process has very mild symptoms. Eventually, teeth can
become loose and may have to be removed.
The main cause
of periodontal disease is bacterial plaque, a sticky, colorless film that
constantly forms on your teeth. However, factors like the following also affect
the health of your gums.
Smoking/Tobacco
Use
As you probably already know, tobacco use is linked with many serious illnesses
such as cancer, lung disease and heart disease, as well as numerous other health
problems. What you may not know is that tobacco users also are at increased risk
for periodontal disease. In fact, recent studies have shown that tobacco use may
be one of the most significant risk factors in the development and progression
of periodontal disease.
Genetics
Research proves that up to 30% of the population may be genetically susceptible
to gum disease. Despite aggressive oral care habits, these people may be six
times more likely to develop periodontal disease. Identifying these people with
a genetic test before they even show signs of the disease and getting them into
early interventive treatment may help them keep their teeth for a lifetime.
Pregnancy
and Puberty
As a woman, you know that your health needs are unique. You know that brushing
and flossing daily, a healthy diet, and regular exercise are all important to
help you stay in shape. You also know that at specific times in your life, you
need to take extra care of yourself. Times when you mature and change, for
example, puberty or menopause, and times when you have special health needs,
such as menstruation or pregnancy. During these particular times, your body
experiences hormonal changes. These changes can affect many of the tissues in
your body, including your gums. Your gums can become sensitive, and at times
react strongly to the hormonal fluctuations. This may make you more susceptible
to gum disease. Additionally, recent studies suggest that pregnant women with
gum disease are seven times more likely to deliver preterm, low birth weight
babies.
Stress
As you probably already know, stress is linked to many serious conditions such
as hypertension, cancer, and numerous other health problems. What you may not
know is that stress also is a risk factor for periodontal disease. Research
demonstrates that stress can make it more difficult for the body to fight off
infection, including periodontal diseases.
Medications
Some drugs, such as oral contraceptives, anti-depressants, and certain heart
medicines, can affect your oral health. Just as you notify your pharmacist and
other health care providers of all medicines you are taking and any changes in
your overall health, you should also inform your dental care provider.
Clenching
or Grinding Your Teeth
Has anyone ever told you that you grind your teeth at night? Is your jaw sore
from clenching your teeth when you're taking a test or solving a problem at
work? Clenching or grinding your teeth can put excess force on the supporting
tissues of the teeth and could speed up the rate at which these periodontal
tissues are destroyed.
Diabetes
Diabetes is a disease that causes altered levels of sugar in the blood. Diabetes
develops from either a deficiency in insulin production (a hormone that is the
key component in the body's ability to use blood sugars) or the body's inability
to use insulin correctly. According to the American Diabetes Association,
approximately 16 million Americans have diabetes; however, more than half have
not been diagnosed with this disease. If you are diabetic, you are at higher
risk for developing infections, including periodontal diseases. These infections
can impair the ability to process and/or utilize insulin, which may cause your
diabetes to be more difficult to control and your infection to be more severe
than a non-diabetic.
Poor
Nutrition
As you may already know, a diet low in important nutrients can compromise the
body's immune system and make it harder for the body to fight off infection.
Because periodontal disease is a serious infection, poor nutrition can worsen
the condition of your gums.
Other
Systemic Diseases
Diseases that interfere with the body's immune system may worsen the condition
of the gums.
Types of Periodontal Disease
There are many
forms of periodontal disease. The most common ones include the following.
Gingivitis
Gingivitis is the
mildest form of periodontal disease. It causes the gums to become red, swollen,
and bleed easily. There is usually little or no discomfort at this stage.
Gingivitis is reversible with professional treatment and good at home oral care.
Aggressive
Periodontitis
A form of periodontitis that occurs in patients who are otherwise clinically
healthy. Common features include rapid attachment loss and bone destruction and
familial aggregation.
Chronic
Periodontitis
A form of periodontal disease resulting in inflammation within the supporting
tissues of the teeth, progressive attachment and bone loss and is characterized
by pocket formation and/or recession of the gingiva. It is recognized as the
most frequently occurring form of periodontitis. It is prevalent in adults, but
can occur at any age. Progression of attachment loss usually occurs slowly, but
periods of rapid progression can occur.
Periodontitis
as a Manifestation of Systemic Diseases
Periodontititis, often with onset at a young age, associated with one of several
systemic diseases, such as diabetes.
Necrotizing
Periodontal Diseases
An infection characterized by necrosis of gingival tissues, periodontal ligament
and alveolar bone. These lesions are most commonly observed in individuals with
systemic conditions including, but not limited to, HIV infection, malnutrition
and immunosuppression.
Surgical Treatment of Periodontal
Disease
If you're
diagnosed with periodontal disease, we may recommend periodontal surgery.
Periodontal surgery is necessary if the tissue around your teeth is unhealthy
and cannot be repaired with non-surgical treatment. Following are the four types
of surgical treatments most commonly prescribed:
Non Surgical Laser
Treatment of Periodontal Disease
A new non surgical approach is now available that involves the use
of a soft tissue laser. With this
method there is less discomfort afterwards and less tissue is removed.
