It is widely understood that chronic periodontitis is due to the presence of subgingival Gram-negative bacterial biofilms proliferating at the junctional epithelium, in periodontal pockets deep beneath the gumline. Mechanical debridement (scaling) and root planing (SRP) is standard therapy for chronic periodontitis. While SRP is useful for the removal of the calculus, SRP unfortunately leaves the majority of the Gram-native biofilm in the periodontal pocket resulting in the need for retreatment every 3 months to control the disease. SRP alone is often inadequate for very deep pockets, for instance pockets that are 10-13 millimetres deep. Patients with deep periodontal pockets typically are referred to specialists for surgical intervention, especially when bone loss is evident. Photodisinfection is a non-antibiotic, light based therapy that offers a non-invasive alternative to surgery. Photodisinfection has been shown to instantly inactivate the Gram-negative bacteria associated with periodontal diseases, as well as the bacterial virulence factors responsible for triggering inflammation. The key virulence factors of P. gingivalis (a primary perio-pathogen) include the cytotoxin lipopolysaccharide (“bacterial endotoxin or LPS”), proteolytic enzymes and many toxic low-molecular weight compounds such as hydrogen sulfide and ammonia. The proteases in particular are thought to be responsible for the majority of periodontal tissue damage. Photodisinfection destroys the LPS and other virulence factors, a significant advantage over conventional antibiotics and antiseptics. Periowave Photodisinfection, more importantly, offers a key advantage over other therapies as it was able to demonstrate direct and immediate inactivation pro-inflammatory cytokines. The Periowave Photodisinfection approach can directly inhibit LPS, reducing the risk of cytotoxic shock, and can substantially reduce protease activity, minimizing the risk of further tissue damage. Periodontal (gum) disease is a chronic disease affecting about half the adult population. It is the leading cause of tooth loss, responsible for about two thirds of lost teeth. Pain and cost factors result in the majority of diagnosed patients neglecting to address their gum disease. Periowave Photodisinfection technology, with its unique ability to simultaneously eliminate the underlying bacteria causing chronic gum disease as well as reduce inflammation, is an important stress free therapy benefitting both the patient and the dental clinician. Periowave is a cost effective and pain-free approach to the treatment of gum disease, whether as a prevention therapy in early stages of the disease or as a possible alternative to surgery in later stages of the disease. Irrigate Illuminate To learn more about Periowave Photodisinfection, please visit www.periowave.com
The most common of human infections is gum (or periodontal) disease, affecting up to 80% of the population at some point in their lives. The primary issue is that teeth are non-shedding surfaces and so bacteria, in the form of biofilms, can easily establish themselves on the surface of a tooth where tooth-brushing or other mechanical debridement is lacking.
Gum disease is caused by the presence of gram-negative bacterial biofilms growing in the periodontal pockets underneath the gum line. These gram- negative pathogens associated with gum disease are largely anaerobic, thriving in environments with little to no oxygen. Bacteria, and their associated virulence factors, cause an immune response by the body. Gram negative pathogens associated with gum disease are not “good” bugs (commensals), that is, they are not part of the body’s natural flora. One pathogen, Porphyromonas gingivalis, according to Dr. Richard Darveau, Dean of the University of Washington’s Dental School, has demonstrated an ability to modify the behaviour of oral commensals, turning bacteria that are normally ‘good’ bacteria into ‘bad’. Perio-pathogens, such as Porphyromonas gingivalis, up-regulate the body’s production of proteolytic enzymes, cytokines and other pro-inflammatory factors in order to sustain their continued growth. The result is inflammation with widespread impact on the local as well as systemic physiology.
Gum disease has been associated with a number of serious systemic conditions including heart disease, stroke, diabetes, pre-diabetes, cancer, Alzheimer’s and pre-term births. The most notable local symptoms of the effects of these perio-pathogens are red inflamed gums and the loss of alveolar bone supporting the teeth. Gum disease is responsible for about two thirds of tooth loss. Scaling and root planing (SRP), the historic standard of care leaves as much as 60% of the perio-pathogens behind to continue the disease process, which is why the SRP protocol requires a 3 month retreatment recall program. Photodisinfection, however, has been able to double the outcomes of SRP in clinical trials.
