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.

Above are bacterial profiles from Hain-diagnostics showing the similarity in bacterial profiles between spouses and between parents and their children.

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.

Allison Requests Oral Cancer Info

"Dad, you should write something about oral cancer. My friends are interested in it, and they want to know what's new." This text message came to me from my daughter Allison who is presently serving in Peace Corps Jordan. She had heard about the VELScope examination we do at our office and was interested in passing on some of the newer information to her friends. Well, here's the latest:

Oral cancer kills one person every hour, 24 hours a day in the United States.

Oral cancer is one of the human cancers that is not decreasing in occurence in the last few years. The incidence of oral cancer is about twice that of skin cancer and about three times that of cervical cancer in women. Oral cancer is the sixth most common diagnosed cancer in the U.S. According to the American Dental Association, oral cancer strikes an estimated 34,360 Americans each year. Approximately 7,550 people (5,180 men and 2,370 women) will have died of these cancers in 2007. African-Americans are especially vulnerable; the incidence rate is 1/3 higher than whites and the mortality rate is almost twice as high (American Cancer Society statistics).

Tobacco and alcohol combined account for about 75% of oral cancers, while the segment of the U.S. population growing disproportionately in new oral cancers is women under 40 years of age. It is speculated that this newer group is related to HPV-16 or one of the forms of human papilloma virus. Human papilloma virus is a sexually transmitted virus, infecting about 40 million Americans, and also causing an increased risk of cervical cancers. The HPV affects tissues that have direct contact with a lesion or sore, and does not circulate through a person's system.

Oral sex is also being tagged as a cause of oral cancer because of contact with HPV lesions. "There is absolutely a link between oral sex and oral cancer," said Dr. Ellen Rome, of the Cleveland Clinic. Although no proof exists yet, there is a chance that HPV can be transmitted mouth to mouth.

NON-smokers and people who are not in traditional risk groups are also experiencing an increase in oral cancer rates. Researchers are still working on finding out what these new risk factors may be.

Oral cancers start as a small white or red spot or sore anywhere in the mouth or on the lips. Other signs of oral cancer could be: a sore that bleeds easily or does not heal; pain, tenderness or numbness that doesn't heal; or difficulty chewing, swallowing, speaking or moving the jaw or tongue. Prolonged exposure to the sun can increase the risk of lip cancer.

Half of the people who are diagnosed with oral cancer die within five years. This is mostly due to the cancer being undetected until it is too large to treat easily. Early detection and intervention allows nearly 90% of all cases to be treated.

Detection of oral cancer starts at the dentist's office. A careful visual examination is performed at least annually. The dentist may use an adjunctive screening tool like the VELScope we have in our office. The VELScope shines a blue light into the mouth, and normal healthy cells fluoresce and appear green while looking through a filtering lens. Suspicious cells look jet black or darker through the scope. Final confirmation or diagnosis of cancer can only be accomplished by biopsy or removal of the lesion for microscopic examination. Many more lesions can be detected by using the VELScope than can be seen with the unaided eye.

Studies suggest that diets high in fruits and vegetables may prevent the development of potentially cancerous lesions. Yes, your mother was right again!

Allison, I hope this helps. Let me know if you need more specifics. Also, text your Dad sometime, and we can discuss that "budget thing."

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!"