Pardon Me But Your Gums Are Showing - how to really mess up a hygienist's day

If you're a dentist or hygienist, you've been here!

Paul J. Jacobs, DDS, D,ABDSM

How To Really Mess Up A Hygienist's Day

You are an amazing dental hygienist and you are at the top of your game and it is the top of the day. Then it happens. You begin probing your third patient of the day. Everything seemed fine. You were on time, and the patient was on time. You knew it would happen . . . sometime. . . today. 

Your hygiene assistant records the numbers. “Three, two, three, three, two, three, FIVE! one, two, four, one, FIVE! You think to yourself – do I keep going? It seemed like everything was fine last time she was here. Is there bleeding? Is there inflammation? Will there be more fives? Will there be sixes sevens or eight? How much bleeding? And in the back of your mind – what will I do and how will I find the time to do it? What was surely going to be a simple prophylaxis and a nice visit with Mrs. Jones has just turned into a nightmare flood of thoughts about how your day could rapidly deteriorate. 

Unfortunately, this is an everyday scenario in every dental office. These are the problems that come to mind. How will I explain to Mrs. Jones that she has a periodontal problem? What words will I use to describe it? At what point – what probing numbers and what amount of bleeding – will I use to make the call? And what will I say to the dentist? And how will the patient respond? And what words will I use to describe the treatment necessary? And how will I convey to the patient the cost involved and the number of appointments necessary to treat this condition? And of course the stress involved knowing that Mrs. Jones is expecting her teeth be cleaned today. 

Enter the bloody prophy. Even though this has happened to you hundreds of times in your career, it’s still difficult to make a split second decision about moving forward and satisfying the patient or calling in the doctor and choosing a completely different path. You know what the outcome of a bloody prophy will be. Some calculus remaining – so it’s only going to be worse next time. Having to apologize for an uncomfortable, tear jerking procedure. Working past the appointed time while keeping your next patient waiting. And not getting paid for what you have actually done and not fully educating your patient on improved dental hygiene home care.

Agreeing On When To Initiate Perio Therapy

So let’s rewind this scenario 45 minutes and start over with Perio360 therapy. You are able to confidently complete your probing and call in the doctor to confirm what you have found. You easily have your words scripted to put the patient at ease while the doctor mirrors what you have told the patient using the same words. A complete diagnosis is rendered including determining the cause of the gum infection – which periodontal pathogens are present. Your patient’s questions are all answered to their satisfaction and complete home care is discussed including any necessary hygiene tools. In advance of treatment, the patient is well aware of the situation, the prognosis, the number of appointments necessary for treatment, and of course the exact cost of treatment.

You have not only preserved your on time performance, but you have now improved the health and care of your patient. You have given yourself the time you need to comfortably and adequately treat your patient. You have created a new disciple of good dental care and of your practice. And finally avoided the “bloody prophy“.

If this is you, and most dentists and hygienists reading this will have encountered this situation, wait no longer. If there is only one thing you do this year to improve your dental practice let it be incorporating Perio360 therapy into your hygiene protocol.

For more information, visit perio360.com or our courses at birchpointconsulting.org or email me at dr.paul.jacobs@gmail.com. 

Perio Pods - Can You Sneeze Heart Disease?

Paul J. Jacobs, DDS, D-ABDSM

Salivary Transmission of Pathogens 

In an article by Jorgen Slots et al. (2011), the infectious risks of saliva containing pathogenic bacteria is discussed. Long recognized is the fact that saliva can contain potential pathogens in sufficient quantities to infect other individuals. The author sites the classic example of serious infection passed through kissing known as mononucleosis.[2] The American Academy of Periodontology (AAP) also reports in its statement on the Transmission of Gum Disease Between Family Members[3] that research suggests the bacteria that cause periodontal disease pass through saliva. 

Salivary transmission can occur in a number of ways, which may include coughing, sneezing, sharing utensils or cups and kissing. 

