Who Shot the Sialolith?

"I shot the sheriff, but I did not shoot the deputy..." The song lyrics remind me somewhat of the photo I received recently from my brother Peter Jacobs, DDS. Pete practices near me in the small northern city of Manistique, Michigan.

You don't need to live in a large metropolitan area to see unique things in a dental office. This is one that I have never seen, so I thought it might be interesting to others. Pete sent me a photo of a sialolith, that is - a calcareous concretion or calculus of the salivary gland or duct. He had a patient come into his office with a swelling below his chin and under his tongue. On an xray examination, an artifact somewhat like a tooth was present. After some investigation, Dr. Pete made a small incision under the patient's tongue, and out popped what you see in the picture. The sialolith looks somewhat like a tooth that is tapered on each end. Over time, calcium deposits can build up in the salivary duct, and start to obscure it, causing a backup of saliva in the gland.

Note the size of the sialolith in comparison to the bullet laid alongside it in the photo. My brother is very passionate about hunting, and happened to have the bullet nearby to easily use as a size comparison. He says it's a 30.06 shell. I'm waiting for the deputy to confirm that!

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!"