The Near Fatal Infection that Almost Claimed my Friend

My motivation for championing Photodisinfection technology stems from my own personal experiences. I almost lost my daughter when she was only 2 due to antibiotic resistant bacterial infection. This was without a doubt, the worst time of my life and spurred my passion to develop technologies that help people prevent or infections using a combination of photosensitizer and light therapy. It takes a decade to develop technologies and another decade sadly, to get the market to adopt. In short, only passion and personal commitment driven out of life experiences such as mine, make it possible to survive the ordeal of developing and commercializing disruptive new technologies. And along the way, there are the inspiring moments that fuel this passion…

My friend Jeremy (name changed to protect his identity) is a healthy mid-forties man who is in great shape. He eats well, he exercises regularly; he is lean and very fit. He does a great job of work/life balance. A few weeks ago, he almost died. This came as such a shock of all of us in our small community who know and love him. Jeremy suffered a stroke and ended up with open heart surgery to replace his heart valve. All of this from the Infectious Endocarditis that he developed from having his teeth cleaned. How is this possible that a healthy man can be so drastically affected by the simple act of teeth cleaning, one wonders? I am sharing his story in the hopes that others can be spared a similar ordeal and to create awareness of potential risks to dental work for those of us with unknown heart conditions.

The mouth is full of bacteria- some estimates suggest that there are over 1,000 different kinds of bacteria. Gram negative bacteria and tenacious biofilm reside under the gum line. These are the bacterial communities responsible for gum disease and thrive in the non-oxygenated environments down deep between the tooth and the gums. Once these bacteria get below 5 mm from the gumline, it is virtually impossible for regular brushing or flossing to eliminate them. Both mechanical debridement and Photodisinfection is needed to eliminate these bacteria. Mechanical debridement alone is not enough; studies have documented that 62% of bacteria are left behind mechanical debridement allowing the bacteria to continue to make inroads into the gums.

When mechanical cleaning occurs, this physical disruption allows these gram negative bacteria to enter into the blood stream (bacteremia). For most people, our immune systems are easily able to control these gram negative bacteria. However, for immunocompromised people, or people with certain kinds of heart conditions (bicuspid aortic valve), the bacteria are able to evade the immune system and lodge themselves with the heart valves leading to the potentially fatal condition called Infectious Endocarditis. The valves of the heart are vulnerable to infection because they do not receive any dedicated blood supply so white blood cells, our defensive immune mechanisms, cannot directly reach the valves via the bloodstream and also therefore limit the accessibility of medication (e.g. antibiotics). If bacteria are able to attach to a valve surface and forms a ‘vegetation’, the host immune response is blunted.

A mitral valve vegetation caused by bacteria endocarditis

Jeremy had his teeth cleaned October 29th and then again November 5th. Few weeks later, he was feeling light-headed and suffered from some vision impairment. He did seek some medical attention, had some tests, but due to his excellent physical condition, some critical confirmatory tests were not undertaken (this is typical in Canada). The doctors were not suspecting infectious endocarditis. He did see a neurologist three weeks later. By January he was suffering from flu-like symptoms and night sweats; by mid-January he had pain in his quadriceps and hamstring muscles. He thought he was suffering from a common cold. By Feb 9th, he had pain in his side and sought medical attention and had a series of tests. By Feb 12th, he was in a hospital being given intravenous antibiotics for 8 days but they were unsure of which bacteria were involved. During this time, however, they diagnosed Infective Endocarditis (inflammation of the inner tissue of the heats eg valves caused by infectious agents) and a bicuspid aortic valve (which occurs in 1-2% of the population).

The doctors changed his antibiotics and released him from hospital Feb 20th. On Feb 23rd he was suffering from headache and feverand noticed that the peripheral vision in his left eye was affected. By Feb 24th, his headaches and fever continued and he was readmitted to hospital due to low blood pressure. New tests indicated that ‘vegetation’ was growing around his heart valve and some of this material broke loose and caused him to have a stroke. Jeremy was also experiencing infection in his toes which gave the heart doctors additional concern. By Feb 26th, Jeremy had a 5 hour open heart surgery and had a valve replaced.

