What we do in our office to chase away the “Bad Guys”. This issue, Part 3, covers the final segment on the topic of Periodontal Disease.
In Part One, (Bugs in Your Mouth! A Look at Periodontal Disease) we learned that an astounding number of people have periodontal disease. And that the simple answer to “What causes Periodontal Disease?” is “bugs”. There are certain “bugs” or bacteria in the mouth that are always associated with bone destruction caused by periodontal disease.
I differentiate the “bugs” in my patients’ mouths, as well as monitor and assess their periodontal health, by screening for infection with the use of a microscope. The microscope allows me to determine if an infection is still present and whether bone loss is historical or an on-going problem.
In Part Two, (Periodontal Disease…A Link to Other Health Problems?) we learned that there are two big reasons for treating Periodontal Disease, 1) Periodontal Disease could be a sign that there is a problem in host resistance and 2) The bacteria and their toxic by-products that are in the periodontal pockets do not necessary stay there – the same blood which travels in your gums travels all over your body.
Part Two also covered health problems that may be systemically linked to the bacteria found in periodontal disease. Among the health concerns covered were potential links to stomach ulcers, stroke, and heart disease. Cardiologist, Stephen Sinatra, MD weighed in with his comments on inflammation as well as correlation of coronary artery disease and periodontal disease.
It’s important to understand just how vital it is to treat periodontal disease, not just for your oral health, but for your whole-body health.
You may recall my discussion about a health practitioner, very much into health and with no complaints, being shocked to see his microscopic slide. It showed a cesspool of spirochetes and amoeba. Subsequent blood testing revealed a compromised immune system and anemia.Alerted by the microscopic periodontal screening, this patient was able to take early intervention measures before overt health problems developed.
So, now let’s talk about the questions I am often asked.
“Doc, where did these bacteria come from?”
Well, the bacteria may always be there, but in very, very low numbers. For instance, the bacteria that causes strep throat, is normally present in our mouths, but only becomes a problem when they overpopulate due to lowered host resistance. Host resistance is a big factor. The other problem is you can have the infection passed on by family members; it could be by kissing, by sharing food, or drink. You can even pick it up from food. But ultimately, in my opinion, the most important thing is host resistance. That is why often you can see one spouse have a problem and the other spouse not have a problem.
“Doc, what are these things on my slide?”
One of the major findings on a slide is the amoeba. The specific type of amoeba found in an unhealthy plaque sample is called Entamoeba gingivalis. It is a one celled protozoan parasite, and is found in 100% of infected periodontal pockets. These single cell protozoan parasites are about ten times the size of a white blood cell. Entamoeba gingivalis has even been found in the lungs and tonsils. These parasites eat red blood cells and white blood cells. It is thought that as the white blood cell disintegrates, enzymes are released. And it is also thought that these enzymes are the cause of bone destruction.
Spirochetes are the other major type of bacteria that we look for under the microscope. These are corkscrew type, snake-like bacteria. Although there are different types of spirochetes, the one in the mouth is called Treponema Denticola. As an aside, the spirochete called Treponema Pallidum cause syphilis and another type of spirochete called Borellia Burgdorferei causes Lyme disease. All three types of spirochetes are bad guys. But in terms of periodontal microscopic assessment we are concerned when we find the spirochete Treponema Denticola, which has been shown to be associated with periodontal disease.
White Blood Cells
Also when we look under the microscope, if there are a lot of white blood cells, we know we have a problem. White blood cells are present to fight infection. When white blood cells “eat” a hole in the bacterial membrane, they release free radicals. As this happens, destruction of surrounding tissue will occur. So the white blood cell, in fighting bacteria, may cause a problem as well.
“Doc, what are you going to do about this?“
Treatment in our office
When patients have a “bad” slide, special precautions are taken in our office. Prior to the hygienists use of instruments to clean under the gum, the hygienist will irrigate under the gums with iodine. This is to help prevent a bacteremia (increase of bacteria in the blood stream). Iodine kills bacteria and amoeba. The hygienist will again use iodine after the scaling.
More important than what the hygienist is doing is what you are doing on a daily basis.
We’ve all been taught that brushing and flossing are the pillars of good home care, this is true – up to a point. Flossing is good for breaking up the bacterial colonies at the contact point where one tooth abuts against another. However, floss cannot really get under the gum if there is any sort of pocket. The best way to do this is with an irrigating device. In our office we have patients place a natural product called Tooth & Gum Concentrate (see newsletter on Natural Oral Hygiene Products) in the reservoir of an irrigating device and irrigate before going to bed.
Culturing bacteria from the pocket is sometimes used for very stubborn cases followed by an appropriate antibiotic which is indicated from the testing. As mentioned before, host resistance is a key part of treatment. Often hair (trace mineral analysis) and blood analysis will be done. Supplementation is helpful, especially the use of natural vitamin C, and co-enzyme Q10, and use of Thymus and Cat’s Claw to boost the immune system. Many of the patients I see are coming to me because they are sick. As treatment progresses and their immune systems improve, a healthy mouth follows. Of course, treating infection of the gums is helpful in eliminating a large stress factor.
If it is found that you have an infection in your mouth, do not panic. It is usually not an immediate life threatening situation. However, over time, it may be a cofactor. This is why we do the slide screenings in our office. Even if in the past a slide has been good, it is important to periodically do another.
For our patients with slides that show undesirable activity, a follow-up slide is essential and is usually done about three weeks after the initial screening. We caution our patients returning for follow-up slides to not use any irrigating products or take any supplements for 24 hours before their visit. We want to evaluate the plaque and make sure the infection is under control without external help. If periodontal pockets are present another scaling and irrigating of these pockets may be necessary as soon as possible. Our hygienist discusses this with our patients on an individual basis.
After reading our three part Periodontal Series, I hope you realize why microscopic screenings are so important.
© 2004, Mark A. Breiner, DDSThe information presented is for educational purposes only. You should consult a qualified dentist or health practitioner for diagnosis and treatment.