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Medical Forum / General / Dentistry / August 2008What is Koch's postulates? And why is it needed?
(1) Isolate the organism from the infected (2) reproduce the organism in a culture (3) inoculate a susceptible host (4)re-isolate the organism from the diseased host Why is it needed? To prove organisms cause a specific disease. Then why doesn't periodontal disease follow Koch's postulates? > (1) Isolate the organism from the infected > [quoted text clipped - 7 lines] > > Then why doesn't periodontal disease follow Koch's postulates? http://cat.inist.fr/?aModele=afficheN&cpsidt=16784225 Steve On Aug 19, 11:16 pm, Steven Bornfeld <dentaltwinm...@earthlink.net> wrote: > oralhea...@comcast.net wrote: > > (1) Isolate the organism from the infected [quoted text clipped - 12 lines] > > Steve Dentists forget the difference between Caries and P.D. Caries is easy to understand, P.D. is not. From the abstract, and from the first line: "The Pathogenesis of periodontal disease is not well known." I didn't say it, the first sentence of the abstract did. Bone loss can only occur from osteoclasts!!! Osteoclasts cause bone loss. Period. Cystokines, chemotactic factors influence the osteoclasts by way of inflammatory cells. This study says that A.A. inoculated in mice resulted in inflammation and different mediators were present over time. Obvious questions about the study? (1) were there controls? (2) What kind of mice did they use? What gene type? What is the lifespan of these mice? (3) Were they prebubescence mice? (4) Why weren't dogs selected vs mice? How good is the mouse model? In cancer it is not that good. (5) Explain the inoculation process? Did they inject the gingiva? In man, no organism are found in the gum tissue, only in the sulcus. (6) Did all sites breakdown? (7) How many organisms were introduced? And the last sentence is interesting, "our results suggest that expression of cytokines and chemokines can the drive the selective recruitment of leukocyte subsets to periodontal tissues, which could determine the stable or progessive nature of the lesion." Also, the periodontal textbooks say that bone loss can occur without any inflammation. Some of the most destructive P.D. lesions occur without any inflammation. > Dentists forget the difference between Caries and P.D. Caries is > easy to understand, P.D. is not. You don't seriously believe either is easy to understand, do you? Both involve an infectious agent, both involve complex micro-ecosystems, both involve complex pathogen-host immunologic interactions. Furthermore, caries is increasingly seen as a medical process with medical interventions, rather than a surgical process of repair. There are many sources on this--here is one that seems to at least attempt to integrate the new medical "paradigm" (how I hate that word, but it seems appropriate here) with endodontic and restorative fields. http://www.med.utu.fi/dent/en/department/cariology/ BTW, in the ancient days of my dental school training, we distinguished between inflammatory periodontal disease and what was referred to as "dystrophic" forms. At the time the dystrophic form was referred to as "periodontosis", but the periodontologists have now pretty much accepted that inflammation is part of these processes too--they comprise the various flavors of juvenile periodontitis. Oh, it's not simple either. Yes, osteoclasts are involved. So are enzyme systems such as collagenase. Certainly inflammation influences the activity of osteoclastic function. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 On Aug 21, 10:31 am, Mark & Steven Bornfeld <bornfeldm...@dentaltwins.com> wrote: > oralhea...@comcast.net wrote: > [quoted text clipped - 28 lines] > Brooklyn, NY > 718-258-5001 Caries is easier to understand because it FOLLOWS Koch's postulates. Dentists fall in the trap thinking periodontal disease does, but it does not. We can introduce cariogenic bacteria into humans and get tooth decay. We cannot do that with P.D. I feel caries occurs when there is an imbalance between acid production and remineralization. Why does Periostat work? Because it affects the immune system, not the plaque. David DiBenedetto DMD author of " Insider's guide to gum disease, orthodontics and dentistry..." > Caries is easier to understand because it FOLLOWS Koch's postulates. > Dentists fall in the trap thinking periodontal disease does, but it > does not. > > We can introduce