A new focus has emerged in the treatment of periodontal diseases. It is known as Biofilm Shifting.
Previous emphasis and focus of gum therapies has been on reduction of ALL oral bacteria through professional cleaning and with the use of antimicrobial rinses and medications. The problem with eradication of all oral bacteria, is that the oral environment becomes an open void, and susceptible to reinfection. Any strong pathogenic bacteria that remain will also have a greater chance of recolonization of the mouth.
Certain rinses which contain chlorhexidine or alcohol also kill the normal oral flora, which are often what we rely on to keep the "bad" bacteria at bay.
Our current goal in gum therapy is to reduce or eliminate the "bad" bacteria which are disease causing, but still keep the healthy bacteria present. This is what the concept of Biofilm Shifting is all about. Biofilm shifting changes the bacterial profile of the subgingival biofilm toward normal using focused therapies. It involves removal, reduction, or inhibition of pathogenic bacteria, while sparing good bacteria. Oral probiotics can be incorporated to keep levels of good bacteria present. Creating a favorable environment for good bacteria, while excluding reintroduction of bad bacteria may include alteration of oral pH levels to make the mouth healthier and less acidic. This is accomplished with proper nutrition and diet, and avoidance of food and drink which will increase oral acid levels.
The emphasis of Biofilm Shifting is to guide the mouth's sensitive ecosystem toward normal, and not just indiscriminately kill all oral bacteria.
Perio 360 (TM) therapy from the Jacobs Smile Center is uniquely designed to accomplish this biofilm shifting for increased long-term health of the mouth and body.
Showing posts with label bacterial testing. Show all posts
Showing posts with label bacterial testing. Show all posts
Wednesday, March 7, 2012
Monday, January 18, 2010
Perio-Pod
Perio-Pod TM Definition: (copyright 2010, Paul Jacobs, DDS)
A perio-pod TM is 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.
A perio-pod TM is 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.
Above are bacterial profiles from Hain-diagnostics showing the similarity in bacterial profiles between spouses and between parents and their children.
Saturday, May 9, 2009
With Knowledge Comes Responsibility
I have kind memories of the old days in dentistry. There was no HIV-AIDS. Gloves were optional, and masks were mostly unthought of. My father owned one periodontal probe he had received in dental school, and the sum total of knowledge about gum problems was neatly compacted into a one eighth inch thick pamphlet. I'm talking about the dentists' knowledge, not just a patient brochure.
When I graduated from the University of Detroit Dental School in 1983, that small pamphlet of facts on gum disease became three hard covered books an inch and a half thick on the principles of periodontal diseases. We certainly had more to know, but the treatments for periodontal disease were essentially the same. Unfortunately, until about 5 years ago, the only difference in treatment procedures for gum disease was that dentists and hygienists were greater proponents. There was greater emphasis on the diseases, but most treatments remained the same.
Enter 2009 - with the advent of DNA testing and bacterial testing for periodontal bacteria, we have turned a new page in the treatment and responsibility for treatment of periodontal diseases. When our patients reported for their dental cleanings in the past, we may have noticed that they had swollen gums or bleeding when we probed their gums. Our general solution was to scold them that they had to floss more and see us more regularly. Most people were agreeable, as they weren't really flossing like they should have. Six months later, they would return with the same problem.
Really bad cases got sent to the gum surgeon. The usual procedure there was to cut away some of the swollen gum tissue, put the patient on more frequent maintenance appointments, and to scold them that they had to floss more. Every five to ten years the surgery might be repeated as long as they still had some teeth left.
Newsflash: I've tested several hundreds of these so called non-flossers over the past year for the possibility that they might be actually infected by a known badly pathogenic bacteria. Results of these tests have confirmed harmful bacteria present in all but one case. Eyeopener #2: I've tested about 21 couples or family groups in the past 3 months, and have found that each group shares an almost identical amount and type of harmful bacteria in their mouths.
No longer are we able to treat our patients with periodontal disease as individuals. There is such a strong correlation between close individuals and their periodontal bacteria, that we now need to look past just the individual.
With Knowledge comes responsibility! When I see Mr. Jones' bleeding, swollen gums, I have to take into account the health of Mrs. Jones. The children of parents with gum diseases need to be watched more closely. As dentists and hygienists, we can no longer deny the health of other family members in making treatment decisions.
Except for the introduction of technology like lasers and ultrasonic scalers, many of our periodontal treatments remain the same. However, the emphasis on who we treat has moved past the individual in the dental chair at the time. We all know to change our toothbrush after we get over a cold or the flu. It's not as easy to change a spouse, partner, or child just because they are infected with one or more of the harmful periodontal bacteria.
Will dentistry move toward the model of "group therapy?" I propose that this may be what we find in our future. More on this as it develops.