Transmission of putative periodontal pathogens between family members has been shown. Vertical transmission from parents to children and horizontal transmission between spouses occurs in up to 75% of cases depending on the specific pathogen.[4] Periodontal pathogens such as P. nigrescens, T. denticola, A. actinomycetemcomitans and P. gingivalis were shown to be found in the saliva of periodontally healthy children, suggesting bacterial transmissions through saliva from their caregivers.[5] Another study observed that children who tested positive for red complex bacteria (either Porphyromonas gingivalis, Treponema denticola, or Tannerella forsythensis) always had a mother who was positive for these red complex bacteria.[6] 

Periodontal / Heart Connection 

As the word “causal” is beginning to appear in the literature, it is well established that the presence of periodontal pathogens and disease is a risk factor for heart disease. The presence of periodontal pathogens, as well as a high total burden of pathogenic species are both associated with increased odds of having myocardial infarction.[7] Other studies showed that periodontal treatment could reduce serum inflammatory biomarkers such as C-reactive protein and even improve endothelial function.[8] 

Recognize the Perio-Pod 

A perio-pod is composed of two or more people that share or potentially share similar oral bacteria, pathogens and/or periodontal risk factors. Inclusion in a perio-pod may affect the periodontal treatment decisions or outcomes for an individual based on the profile of the group.[9] 

Upon comparison of thousands of oral microbiome DNA bacterial profiles in my private dental practice as early as 2008, I noted that groups of people who were closely related showed similar periodontal pathogen profiles. Commonalities can often be seen in parents, spouses, children, and grandchildren. Below is an example of the presence of Tannerella forsythia in spouses and their three adult children. (Figure 1) 

Personalizing Medicine With Perio360 Profile DNA Testing 

A new era is dawning in which dentists and hygienists have the tools available to more accurately diagnose the causative factors of periodontal diseases. We no longer have to treat all patients alike while standing back scratching our heads trying to find out why patients return repeatedly with the same symptoms as they had before treatment. Acknowledging that some pathogenic oral bacteria are mechanically resistant to treatment helps to personalize care plans. An awakening to DNA tools will become a necessary strategy in maintaining the health of our nation. Perio360 Profile testing, translation, and treatment are now setting a trend for the future. Patients are looking for answers, and searching out understandable resources like those found at perio360.com. 

Future Strategies in Heart Health 

Research should continue to elucidate the importance of periodontal disease and pathogens in the progression of heart disease. Salivary transmission of periodontal pathogens has been shown through continuing research. Health care workers must be made aware that full mouth disinfection may reduce the risk for cross-infection of oral pathogens between individuals in close contact.1 The AAP recognizes that treatment of gum disease may involve entire families. If one family member has periodontal disease, the AAP recommends that all family members be screened.3 It appears hopeful that periodontal treatment could reduce the risk of coronary heart disease and therefore become one of many prevention strategies for heart disease.6 

Be aware of the potential of the contagious nature of periodontal pathogens and their risk to people near to you. Understand that care may need to go beyond the individual. Remember to cover your sneeze into your elbow, as you may be saving others from more than just catching your cold. 

For more information, visit: perio360.com, or contact the author. 

[1] “Sneeze” Photo courtesy CDC/ Brian Judd. 

[2] Slots J, Slots H. Bacterial and viral pathogens in saliva: disease relationship and infectious risk. Periodontol 2000. 55: 48-69, 2011. 

[3]Transmission of Gum Disease Between Family Members. Amer Acad Periodontology Consumer Info. 2011, URL:http://www.perio.org/consumer/families.html. Accessed 2011-04-18. 

[4] Van Winkelhoff AJ, Boutaga K. Transmission of periodontal bacteria and models of infection. J Clin Periodontol.32 Suppl 6:16-27, 2005. 

[5] Kulekci G, Leblebiciogu B, Keskin F et al. Salivary detection of periodontopathic bacteria in periodontally healthy children. Anaerobe. 14(1):49-54, 2008 Feb. 

[6] Lee Y, Straffon L, Welch K, Loesche W. The Transmission of Anaerobic Periodontopathic Organisms. J Dent Res85(2): 182-186, 2006. 

[7] Andriankaja O, Trevisan M, Falkner K et. al. Association between periodontal pathogens and risk of nonfatal myocardial infarction. Community Dent Oral Epidemiol. 39(2):177-85, 2011 Apr. 