cariogenic bacteria into humans and get tooth decay. > We cannot do that with P.D. This distinction is not so clear as you feel, if my reading is correct. > I feel caries occurs when there is an imbalance between acid > production and remineralization. > > Why does Periostat work? Because it affects the immune system, not > the plaque. How's that? I've only heard that it inhibits the activity of collagenase; I've heard of no direct effect on either cellular or humoral immunity. If you've heard differently, please enlighten me. Steve > David DiBenedetto DMD author of " Insider's guide to gum disease, > orthodontics and dentistry..." On Aug 21, 11:21 pm, Steven Bornfeld <dentaltwinm...@earthlink.net> wrote: > oralhea...@comcast.net wrote: > [quoted text clipped - 21 lines] > > David DiBenedetto DMD author of " Insider's guide to gum disease, > > orthodontics and dentistry..." To be enlightened and to see countless articles, go to google, and type in tetracycline and osteoclasts. Do you have any patients on Embrel or Humira? Look at their gingiva before and after treatment!!! AFAIK, for BOTH caries and periodontal disease(s) follow the "modern" theory of Koch's Postulates: bacteria + host + substrate + altered host immune response = disease (i.e. tooth decay/attachment loss) AND Caries bacteria or periodontal pathogenic bacteria ARE transmissible to non-infected hosts. So... WTF are you trying to say, other than the need to buy your obscure book. > AFAIK, for BOTH caries and periodontal disease(s) follow the "modern" > theory of Koch's Postulates: [quoted text clipped - 9 lines] > So... WTF are you trying to say, other than the need to buy your obscure > book. Dentists have altered Koch's postulates to prove microorganisms cause P.D. Well, microorganisms may trigger the immune system to be destructive, but it is the osteoclasts, not the microorgansims that cause the tissue destruction. How is the immune system triggered? Does the immune system of a person determine the response? Does smoking, Vit D levels, hormone levels, or blood sugar levels determine how a person responds to a triggering event? Does P.D. only occur when a person's immune response want it to? I believe the immune response is more important than anything else when it comes to P.D. This is where I stand. David DiBenedetto DMD author of "Insider's guide to gum disease, orthodontics, and dentistry...." >This is where I >stand. "Give me a place to stand and I will move the earth." http://www.cs.drexel.edu/~crorres/Archimedes/Lever/LeverIntro.html >David DiBenedetto DMD author of ... ... "A Narcissists Guide to Annoying SMD." >>This is where I >>stand. [quoted text clipped - 5 lines] > >... "A Narcissists Guide to Annoying SMD." Oh yeah, and then there's this from dict.org : (Note: Could not find "Koch's Axioms".) http://www.ask.com/web?q=%22Koch%27s+Axioms%22&search=search&qsrc=0&o=0&l=dir 5 definitions found for postulate From The Collaborative International Dictionary of English v.0.48 : Postulate \Pos"tu*late\, v. t. [imp. & p. p. Postulated; p. pr. & vb. n. Postulating.] 1. To beg, or assume without proof; as, to postulate conclusions. [1913 Webster] 2. To take without express consent; to assume. [1913 Webster] The Byzantine emperors appear to have . . . postulated a sort of paramount supremacy over this nation. --W. Tooke. [1913 Webster] 3. To invite earnestly; to solicit. [Obs.] --Bp. Burnet. [1913 Webster] From The Collaborative International Dictionary of English v.0.48 : Postulate \Pos"tu*late\, a. Postulated. [Obs.] --Hudibras. [1913 Webster] From The Collaborative International Dictionary of English v.0.48 : Postulate \Pos"tu*late\, n. [L. postulatum a demand, request, prop. p. p. of postulare to demand, prob. a dim. of poscere to demand, prob. for porcscere; akin to G. forschen to search, investigate, Skr. prach to ask, and L. precari to pray: cf. F. postulat. See Pray.] 1. Something demanded or asserted; especially, a position or supposition assumed without proof, or one which is considered as self-evident; a truth to which assent may be demanded or challenged, without argument or evidence. [1913 Webster] 2. (Geom.) The enunciation of a self-evident problem, in distinction from an axiom, which is the enunciation of a self-evident theorem. [1913 Webster] The distinction between a postulate and an axiom lies in this, -- that the latter is admitted to be self-evident, while the former may be agreed upon between two reasoners, and admitted