Early information suggests that attachment of the gum tissue to the bone
and teeth can be regenerated and in some early situations regeneration of bone
itself. Ask us if you are a
candidate for this less invasive procedure.
If
you've already lost a tooth to periodontal disease, you may be interested in dental
implants – the permanent tooth replacement option.
Find Out More
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Treatment Options – Surgical and Non Surgical
Let’s talk about what we can do to successfully treat your
gum disease. We have some new
treatment options that we’ve found to have almost miraculous results.
The more successful the treatment outcome is, the more likely it is that
you will be able to avoid the need for future treatment such as gum surgery.
Root Planning:
We have found that the conventional way of non-surgically
treating gums does have some success, but frequently is insufficient for
long-term gum health. This involves
something called ‘root planing’. With
conventional root planning, anesthetic is used, and the teeth roots, under the
gums, in the pockets, are planed. They’re
NOT simply cleaned.
Just like when a wooden door swells when it rains, and you
need to use a “wood plane” to remove a bit of wood off the bottom of the
door, likewise, when we plane the roots, we need to remove just a few microns of
diseased root structure off the surface of the roots.
Gums will never re-attach to unhealthy roots.
The conventional way of root planning is to use hand
instruments to scrape the roots – these instruments are very similar to teeth
cleaning instruments that you’ve seen. But
we’ve found a MUCH better way to do this – much easier on the patient, much
quicker, and most importantly, much more effective.
We’ve discovered a very unique ultrasonic instrument that will more
gently plane the surfaces of the roots, with a very light touch, and as I said,
it’s much more effective.
If you have insurance, it will usually cover a portion
of the root planning, and we don’t make any extra charge for using the
ultrasonic instruments.
Doxycycline:
We will also place you on an antibiotic called doxycycline for
two weeks. This antibiotic is in the
‘tetracycline family’. You may
have heard that this type of antibiotic is often used for skin conditions such
as acne. Well, gums are just another
form of skin. The body concentrates
this type of antibiotic more in the skin tissues than other parts of the body.
In fact, this antibiotic is actually excreted a little right into the
pockets, right where we need it. This
doxycycline does a LOT more than simply kill bacteria.
It also inhibits an enzyme called “collagenase” from being created.
The body forms collagenase in response to bacteria, and it’s actually
the collagenase that causes the bone to dissolve away.
And doxycycline has also been shown to enhance a cell called a
‘fibroblast’ to attach to the root surface.
This may enhance gum healing.
In addition to the ultrasonic root planning, we use something
called “Arestin”. Arestin is a
concentrated form of antibiotic similar to doxycycline.
It is placed, in powder form, right into the deepest pockets the same day
we finish the root planning. Arestin
comes in special little cartridges that allow the powder to be placed all the
way to the bottom of these pockets. Once
the powder gets into the pocket, it spreads out and then becomes moist and
sticky. That allows it to stay at
the bottom of the pocket, slowly dissolving for 7 – 10 days.
This has the same effects and benefits that we already
mentioned, but is hundreds of times more concentrated in the pocket, and is
therefore much more effective right where we need it – in the deepest pockets.
In addition to this, the Arestin powder is slightly acidic.
This mild acid may neutralize any small amounts of bacterial poisons that
may have been left after ultrasonic root planning.
All in all we’ve found Arestin to have very significant
effects on the healing of the gums after treatment.
Arestin cartridges are rather expensive, and the downside is that dental
insurance will usually not cover it. However
if your desire is to achieve healing that is likely to prevent the future need
of surgery, it is essential to
use it.
The etiology of periodontitis is multifactorial; its nature
and severity are determined by complex interactions between microbial factors
and a susceptible host. Although pathogenic bacteria in the gingival sulcus are
necessary for periodontitis, bacteria alone are not sufficient for the
progression of the disease. Research during the last 20 years has indicated that
the body’s own local and systemic response to bacterial toxins is a major
determinant of the severity of periodontitis. The end result of the interaction
between the infectious bacteria and the host response is the bone and soft
tissue destruction and attachment loss that characterize periodontitis.
Current first-line therapies for periodontitis primarily address the bacterial
component of the disease. The current nonsurgical standard of periodontal care
is scaling and root planing (SRP), a mechanical intervention designed to
physically remove bacteria and its deposits from the surface of the tooth. If
indicated, SRP may be supplemented by antimicrobial drugs, either locally or
systemically.
Periostat:
Periostat® is the first and only therapeutic agent
designed to modulate the host response and, when prescribed as an adjunct to SRP,
has been shown to help slow the progression of adult periodontitis.
Periostat® works by reducing the activity of host-derived enzymes,
such as collagenase, which have been shown to be associated with the destruction
of the periodontal support structures during the progression of adult
periodontitis. Periostat® is administered systemically, offering the
additional advantage of being able to treat all the tooth sites simultaneously
— a whole-mouth approach to the management of the host response.
