It is widely documented in medical and dental journals, yet few healthcare professionals have changed their protocols. Yes, I’m speaking of periodontal disease. What will it take for dentists to change the existing standard of care to better protect patient health?
The microbial-enzymatic N-benzoyl-DL-arginine-2-napthylamide (BANA) test is one of the modern alternatives to bacterial cultures. It detects the presence of three of these top periodontal pathogens in the subgingival plaque (Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) and takes 5 minutes to do in the office. The needed incubator and test strips are available online.
Is the Infection in the Bloodstream?
If there is bleeding on probing, the infection will be in the bloodstream.
Is It increasing Systemic Health Risks?
Typically, systemic health risks first appear as consistent high blood pressure. There are many causes of high blood pressure, but most clinicians agree that bacterial infections top the list. If the patient is taking blood pressure medication, the medication may be masking this first indicator. Is your hygienist regularly taking and documenting blood pressure to see readings patterns?
Measuring CRP produced in the liver measures chronic inflammation, which is a marker that can measure systemic risks for heart disease. Just 4 mg CRP per liter of blood can increase heart disease risks by a factor of four.
A1c measures glycated hemoglobin averaged over the past 90 days and should be less than 6%. Both tests can be performed with a single finger stick using a dry blood test by any dental assistant. A1c/CRP tests are available online.
How Do I Get Rid of the Infection?
Scaling and root planing are the gold standard for periodontal disease control since they remove the plaque and calculus irritating tissues below the gumline. Chlorhexidine mouthwash, however, has been found to cause heart disease. Adding laser therapy, periodontal trays, or ozone to scaling and root planing, though, may increase success.
Laser-assisted periodontal therapy (LAPT) uses a carbon-dioxide, Er:YAG, or diode laser to remove necrotic tissues via ablation. The laser-assisted new attachment procedure (LANAP) uses a hotter (1064 nanometer) Nd:Yag laser to surgically remove necrotic tissue from the underlying connective tissue. Although there is conflicting research as to which is best, both kill bacteria and oxygenate tissues to promote healing.
Custom periodontal trays designed to deliver medicines beneath the gumline can also reduce bacteremia when used before scaling and root planing. This therapy requires patient compliance, as trays must be worn for 15 minutes three times each day.
The application of ozone in periodontics comes as a result of its physic-chemical properties. It is known to have antimicrobial, analgesic, immunostimulating, antihypoxic, and detoxicating effects on the human body.
Medical grade ozone is a mixture of pure oxygen and pure ozone in the ratio of 0.05% to 5% of O3 and 95% to 99.5% of O2. Due to the instability of the O3 molecule, it must be prepared immediately before use and cannot be stored over long periods of time.
Systemic antibiotics are taken internally to kill bacteria. Overuse of broad-spectrum antibiotics can cause antibacterial resistance.
Since periodontal disease is multi-causal, choosing which therapies to use depends on the patient’s level of health as well as dental health, genetic propensity to inflammation, current medications, age, nutrition, and lifestyle. Although standard treatment may apply based on disease classifications, no one size fits all. Does your protocol allow for customization based on these factors? How do you measure therapy results? How do you create a followup treatment plan?
How Well Did Therapy Work to Control or Reverse the Infection?
Since periodontal disease is a bacterial infection, measuring bacteria before and after therapy is the best indicator of infection control. Oral DNA’s Alert 2 quantifies and compares before and after therapy results, eliminating guessing. It also shows genetic predisposition to inflammation.
How to Keep the Infection from Coming Back?
When we eat, drink, or breathe, we are re-exposed to bacteria. A healthy immune system helps control bacteria. Even though about 30% of the population is genetically predisposed to inflammation, the best way to avoid infection is to live a healthy lifestyle with diet and exercise while avoiding smoking, alcohol, and recreational drugs.
Keeping your mouth clean plus adding nutritional support can give your mouth and body the healthy support it needs to resist gum disease. For example, one reason why gum disease returns is that most people don’t eat enough fruits and vegetables to produce inflammation-squelching antioxidants.
How many of these six questions can you answer for your patients? How well are your recommended therapies, tools, and products stopping periodontal disease, the silent killer?
Ms. Meditz is founder and executive director of HCP Wellnet and formulator of Clean Kiss products. Her career mission is to “make HEALTH contagious” via oral health. She can be reached at firstname.lastname@example.org.