[8] Ouyang XY. Association between periodontal disease and coronary heart disease. Beijing Da Xue Xue Bao.18;40(1):112-5, 2008 Feb. 

[9] Jacobs P. Dental Nation – Perio-Pod. . 2011-04-18. URL:http://dentalnation.blogspot.com/2010/01/perio-pod.html. Accessed: 2011-04-18. (Archived by WebCite® at http://www.webcitation.org/5y3EgA7d2

5 Reasons Why Periodontal Treatments Don't Work

Paul J. Jacobs, DDS, D-ABDSM

1. Biofilm

   The nature of biofilms makes them a very difficult target. As strains of pathogenic bacteria multiply and organize into a mature biofilm, they form a protective coating over their community called a glycocalyx. This glycocalyx walls off the biofilm and makes it impervious to attack by infection fighting cells and antibiotics. The most effective tool against pathogens in a biofilm is dental ultrasonics. Ultrasonic treatment breaks down the glycocalyx and renders the biofilm more susceptible.

2. Mechanically Resistant Bacteria

   Some periodontal pathogens are mechanically resistant to treatment. That means that they don’t respond to brushing, flossing, or scaling and root planing. Specifically, those are: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, and Peptostreptococcus micros. Knowledge of the presence of these bacteria, which is accomplished through oral microbiome DNA testing, allows the dentist or hygienist to employ more focused therapies for success.

3. Timing of Treatment

   Bacterial loads can double every 5 hours. Traditional sequencing of periodontal therapies involves quadrant or half mouth appointments. The problem with these approaches is that they don’t allow for enough multiple appointment, sequential reduction in bacterial load. Research shows that successful treatment of biofilms includes full mouth disinfection within a 24 hour period. Also, when antibiotics are used in treatment, they must be administered within 2 hours of ultrasonic treatment.

4. pH Balancing

   Periodontal pathogens thrive in an acid environment. Periodontal health is difficult to attain when there is no attention paid to improving the pH of the oral environment. Techniques must be employed such as reducing consumption of red meats and other pH reducers. Eating green leafy vegetables and avoiding frank dietary acids like soda or lemon water help to boost salivary pH. Prebiotics and probiotics must be considered in shifting from pathogenic to healthy microbiomes.

5. Use of Mouthwashes

   Use of mouthwashes, especially those containing alcohol or wide spectrum disinfectants should be discouraged. The mouth and its healthy microbiome are essential to overall body health. Normal commensal bacteria are necessary gatekeepers to the mouth. They help reduce pathogenic bacteria by competing for nutrition and staving off undesirable bacteria and viruses, yeasts and fungi. When free floating (planktonic) bacteria are eliminated by mouthwashes, the remaining anaerobic subgingival pathogens are free to replicate unhindered.

Understanding the science and microbiology behind the cause of periodontal diseases is a necessary first step toward successful treatments. For too long, we as dentists and hygienists have treated all patients and all bacteria as if they respond identically to treatment. Once we encounter patients who are non responsive, we are quick to assume that we have done all that we can, and to incorrectly blame our patients for “not flossing enough.” New knowledge of the etiology of periodontal diseases should be employed in order to finally control this insidious, chronic infection.

New Link Between Periodontal Disease and Erectile Dysfunction

Gum disease makes men twice as likely to have difficulty getting an erection, finds study

Men with gum disease are more than twice as likely to have difficulty getting an erection, according to research. 

Experts say the link works both ways and having either gum disease or erectile dysfunction makes men more likely to develop the other.  

In the first study to be done on European men, scientists at the University of Granada in Spain, say both conditions are linked to the same protein made in the liver.

Gum disease is also thought to be linked to heart disease and the researchers suggest it may affect small blood vessels in the penis first, then larger arteries later.

And the study suggests gum disease is a bigger factor in erectile dysfunction than either diabetes or heart disease. 

Oral health experts say the study suggests the benefits of taking care of your mouth extend beyond avoiding losing teeth, and the mouth affects other parts of the body.

They say brushing your teeth twice a day and visiting the dentist regularly could help men to avoid gum disease and erectile dysfunction as well.

For complete article, visit: full article.