Despite all the antibiotics Jeremy had been taking since Feb 12th, the ‘vegetation’ had grown significantly in only a matter of weeks and was affecting his heart function. This vegetation matter that was accumulating around the bicuspid valve had broken off preventing blood flow to the brain causing a stroke. All this from bacteria escaping into the blood stream during a simple tooth cleaning exercise. Even tooth brushing can cause bacteria to enter into the blood stream.5 Once in the blood stream, these bacteria attach to the surface of the heart valves and can attack the heart valve causing growths on the valve, holes in the value (as was the case with Jeremy) or scarring of the valve tissue causing the valve to leak or to become stenotic. Left untreated, Endocarditis can destroy heart valves and can result in fatal outcomes.

Eight doctors and a major surgery were needed to keep Jeremy alive. Endocarditis is not common in people with healthy normal hearts. Those at greatest risk are people with a damaged heart valve, an artificial heart valve or other heart defects (as in Jeremy’s case). But how do we know if we do not have a normal heart and that we may be at risk of serious complications from simple dental work? Jeremy had no idea that he had a bicuspid aortic valve (only 1-2% of people have this condition) and only discovered this the hard way. Knowledge and prevention are so important which is the purpose of this article. If there is a history of heart defects in your family, you may be at risk and should take extra precautions during dental work. Prevention is always the best measure and always well worth the extra time and money spent. Even though you may not be at a serious risk, isn’t peace of mind worth it?

Canada’s McGill Dental Team Shines in Mexico

There are no words to express my pride for the extraordinary work of my fellow Canadians in Yucatan Mexico. Dr. Veronique Benhamou and her team of Canadians volunteer their time and the resources to help Mayan- speaking people from a remote part of Mexico receive the dental care they need.  In a matter of ten days more than 750 treatments were performed, generating more goodwill between Canadians and Mexicans than a bevy of international trade delegates.

The experience for all involved was beyond description and will rank as one of the highlights of our careers. The simple act of kindness and sharing of one’s time and skills can only be seen as generosity of spirit and has a far greater value than just the relieving of pain and the fixing of teeth.  The work is hard work…very hard work day after day, and represents respect and personal commitment to the well-being others.

The fact that our worlds are so different and our lives are filled with so much privilege and abundance gives meaning to those receiving the care. The people of Espita Mexico were very touched by the kindness in action of Dr. Benhamou’s team and are already counting on the return of the McGill team next year.

2014 Dental Mission to Yucatan Mexico – 755 Patient Treatments

Led by the spirited Dr. Veronique Benhamou, Head of Periodontology of McGill University, the Canadian dental team completed another successful dental mission in the Yucatan. This 2014 trip was the team’s second time in Mexico providing Mayans living in remote parts of the Yucatan, with access to world class dentistry. More than 750 patients were treated during this ten day “Kindness in Action” mission. The team of 22 consisted of McGill dental students, volunteering dentists largely from the Montreal area, and volunteers from companies in the dental industry including 3 from Periowave Dental Technologies Inc.

This mission was facilitated by support from Mexicans from the Yucatan, Guadalajara and Mexico City. Captain Carlos Erosa, mayor of Espita and local businessmen including Professor Montforte, Alfonso Salazar and Gabriel Domenzain provided help with logistics, equipment as well as the provision of local facilities. The joint effort produced a great experience for all involved and most importantly, resulted in a very large number of under-privileged people in the remote area of Espita Yucatan obtaining the dental care that they urgently needed. Dr. Miguel de la Isla, Guadalajara-based President of the Mexican Periodontology Association (AMP) participated in this year’s dental mission, volunteering his time and dental supplies to assist alongside the Canadian team.

It was a real privilege to participate in this dental mission as a volunteer and as a sponsor. I was extremely proud of the professionalism as well as the technical talents of our dedicated Canadian team. Under the right leadership, extraordinary things are possible. It truly was “kindness in action” with a palpable impact on the community, reaching far beyond those that were treated.