Effective gum disease eradication requires 3 components which only Periowave Photodisinfection provides: the instantaneous elimination of virtually all of the gram negative anaerobic perio-pathogens, the destruction of their associated virulence factors, and the inactivation of the host inflammatory factors. When removing both the biofilm and the inflammation simultaneously, the body is then able to repair itself through soft and hard tissue regeneration. Periowave Photodisinfection has been proven to rapidly and effectively kill the micro-organisms located in periodontal biofilms and to destroy the virulence factors produced by these pathogens. Most importantly, Periowave has a unique advantage, an ability to rapidly and substantially reduce protease activity, providing a high-level suppression of pro-inflammatory cytokines needed to restore oral health.
Photodisinfection is a topical, non-antibiotic antimicrobial therapy that destroys a broad spectrum of pathogens including fungi, bacteria and virus without damaging human tissue. Unlike antibiotics, Photodisinfection selectively kills virulence factors such as the endotoxins and exotoxins produced by pathogens, leading to a clinically observable anti-inflammatory effect. The treatment process takes only minutes, making it over 1,000 times more effective at biofilm killing than antibiotics.
Photodisinfection is a minimally invasive non-thermal therapy involving the light activation of a photosensitizer to eliminate topical infections in a highly targeted approach. Photodisinfection has been proven to be safe and effective in other applications such as for the dental, sinusitis and hospital acquired infection prevention markets. In dentistry, Photodisinfection has been proven to be highly effective for the treatment of caries, endodontics, restorative dentistry, periodontitis, peri-implantitis and halitosis. Many new applications of Photodisinfection are now under development.
The Photodisinfection Process: Instant Antimicrobial Therapy
Apply Photosensitizer to Infection Site & Illuminate with Appropriate Wavelength for Several Minutes
A photosensitizing solution is applied to the treatment site where the photosensitizer molecules preferentially bind to the targeted microbes. The photosensitizer molecules are inactive at this stage. A light of a specific wavelength and intensity illuminates the treatment site and a photocatalytic reaction occurs. The wavelength is carefully chosen to maximize absorption of light energy by the photosensitizer.
This 2 step procedure results in the destruction of the targeted microbes and their virulence factors without damaging host cells. This reaction involves the formation of short-lived, highly reactive free-radical oxygen species. These radicals cause a physical disruption of the microbial cell membrane through oxidative reactions, resulting in immediate rupture and destruction of the cell. This process occurs in seconds with total kills completed in minutes.
The Photodisinfection process has also been shown to eliminate a multitude of virulence factors, unlike antibiotics. When the light isremoved, the photocatalytic reaction ceases along with all antimicrobial action. Photodisinfection does not promote the development of resistance.
The Photodisinfection process is both pain-free and stress-free due to lack of side-effects or damage to human tissue.
Source: Eastman Dental Institute, UK
Head of McGill’s Periodontal Department Recipient of Humanitarian Award from Mexican Periodontal Association (AMP)By
Dr. Veronique Benhamou, Head of the Periodontal Department of McGill University’s Dental School, was honoured last week at the 23rd International Periodontal Congress of the Association of Mexican Periodontists (AMP) held in beautiful Morelia, Mexico. AMP President Dr. Miguel de la Isla and Plenary Chair, Dr. Raoul Caffesse, of Argentina, presented Dr. Benhamou with the AMP Humanitarian Award for her work earlier this year in Espita Mexico.
Leading a small team of students, teachers and alumni of McGill University, Dr. Benhamou was responsible for providing dental care to over 700 Mayan patients in the Yucatan, an area of Mexico with limited opportunities for dental care. This mission to Espita, Mexico is one of over a dozen such missions led by Dr. Veronique Benhamou to underprivileged regions and Developing Nations. Dr. Benhamou and her team plan to return to Espita in January 2014 for another mission of dental care. Periowave Dental Technologies wishes to congratulate Dr. Benhamou for her well-deserved recognition at the AMP.