The daily dosing regimen of Periostat® (20 mg twice daily) has been
studied extensively and has been shown to produce plasma levels of doxycycline
that are substantially lower than that required to induce an antimicrobial
effect — in other words, a subantimicrobial dose. When administered according
to the dosage regimen prescribed in the labeling, Periostat® has
been shown to have no detrimental effect on the susceptibility of the microflora
to doxycycline and other common antibiotics.
Extensive clinical studies have shown that the use of Periostat® as
an adjunct to SRP is more effective than SRP alone in reducing probing pocket
depth and enhancing clinical attachment level gain in patients with adult
periodontitis.
In clinical trials, adverse reactions to Periostat® were similar to
taking a placebo. Don’t take Periostat® if you are pregnant,
nursing, or if you’re hypersensitive to tetracyclines.
Peridex:
We will also prescribe a mouthwash that controls bacteria at a
local level (Peridex). The
combination of root planning (deep cleanings), the antibacterial products
mentioned above, an oral irrigator and electric tooth brush bring us better and
more predictable methods of treating and maintaining periodontal disease.
Laser:
And the last option is even more incredible - the new lasers.
In a very technical sense, the laser does perform surgery, because it
will remove infected, malformed tissue in the pocket.
But it’s not the type of surgery that you normally think about –
there are no scalpels or stitches needed – the gums are not pushed away from
the teeth – there is no grinding on bone.
These lasers specifically seek softer tissue and heavily
pigmented tissue. You’ve probably
heard of lasers that can be used to remove tattoos.
Tatoos are pigmented, right? Well,
infected gum tissue is very soft and mushy, and it’s also very dark. Immediately
after root planning, we slide the fiber of the laser under the gums, and it
removes only the unhealthy, mushy, infected gum tissue down in the pocket, and
leaves the healthy gum tissue. Obviously,
healthy gum tissue will attach more effectively to the root surfaces than
unhealthy infected gum tissue.
Then there is something called “biostimulation”.
You may have heard that lasers are now being used to help heal various
injured areas of muscles and joints. And
why is it that we hear so often about how lasers make surgical procedures easier
for patients? We think the answer is
biostimulation. For lack of a better
explanation, biostimulation may make the area where the laser was used heal as
if you were 16 again.
And remember that lasers will kill bacteria and partially
sterilize the pocket. Not only that,
but lasers are also effective at killing bacteria that live deeper within the
gums. We think this may help prevent
bacteria from coming out of the gums, back into the pockets.
The results seen from the laser have been nothing less than
miraculous. In fact, there have been
many cases where the laser has prevented the immediate need of conventional
surgery – that without the laser, the patients would have needed surgery right
away.
We also find that patients have VERY little discomfort after
laser treatment. It’s really very
amazing and far more comfortable than conventional periodontal surgery.
Keep in mind though that the more advanced the periodontal disease the
more likely the need for surgery. This
makes laser treatment as early in the disease process as possible important.
Obviously, we have seen that the use of Doxycycline, Periostat,
Arestin as well as the Laser, offer a HUGE benefit in achieving the very best
result, and the best chance for long-term gum health and prevention of the need
for surgery.
But again, the downside is that this procedure is rather new
and usually not covered by insurance. It
is well known that insurance resists covering newer procedures in an attempt to
save them money since new advancements are not readily figured into their costs
payed out vs premiums collected.
WE do not cure
your gums for the long-term – YOU DO? We do
nothing more than make it possible for YOU to cure your own gum disease by
keeping the bacteria out from under your gums, 360 degrees around each and every
tooth. And if you do NOT brush and
floss each and every day as we will show you, any treatment we provide will
probably fail.
Unless you can be absolutely certain you will follow through
with the home care we will teach you EVERY SINGLE DAY, THE REST OF YOUR LIFE,
don’t even bother having the treatment done.
Don’t waste your time or money. HOWEVER,
if you really don’t want to lose your teeth or end up needing surgery, and you
will follow our instructions exactly, then it will likely be the best investment
you’ve ever made – three months from now you will tell me that your mouth
has never felt that good your entire life.
In summary the recommended
sequence of treatment is as follows:
·
Local anesthetic
(and nitrous oxide as needed) to provide comfort during the treatment.
·
Root planning as
described above on one side of the mouth upper and lower.
·
Laser treatment of
the infected pockets to deal with the diseased tissue and bacteria.
·
Placement of
Arestin in the deeper pockets.
·
Two weeks of
Doxycycline
·
Peridex rinse in
addition to brushing with an electric tooth brush, flossing and the use of an
oral irrigator.
·
Treatment of the
opposite side within one week (to still take advantage of being on the
periodontal specific antibiotic Doxycycline.)
·
Nine months of a
second periodontal specific antibiotic – Periostat
·
Reevaluation and
followup.
(AHA) recommended that patients with
certain heart conditions take
antibiotics shortly before dental
treatment. This was done with the belief
that antibiotics would prevent infective
endocarditis (IE), previously referred
to as bacterial endocarditis. IE is an
infection of the heart’s inner lining
or valves, which results when bacteria
enter the bloodstream and travel to the
heart. Bacteria normally are found in
various sites of the body including on
the skin and in the mouth.