When I graduated from the University of Detroit Dental School in 1983, that small pamphlet of facts on gum disease became three hard covered books an inch and a half thick on the principles of periodontal diseases. We certainly had more to know, but the treatments for periodontal disease were essentially the same. Unfortunately, until about 5 years ago, the only difference in treatment procedures for gum disease was that dentists and hygienists were greater proponents. There was greater emphasis on the diseases, but most treatments remained the same.
Enter 2009 - with the advent of DNA testing and bacterial testing for periodontal bacteria, we have turned a new page in the treatment and responsibility for treatment of periodontal diseases. When our patients reported for their dental cleanings in the past, we may have noticed that they had swollen gums or bleeding when we probed their gums. Our general solution was to scold them that they had to floss more and see us more regularly. Most people were agreeable, as they weren't really flossing like they should have. Six months later, they would return with the same problem.
Really bad cases got sent to the gum surgeon. The usual procedure there was to cut away some of the swollen gum tissue, put the patient on more frequent maintenance appointments, and to scold them that they had to floss more. Every five to ten years the surgery might be repeated as long as they still had some teeth left.
Newsflash: I've tested several hundreds of these so called non-flossers over the past year for the possibility that they might be actually infected by a known badly pathogenic bacteria. Results of these tests have confirmed harmful bacteria present in all but one case. Eyeopener #2: I've tested about 21 couples or family groups in the past 3 months, and have found that each group shares an almost identical amount and type of harmful bacteria in their mouths.
No longer are we able to treat our patients with periodontal disease as individuals. There is such a strong correlation between close individuals and their periodontal bacteria, that we now need to look past just the individual.
With Knowledge comes responsibility! When I see Mr. Jones' bleeding, swollen gums, I have to take into account the health of Mrs. Jones. The children of parents with gum diseases need to be watched more closely. As dentists and hygienists, we can no longer deny the health of other family members in making treatment decisions.
Except for the introduction of technology like lasers and ultrasonic scalers, many of our periodontal treatments remain the same. However, the emphasis on who we treat has moved past the individual in the dental chair at the time. We all know to change our toothbrush after we get over a cold or the flu. It's not as easy to change a spouse, partner, or child just because they are infected with one or more of the harmful periodontal bacteria.
Will dentistry move toward the model of "group therapy?" I propose that this may be what we find in our future. More on this as it develops.
Saturday, March 7, 2009
Gumdog Millionaire
What do the slums of Mumbai, India and your mouth have in common? Beside the fact that they can both be dirty places, your mouth is also a place inhabited by mostly "good" residents. Like the occupants of the Mumbai slum in the recent award winning movie Slumdog Millionaire, your mouth also may house some really "bad" characters.
Dental research has identified nearly 700 different bacteria living in the human mouth, most of them "good". Newer technology has allowed us to identify with great accuracy thirteen "bad" pathogenic bacteria believed to be involved with degenerative periodontal (gum) infections. My first exposure to this technology was through a course I took by Lou Graham, DDS about 3 years ago. In the past year I have sampled about 200 people with signs of periodontal disease or infection looking for these horrible critters.
Analyzing these bacterial test results has been a large eye opener for my dental team and for me. We have found many more "Gumdog Millionaires" than I could ever had imagined. I see a gumdog millionaire as a person who is rich indeed. Rich and teeming with microorganisms too nasty to inhabit the slums of Anymouth, USA. Of all the bacterial tests I have done to date, only one person had a test returned with no periodontal pathogens. I even had to do a free retest to confirm to myself that this could have occured. Now keep in mind that I am only testing people with evidence of periodontal infection or disease, but impressive none-the-less!
Where, why, how? Research is still out on the final answer to these questions, but this is what we know so far. Periodontal pathogenic bacteria are probably passed from a caregiver to a child in a family setting at an early age - coughing, sneezing, kissing, tasting off the same spoon, drinking out of the same cup, sharing a straw. People with a stronger immune system are less likely to take on the new bugs, while those with lesser immunity will begin to host the bugs earlier.
As a person ages or their immune system is challenged, the "bad" bugs may overgrow, now showing the signs and symptoms of gum infection or periodontal disease. Present in larger quantities, these bacteria are next passed through saliva again to the person's spouse or partner.
Most recent shocking findings in my dental office are that married couples that we have tested in the past 4 weeks have all shown the same combination of pathogenic bacteria present in their mouths, and we have even found these bugs in the same quantity in each partner. I have tested about 6 couples and 1 family unit to date. Father, mother, and child demonstrated the same bacteria!
