Question:
I was curious as to why gum disease is a chronic condition, and can only
be cured
by pulling the teeth. Is it because of the position of the germs, kind
of in-between the teeth
and gums, but not really on either?
I wonder what would happen if a person were able to inject antibiotics
known to fight the
most prominent bacteria in gum disease, into the spaces all around each
of the teeth. Would
there be any improvement then, theoretically?
It just sounds like, from what I'm reading, gum disease is like Osama
Bin Laden's organization -
it hides and just comes out here and there to cause terrible trouble,
and then goes back to hiding.
I read a story once that said they used to use radiation to "cure" all
sorts of things back when X-rays
were still a new thing and not much was known about them. They would
use radiation even to
kill the germs that caused acne. I wonder - not that radiation is a
good solution to the problem of
gum disease - if radiation were applied to the area, would it kill the
germs wherever they might be hiding?
And thus "cure" gum disease (and then give cancer, which is worse)?
Answer:
We got it. It is called PerioChip. It is a gelatin wedge with doxcycline
hyclate impregated within that allows the medicine to be dispensed over 5
days.
Periodontal disease is a multi-factorial disease. Many decades ago, we
thought perio was simply an oral hygiene deficiency. A substantial amount
of research into the pathogenesis of perio, as well as our clinical
experience, has shown us that there are many contributing factors.
First, we know that generally bacteria are the initiating factor. Since no
one has a sterile mouth, the question arises, Why doesn't everyone have gum
disease? That is where the other factors play a role. Some of the risk
factors for periodontitis include the following:
1. Smoking. We know that smokers have a substantially higher incidence of
gum disease than non-smokers.
2. Age. As people grow older, they seem to develop signs and symptoms of
the disease more readily.
3. Genetics. Some people seem to have a familial gene that predisposes them
to developing the disease.
4. Diet. Inadequate intake of certain nutrients can contribute to
exacerbation of the disease.
5. Systemic conditions, such as diabetes can complicate the treatment of the
disease.
These are just some of the factors that play a role in periodontitis. There
are others, but I'm not going to look them up right now.
In short, periodontitis is a chronic, progressive, site specific, episodic,
inflammatory, degenerative condition of connective tissue in the structures
surrounding your teeth.
The disease is diagnosed by observing one or more of the following signs:
1. Gums that bleed easily upon gentle probing, brushing, or flossing.
2. Edema of the gingiva with loss of stippling. (swollen gums)
3. Sulcus depths greater than 3-4mm. This is a fine measurement that your
dentist or hygienist can take at any appointment.
4.Loss of clinical attachment of greater than 1-2mm. Another measurement
that can be taken by your dentist or hygienist.
5. Receding gumline.
6. Loose or shifting teeth.
7. Loss of bone and supporting tissue around the teeth. (seen on dental
x-rays)
Traditional treatments used to focus primarily on controlling the bacterial
that initiate the disease. This was accomplished by improving oral hygiene,
scaling and rootplaning to remove calcified deposits, systemic antibiotics
sometimes to kill bacteria, surgery to alter the size and shape of the
pockets, thereby allowing easier oral hygiene. These procedures, while
generally improving the status and prognosis of the condition, do not always
produce satisfactory long-term results. This can be quite frustrating to
the clinician as well as the patient.
Recent developments in a number of areas are showing promise in being able
to more effectively manage the disease on a long-term basis. While we have
not yet found a way to cure periodontitis, dentistry is moving toward a
medical model of disease management. Medical physicians have had to deal
with many incurable conditions, such as hypertension and diabetes, and now
dentists are beginning to adopt their methods as well.
Long-term management of the disease now frequently can include locally
applied antimicrobials, as you suggested in an earlier post. The most
commonly used are:
Atridox - 10% doxycylcline in a gel that conforms to the size and shape of
the pocket, and delivers the active ingredient over a period of several
days. Effectively kills pathogenic bacteria without risks of systemic side
effects. Indicated to reduce probing depths and bleeding, increase clinical
attachment (carries the ADA Seal of Acceptance)
Periochip - chlorohexadine in a polymer which reduces bacterial counts,
thereby allowing better healing. Indicated to reduce pocket depths and
bleeding. No indication for improved clinical attachment.
Arestin - minocycline microspheres which reduce the pocket depths and
decrease bleeding. No indication for improved clinical attachment.
In addition to these locally applied antimicrobials, another therapy has
shown substantial promise in the long-term management of perio disease is
Periostat. Periostat is a 20mg systemic dose of doxycycline hyclate. Taken
twice a day, this medication inhibits an enzyme called collagenase.
Elevated levels of collagenase are almost always present in active
periodontal lesions. According to the Academy of Periodontology,
host-derived collagenase is primarily directly responsible for connective
tissue breakdown in periodontal lesions. By inhibiting or suppressing this
enzyme while the healing takes place, better clinical outcomes are
frequently seen. The 20mg dose is important. This dose is below the
traditional doses of doxycycline given as an antibiotic. This enzyme
suppression dose provides for the desirable enzyme suppression while
avoiding the unwanted risks associated with long-term antibiotic use. A
patient will typically be on a Periostat regimen for at least 90 days, and
sometimes longer if the healing process requires it. Periostat also carries
the ADA Seal of Acceptance. Periostat is not appropriate for patients who
should not take tetracyclines. Periostat can be used safely with any of the
locally applied antimicrobials.
None of these treatments are a substitute for conscientious oral hygiene or
regular clinical treatment in the dental office. They can, in many cases,
improve the results that many patients currently obtain with the traditional
treatments.
In any event, perio disease is easier to treat and control if caught early.
Much of the damage caused by perio disease is not reversible. That is why
prevention is so critical. Frequent maintenance appointments, along with
one or more of these new adjuncts, have shown to help most patients control
their disease.