Read More About the Periowave Outreach Program in Mexico HERE
A recent case study using Periowave completed by Dr Robert Fortier, DDS Cert. Perio, Quebec
Patient Profile: 29-year old female, non-smoker, 7 months pregnant. Exhibiting pregnancy gingivitis with full-mouth gingival hyperplasia caused by combination of hormonal changes of pregnancy and anticoagulation therapy. Generalized 4-5 mm pockets with profuse bleeding on probing (Fig 1.1)
Treatment Protocol: Initial Periowave treatment: Full-mouth SRP and PW treatment was performed along with localized gingivectomy to remove gingival hyperplasia. Cessation of anticoagulant therapy at birth.
Second Periowave treatment: 10 months after initial PW treatment following full mouth debridement.
Result: 10 months after initial Periowave treatment: 8 months after birth and 1 month after cessation of breast feeding, restoration of oral health. Some 4-5 mm pockets with no BOP and reduced inflammation (Fig 1.2).
A recent case study using Periowave completed by By Catherine Fairfield, RDH, Alberta:
Patient Profile: 69-year old, non-smoker male with generalized chronic periodontitis. Regularly scheduled supportive periodontal therapy (SPT) with unresponsive 7 mm pocket depth with heavy bleeding on probing on mesial of #13 (Fig 1.1).
Treatment Protocol: Initial Periowave treatment: 6 days after SPT due to heavy BOP in 7 mm PD treatment site.
Second Periowave treatment: 5 months after initial PW treatment in 5 mm PD treatment site with moderate BOP at SPT appointment.
Result: 5 months after initial PW treatment: Mesial #13 reduced from 7 mm PD with heavy BOP to 5 mm PD with moderate BOP (Fig 1.2).
4 months after second PW treatment: Mesial #13 further reduced to 3 mm PD with light BOP (Fig 1.3).
Case and photos provided by: By Catherine Fairfield, RDH, Alberta
A recent case study using Periowave completed by Leanne Carlson, RDH & RDT:
Patient Profile: 62-year old male with generalized 6-8 mm probing depths accompanied by bleeding and suppuration.
Treatment protocol: Patient refused periodontal surgery so scaling and root planning with local anaesthetic was provided. Periowave treatments at 6-week intervals were also added to the treatment plan.
Result: At 6 weeks there was a reduction in BOP and at 12 weeks no evidence of bleeding. Pocket depths reduced to 3 mm and 4 mm. Patient was put on a 4-month recall and given Periowave treatment as needed.
Case and photos provided by: Leanne Carlson-Mann, RDH
For many people, a trip to the dentist is a traumatic experience involving pain and fear. Fear of pain is a major reason why many people ignore their oral health and allow their gums to recede and bleed. One Government study (NHANES 1994) found that 70% of the diagnosed patients with gum disease failed undertake treatment. If gums were visible, such rampant infection would never be tolerated. Who, for instance, would allow a 2 inch pussy wound on their arms or face to remain untreated for years on end? No one. But for many, gum disease is a constant companion because it is relatively painless until the disease reaches very end stages that result in tooth mobility and tooth loss.
Traditional treatment of gum disease involves rigorous scaling and root planing at 3 month intervals and often requires surgical procedures involving slicing the gums open, flapping them back, recontouring bone tissue, adding replacement bone matrix and grafting tissue from the roof of the mouth onto the gums to reclose the area. If there ever is an unpleasant procedure, this is it. It is hard to imagine that any patient would opt for this type of treatment in the face of less invasive alternatives.