At a recent course sponsored by Hain-Diagnostics, I learned that four of these bacteria (called red complex) predispose people to a 700% greater chance of having heart disease. People with two other (called green complex) bacteria are more prone to diabetes. Orange complex bacteria can be related to inflammatory diseases such as rheumatoid arthritis. The presence of these bacteria shows a risk factor, not necessarily causal. Research is beginning to point to a causal effect, though in some cases.
These bad bacteria are difficult to get rid of, but it can be done. Removing pathogenic bacteria may not eliminate things like heart disease, cancer, diabetes and arthritis, but it will definitely remove some of the risk factors. The earlier in life that bad bugs are detected and treated, the greater chance of having a healthy adulthood, continuing into the "golden years".
Oh, yea - don't be kissing your dogs on the face either. Last Monday's patient informed me that he was taking his dog to the vet for periodontal treatment. The vet said that the dog would get heart disease if this kept up! Another dentist I met recently had a woman's dog tested for periodontal bacteria. Amazingly, the dog and owner shared the identical bad bugs. The dog's better now, by the way. The woman finally tested clean after the dog was treated.
"Now Jamal, your final question is worth a staggering 20 million rupees! Which periodontally pathogenic bacteria can raise your risk of heart disease by 700%? Is it A: Aggregatibacter actinomycetemcomitans? B: Porphyromonas gingivalis? C: Tannerella forsythia? or D: Treponema denticola? . . . . What is your final answer?"
"I know the answer is all of the above," spats Jamal, "as I have been a Gumdog Millionaire!"
Dental research has identified nearly 700 different bacteria living in the human mouth, most of them "good". Newer technology has allowed us to identify with great accuracy thirteen "bad" pathogenic bacteria believed to be involved with degenerative periodontal (gum) infections. My first exposure to this technology was through a course I took by Lou Graham, DDS about 3 years ago. In the past year I have sampled about 200 people with signs of periodontal disease or infection looking for these horrible critters.
Analyzing these bacterial test results has been a large eye opener for my dental team and for me. We have found many more "Gumdog Millionaires" than I could ever had imagined. I see a gumdog millionaire as a person who is rich indeed. Rich and teeming with microorganisms too nasty to inhabit the slums of Anymouth, USA. Of all the bacterial tests I have done to date, only one person had a test returned with no periodontal pathogens. I even had to do a free retest to confirm to myself that this could have occured. Now keep in mind that I am only testing people with evidence of periodontal infection or disease, but impressive none-the-less!
Where, why, how? Research is still out on the final answer to these questions, but this is what we know so far. Periodontal pathogenic bacteria are probably passed from a caregiver to a child in a family setting at an early age - coughing, sneezing, kissing, tasting off the same spoon, drinking out of the same cup, sharing a straw. People with a stronger immune system are less likely to take on the new bugs, while those with lesser immunity will begin to host the bugs earlier.
As a person ages or their immune system is challenged, the "bad" bugs may overgrow, now showing the signs and symptoms of gum infection or periodontal disease. Present in larger quantities, these bacteria are next passed through saliva again to the person's spouse or partner.
Most recent shocking findings in my dental office are that married couples that we have tested in the past 4 weeks have all shown the same combination of pathogenic bacteria present in their mouths, and we have even found these bugs in the same quantity in each partner. I have tested about 6 couples and 1 family unit to date. Father, mother, and child demonstrated the same bacteria!
At a recent course sponsored by Hain-Diagnostics, I learned that four of these bacteria (called red complex) predispose people to a 700% greater chance of having heart disease. People with two other (called green complex) bacteria are more prone to diabetes. Orange complex bacteria can be related to inflammatory diseases such as rheumatoid arthritis. The presence of these bacteria shows a risk factor, not necessarily causal. Research is beginning to point to a causal effect, though in some cases.
These bad bacteria are difficult to get rid of, but it can be done. Removing pathogenic bacteria may not eliminate things like heart disease, cancer, diabetes and arthritis, but it will definitely remove some of the risk factors. The earlier in life that bad bugs are detected and treated, the greater chance of having a healthy adulthood, continuing into the "golden years".
Oh, yea - don't be kissing your dogs on the face either. Last Monday's patient informed me that he was taking his dog to the vet for periodontal treatment. The vet said that the dog would get heart disease if this kept up! Another dentist I met recently had a woman's dog tested for periodontal bacteria. Amazingly, the dog and owner shared the identical bad bugs. The dog's better now, by the way. The woman finally tested clean after the dog was treated.
"Now Jamal, your final question is worth a staggering 20 million rupees! Which periodontally pathogenic bacteria can raise your risk of heart disease by 700%? Is it A: Aggregatibacter actinomycetemcomitans? B: Porphyromonas gingivalis? C: Tannerella forsythia? or D: Treponema denticola? . . . . What is your final answer?"
"I know the answer is all of the above," spats Jamal, "as I have been a Gumdog Millionaire!"
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