Category: Periodontal Disease

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.

A Moderate Periodontitis Case Study: Periowave

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

World Oral Health Day 2013 – Why The Mouth Is A Gateway To Your Body

Oral health is critical to our well-being and yet too many of us take it for granted. Despite decades worth of research linking oral health to systemic health, far too many people remain unaware of the importance in maintaining good oral health. A quick search on the internet reveals millions of articles discussing the link between gum disease and major chronic diseases such as cancer, stroke, heart disease, diabetes, pre-diabetes, arthritis, pre-term births etc. Gum disease is the most prevalent human infection with little progress being made.

No one would walk around with with chronically bleeding fingernails or pus-filled scabs on their arms, but because gums are hidden from view, most people will ignore their symptoms until it is too late and much damage has been done.  Why is this? Studies have demonstrated the general unwillingness to address chronic gum disease when up to 70% of patients diagnosed with gum disease failed to get treatment due primarily to cost and fear of pain. (It can be assumed that 100% of those undiagnosed are not seeking treatment and this may represent about half of the population). Read More

Beyond Inflammation – The 4 Stages of Periodontal Disease

A recent study conducted by the CDC, estimates that nearly half of Americans 30-years-of-age or older show some form of periodontal disease— whether this ranges from mild illness, with shallow pocket formation around teeth, to severe illness involving bone loss and systemic inflammation.  For seniors, the numbers are even higher— skyrocketing to an astounding two-thirds of the population sampled.  As with most complex illnesses, early intervention is often key to a better outcome; in this case, intervention may prevent tooth and bone loss, or even later manifestations of cardiovascular disease.

Unsurprisingly, oral bacteria and plaque are the main drivers behind periodontal disease.  As a bacterial biofilm, with a complex, communal structure, plaque is much more resilient than single-celled bacteria and has greater resistance to bodily defenses and antimicrobial agents.  Even in the short term, plaque biofilms have been shown to promote the release of pro-inflammatory cytokines and enzymes from immune cells; these substances, in turn, contribute to the breakdown of the periodontal ligament— the connective tissue that holds teeth in place. Read More

Can Dry Mouth Lead To Gum Disease?

Dry mouth, or xerostomia, is an unpleasant condition where insufficient saliva is produced to keep the mouth moist and comfortable. It can be due to several different reasons, as it can be a side-effect of existing health conditions such as diabetes, Parkinson’s disease,or Alzheimer’s, or it can be due to tobacco use, and some cancer treatments can permanently damage the salivary glands, reducing saliva production.

Sometimes it can be down to medication, as certain drugs, especially those used to treat depression and anxiety, or to treat Parkinson’s disease or medication for high blood pressure, can create dry mouth as a side-effect. Xerostomia can also be as a result of nerve damage to the head and neck area. Older people are also more likely to suffer from dry mouth, not because aging is a risk factor for this condition, but because they are more likely to suffer from health conditions which may cause dry mouth, and are more likely to be on medication that can exacerbate the condition.

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Understanding the Different Stages of Gum Disease

Did you know that gum disease affects more than half of all people over the age of 30? As prevalent as this disease is, many people still remain undiagnosed. Typical symptoms of patients with gum disease include red, swollen, and puffy gums that feel tender to the touch. If left untreated, the disease can progress and result in loss of connective tissue, gum recession, and even tooth loss. Pus can also develop in the pockets between the teeth and gums as the body attempts to fight the infection. Not surprisingly, this creates a permanent bad taste in the mouth, and sufferers will also have bad breath. Not only does gum disease wreak havoc in your mouth, studies have also shown that is linked to serious conditions such as heart disease, diabetes, and even impotence.

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The Use of Antimicrobial Photodynamic Therapy in the Treatment of Periodontitis

By: Veronique Benhamou, DDS, BSc, Cert. Perio, FPFA, FADI, FACD

INTRODUCTION

It has been known since the beginning of the last century that microorganisms can be killed by various combinations of dyes and light. Ancient Egyptian, Indian and Chinese civilizations used light to treat various diseases, including psoriasis, rickets, vitiligo and skin cancer. In 1901, Niels Finsen used light to treat smallpox and cutaneous tuberculosis and in 1903, he won the Nobel Prize for his work on phototherapy (Nature 2003, Dennis et al) However, the interest in antimicrobial Photodynamic Therapy (aPDT) was diminished concurrently with the introduction of antibiotics; it is only in recent years, with the emergence of antibiotic-resistant strains, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecalis that a search for alternative treatments has stimulated a revival of interest on aPDT. It is an effective antibacterial therapy that involves the use of specific-wave light energy to activate a photosensitive compound (photosensitizer), which interacts with locally present molecular oxygen. APDT has the potential to be a powerful alternative to antibiotic therapy, particularly for the treatment of localized infections of the skin and the oral cavity. Microorganisms that are killed by this technique include bacteria, fungi, viruses, and protozoa. Read More

Does Our Diet Cause Bad Teeth?

Apparently poor dental health could be attributed to our modern diet, as today’s food tends to be a lot mushier than in ancient times. A recent conference, Evolution of Human Teeth and Jaws: Implications for Dentistry and Orthodontics[1] in North Carolina put forward the suggestion that our diet is so radically different from our ancestors that numerous dental health problems, including cavities and crowded teeth are just about inevitable.

Their findings were based on studies of ancient teeth which tend to be well preserved. Archaeologists have been able to examine the teeth of not only our ancient ancestors, but also people who lived more recently, and who followed a hunter gatherer diet such as Kalahari Bushmen and the aboriginals. Around 13,000 years ago these hunter gatherers began to become farmers, and as a result food became much softer and didn’t need to be chewed so much. One of the effects is that the human jaw has become smaller, and more people suffer from overcrowding, and there is frequently little space for wisdom teeth to erupt.

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Why Does Gum Disease Become More Prevalent With Age?

A new research study, carried out by the University of London in collaboration with American research groups, has gone a little way towards explaining why gum disease is more likely to be found in older people. The study was recently published in Nature, and found that as we age, the production of a chemical called Del-1 gradually falls. It is hoped that gaining a better understanding about this chemical could lead to the development of alternative and hopefully more effective methods of treating and preventing gum disease.

The latest research is showing a link between low levels of the chemical Del-1 and an increased likelihood of developing gum disease.

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Smoking Can Increase Your Risk of Developing Periodontal Disease

Everyone knows that smoking gives you bad breath, but not everyone is aware that it greatly increases your likelihood of developing periodontal disease. The facts and figures are compelling. Data from the Centers for Disease Control and Prevention show that for people aged 65 and above, smokers are 2x more likely to lose all their teeth compared to non-smokers.

Part of the problem lies in the fact that smokers tend to have poorer oral hygiene than non-smokers as they are perhaps less health-conscious. Smokers are more likely to have significant calculus deposits that can only be removed during a professional cleaning, and this can depend on whether or not a person is a pipe or a cigarette smoker. Some researchers have found that pipe smokers tend to have more significant deposits1 of supragingival calculus. There is speculation that this is due to the fact that pipe smoke is of a higher pH than cigarette smoke, and pipe smokers tend to keep the smoke in the mouth for longer and produce more saliva which contains calcium, exacerbating the deposits of calculus.

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