Can Oral Infections be Life Threatening?

If we know anything about a toothache it’s that as painful as it might be (can we say ‘root canal’) at least it’s not life threatening.

At least that’s what most people think. The truth, however, is that not only are tons of people running to the ER every year for treatment for their dental infections, but these infections can also turn lethal.

A case in point is 24 year-old Cincinnati father Kyle Willis and his wisdom tooth that started hurting. When dentists told him it needed to be pulled, he decided to forgo the procedure for financial reasons. The tooth infection spread, causing his brain to swell and then he died within weeks of his toothache first appearing.

12-year-old Deamonte Driver

In Maryland, 12-year-old Deamonte Driver also died of what began as a toothache. By the time Deamonte’s aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, he died. The picture of the boy included in this piece, shows the long scar across the top of his head from his brain surgery that ultimately failed in an effort to save his life.

Kyle Willis and Deamonte Driver aren’t alone. Death from tooth infection while low in numbers is nonetheless more common than we think. A study conducted by researchers in Boston found that between 2000 and 2008 a total of 66 patients died in hospitals as a result of oral infections.

One problem is that the brain is only about three inches from the tooth roots and a dental infection caused by a tooth abscess can spread to the brain through the veins in the head.

The heart and lung can also implicated in life threatening situations. Inflammation of the inside of the heart can be caused by bacteria from a tooth abscess. As bacteria attach to the inside of the heart, they grow and can damage the heart permanently. If the bacteria enter the lungs, they can cause pneumonia.

Far more common, however, are the huge numbers of people hospitalized every year because of dental infections. A study conducted by the Pew Charitable Trusts estimates that preventable dental conditions were the primary reason for 830,590 ER visits by Americans in 2009 – a 16 percent increase from 2006.

Shelly Gehshan, director of the Pew Children’s Dental Campaign, warns us about having tooth problems treated at a hospital: “The care provided in an ER … generally doesn’t solve dental problems. Most hospital ERs are not staffed with dentists, and the medical personnel who work there are not trained to treat the underlying problems of patients with untreated dental issues.”

Commenting on the large and growing number of people using the hospital (instead of their dentist) for their oral infections, Dr. Mark Wong, the chairman of oral surgery at the University of Texas Health Science Center at Houston, says “To call this an epidemic of dental infections we are seeing in major hospital environments and in our emergency rooms — it’s not an overstatement.”

The good news is that the ER visits and even the deaths are avoidable if we act in a timely manner. “It’s better to have it treated when it’s treatable than to wait until it gets out of hand and is possibly life-threatening,” says Dr. Gary R. Hartwell, the president of the American Association of Endodontists

Given that tooth decay is the single most common chronic childhood disease—5 times more common than asthma – Dr. Hartwell’s warning is especially important for all parents.

Dental Students are at Risk for Increased Exposure to MRSA: What does this mean for their Patients?

Dental student are at a much greater risk of being exposed to methicillin-resistant Staphylococcus aureus (MRSA), the potentially lethal bacteria often found in hospitals and now increasingly in the general community. Known as one of the superbugs due to its ability to resist multiple antibiotics, the mortality rate for a MRSA bloodstream infection is about 20-30%.1 The findings of a recently published study in The Journal of Hospital Infection entitled “Higher prevalence of methicillin-resistant Staphylococcus aureus among dental studentshttp://www.journalofhospitalinfection.com/article/S0195-6701(14)00009-7/abstract lead to the inevitable conclusion that greater consideration for infection control and prevention is needed for both dental clinicians and their patients.

The study undertaken in Mexico City comparing 100 dental students (exposed to patients for 5-6 years) with 81 non-dental students found that the dental students had a significantly higher rate of carriage of MRSA. The study found that 20% of the dental students versus 6% of non-dental students were colonized with MRSA (odds ratio: 4.04; 95% confidence interval: 1.6–12.6; P = 0.0033). The conclusion of the study is that the dental students were occupationally threatened by exposure to this highly antibiotic resistant pathogen with implications that greater steps are needed to try to address this potential risk to their health. The other worrisome implication of this study is that these dental clinicians are also likely to be vectors for MRSA transmission to their patients if the proper precautions are not undertaken.