Periowave Photodisinfection is a non-surgical alternative, offering a non-invasive approach to gum disease. It is a pain-free therapy that uses a two-step process involving a photosensitizer activated by a cold (non-thermal) red light. There is no burning or charring of tissue unlike thermal lasers often used for periodontal disease treatment. Instead, there is the power of photodisinfection which can eliminate bacteria and their virulence factors, can inactivate the inflammatory response and can promote innate host immune responses that other therapies are unable to achieve. Unlike antibiotics, there is no resistance generation and can therefore be used as often as needed. With this value proposition, photodisinfection is an important new approach for the treatment of gum disease including peri-implantitis for patients looking for effective, pain-free dental therapy.
April is Dental Awareness Month, and for most people, this means the state of their teeth. However, teeth are only a part of dental health; soft (gum) tissue and hard (bone) tissue, are also very much part of the equation. Dental Awareness Month is therefore a very good time to focus on the bone and gum tissues that support a healthy mouth.
There are many reasons why we should take some time this month to learn about periodontitis which most people know as gum disease. Gum disease is the most common human infection, affecting not only our oral health, but our overall systemic health too. It is well worth remembering what the bard once wrote: an ounce of prevention is worth a pound of cure. Prevention of gum disease is a good example of this lesson, as early intervention can be highly effective and not very involved while postponing treatment can lead to extreme consequences such as loss of teeth, bad breath and the risk of some serious long term chronic health issues like heart disease, stroke, diabetes, etc.
When not brushed and flossed properly, a bacterial infection might develop where the gums join the teeth. This includes plaque and tartar building up at the base of the teeth, filling up inflammatory pockets. Several adverse effects result since plaque contains bacteria; damage of tissue (teeth and gums), infection, and tooth abscess. Bacteria from the plaque may also travel into the bloodstream and increase the risk of heart diseases, diabetes, arthritis, and other diseases. This is why regular brushing and flossing is crucial.
Some common treatments of periodontitis include the application of antibiotic microspheres (containing minocycline), antibiotic gel (containing doxycycline), antiseptic chips, anti-microbrial mouthrinse, enzyme suppressants, or oral antibiotics. These forms of treatment rely heavily on patient compliance and can lead to resistance, as in the case of antibiotics. However, there is a non pharmaceutical alternative that has shown, through a numerous clinical trials, significant gains in clinical attachment and overall improvement of oral health. Periowave™ Photodisinfection System is a non-antibiotic approach to the treatment of gum disease, providing a simple solution to complex oral infections.
Periowave™ is a new approach to the treatment of gum disease that harnesses the powerful photodisinfection reaction to inactivate the bacteria and toxins that are left behind after scaling and root planing. The application of Periowave™ is essentially a two step process. The first step is called irrigation, where a specially formulated photosensitizing solution is topically applied to the gums at the treatment site. This photosensitizing solution preferentially attaches to the harmful bacteria and toxins associated with periodontal disease (Figure 1). Next, a thin plastic light guide is placed into the treatment site. The light guide illuminates the treatment site with a specifically calibrated laser light, activating the photosensitizer solution and destroying bacteria beneath the gum line (Figure 2). The entire treatment is painless, creating less stress for both the patient and the dental clinician.
Photodisinfection has many clinically proven advantages, offering superior patient outcomes and better overall oral health. Photodisinfection instantly inactivates host inflammatory factors, eradicates P. gingivalis from dental implants without altering their surface chemistry, and does not generate antibiotic resistance. One trial demonstrated that Periowave™ kills 99.99% of all P. gingivalis biofilm within 60 seconds, the standard duration of treatment. No other therapy can match these results without the risk of damaging human tissue.
Periowave™ is an innovative technology that has the potential to drastically decrease periodontitis in a safe and timely manner. The benefits of Periowave™ include: no patient compliance after the treatment, rapid action, high specificity to disease-causing bacteria and anti-inflammatory impact. The combination of these benefits results in better patient outcomes, including a healthier mouth leading to improved overall systemic wellness. Periowave™ is minimally invasive and has changed the way dentists treat gum disease. Photodisinfection serves the dental clinician both as a therapy for severely diseased gums and as a preventative intervention. Periowave™ is, therefore, the ounce of prevention that patients have been looking for. For a dentist with Periowave™ nearest you, click here.