A key observation from this Mexican study underscores how widespread MRSA is in Mexico. If our data is to be trusted, North American and UK rates of MRSA colonization are significantly lower than in Mexico…. 2-3% versus the 6% found in the study’s non-dental student population. People colonized with MRSA are at a greater risk of self-infection, especially when immunocompromised as in the case of a surgery or major illness. 20-60% of patients identified as being colonized with MRSA in hospital subsequently develop an MRSA infection 2

Until recently, most antibiotics in Mexico were available over the counter and not by prescription. The ability of patients to self-prescribe (not matching the appropriate antibiotic to the prevailing infection) combined with standard non-compliance practices (taking sub-lethal doses) led to the emergence of high antibiotic resistance rates as evidenced by the finding of this study. Fortunately, there are greater controls over how antibiotics are now dispensed in Mexico which should help to lower antibiotic resistance rates in the Mexican public in the future. A reduction of the overuse and abuse of antibiotics in Mexico should, in the future, contribute to lowering the risk of MRSA colonization in the dental clinician population. In the meantime, however, the results of this study are shocking and must be taken as sign that more must be done to protect the dental clinician and their patients from this potentially deadly superbug.

1. http://jcm.asm.org/content/48/6/2307
2. http://www.ammi.ca/pdf/MRSApositionpaper.pdf

Periowave: A Unique Anti-Inflammation Therapy that Yields Superior Patient Outcomes

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

Periowave Photodisinfection- The Unique 3 Prong Attack on Periodontal (Gum) Disease

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.

How does Photodisinfection Work?

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)

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.

A Look Back at McGill’s ‘Kindness in Action’ Dental Mission

A blog by Patricia Martinez

Espita, Yucatán

It is the afternoon of January 28th. An amazing chapter in my life has concluded.

I think that from our arrival in Espita, all of those who integrated the team, were about to realize that we were going to be part of an adventure, but we weren´t aware of what this adventure would mean.

As I look back on my days in Espita, I realize that I had the opportunity to share experiences with people who gave themselves in a personal and professional way to their Mexican brothers.

By trying to support the cause, and without being a dentist, I decided to live the experience God, Espita and this amazing group of professionals gave me, at my fullest by sharing the opportunity to give myself in a region that I had never visited in my own country.

I am not very sure of the exact moment where I found out I was going to be part of the mission, but from the very beginning, I had a need to collaborate in such a noble project; I didn´t even know Dr. Veronique Benhamou, Dr. Gerard Melki or Dr. Bob Clark, but now that I know them, I know that I am very fortunate to have been able to live such a gratifying experience by their sides.

We had some time to visit some of the surroundings, to have fun, to eat delicious Mexican meals, and even to see typical regional dances performed by local kids in honor of our presence. This is where I can reflect on my arrival in Espita. “I’ve been witness of an endless exchange of smiles (that from now on will be a lot healthier), between the people in Espita, and the group of foreigners that are now more Mexican than Mole”. These two groups have been put together with the purpose, to learn from each other.

Thanks to all the people in Espita (Mr. and Mrs. Monforte, Mr. and Mrs. Erosa and Conchi) and the McGill University team (Daniel, Gabrielle, Leslie, Jessica, Hannah, Mike, Sina, Rachel, Laura, Gursandeep, Gerard, Veronique and Bob) that made this beautiful experience possible.

Now I am home, and I see my kids and with them, the opportunity to keep on giving myself for causes that don’t have to be personal, since I find, that in non-personal causes, I can find the inspiration that I didn’t have before my trip to Espita.

It was the afternoon of January 26th of this 2013. On the moment I got on the airplane to Cancún, I never imagined that this particular trip would last me a lifetime.

Read More About the Periowave Outreach Program in Mexico  HERE

Related Posts Plugin for WordPress, Blogger...

Staypressed theme by Themocracy