by both, but not as proposition which it would be impossible to deny. --Eng. Cyc. [1913 Webster] > Dentists have altered Koch's postulates to prove microorganisms cause > P.D. Well, microorganisms may trigger the immune system to be > destructive, but it is the osteoclasts, not the microorgansims that > cause the tissue destruction. Oh pul-leaze! Do you honestly believe you are the first dentist to realize that plaque is not the only issue regarding perio disease or that osteoclasts might actually be at work dismantling the bone? Maybe you have a way of changing the patients with PPP syndrome into normal, healthy specimens. That would be interesting. Your ridiculous assumptions about the stupidity of dentists is only exceeded by your excessive delusions of grandeur. D > > Dentists have altered Koch's postulates to prove microorganisms cause > > P.D. Well, microorganisms may trigger the immune system to be [quoted text clipped - 6 lines] > plaque is not the only issue regarding perio disease or that > osteoclasts might actually be at work dismantling the bone? NO, I don't. But everyone puts an emphasis on plaque. > Maybe you have a way of changing the patients with PPP syndrome > into normal, healthy specimens. That would be interesting. This is what should be emphasized. Unhealthy people get P.D. > Your ridiculous assumptions about the stupidity of dentists is > only exceeded by your excessive delusions of grandeur. I guess you follow into that trap. Are these people unhealthy because of lifestyle habits? Are they unhealthy due to genetic deficiencies? Are they unhealthy due to the attack of multiple chronic diseases? Stress? Allergies? Chemical exposure? Blah, blah, blah? We, as a society, we have done away with the course of natural selection. Health care providers are assigned the task of 'fixing' people. Gotta do something.... Once perio starts, do you think you can stop it without dealing with the calculus and plaque issues? And if you don't think you're god's answer to all things dental, why don't you come on a forum with other professionals and try to have a dialogue instead of pontificating about how you wrote a book? Oh, I forgot, we are all stupid......... Steve Fawks >>Maybe you have a way of changing the patients with PPP syndrome >>into normal, healthy specimens. That would be interesting. > > This is what should be emphasized. Unhealthy people get P.D. This guy, Debenedetto or whatever he is called, should know is that dentists aren't stupid, as he is, purportedly, one himself. Because our profession doesn't have dramatic life-saving cures/control methods such as a small-pox vaccine, 1940's penicillin for infections, cancer chemo, etc. etc, doesn't mean we are not intelligent, thoughtful, resourceful, or caring for our patients. BTW, if he wanted to be a "Real Doctor", why didn't he go to Tufts Med instead of Tufts dental? >This guy, Debenedetto or whatever he is called, should know is that >dentists aren't stupid, as he is, purportedly, one himself. [quoted text clipped - 6 lines] >BTW, if he wanted to be a "Real Doctor", why didn't he go to Tufts Med >instead of Tufts dental? MCATS & MD national boards PT2 vs. DAT >>This guy, Debenedetto or whatever he is called, should know is that >>dentists aren't stupid, as he is, purportedly, one himself. [quoted text clipped - 8 lines] > >MCATS & MD national boards PT2 vs. DAT And here I was thinking it was because he couldn't get into Veterinarian school. Had a classmate in dental school who had the "RD" complex. Eventually got into med school and graduated. Somewhere along the way he was convicted of molesting his own kids and ended up in the slammer. Not too many years later he died from something fatal <G>. A little unbalanced was he. D >>>BTW, if he wanted to be a "Real Doctor", why didn't he go to Tufts Med >>>instead of Tufts dental? [quoted text clipped - 3 lines] > And here I was thinking it was because he couldn't get into > Veterinarian school. More correctly what "are" instead of "is" for a plural direct object in the English language. > More correctly what "are" instead of "is" for a plural direct object in > the English language. You are forgiven, my son. In Brooklyn, correct usage dictates what "be". Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 I am sorry to be a pest to you. However, you must admit, that when Herr Doktor Koch formulated his postulates a century + ago, almost nil was known/understood about immunology, the host immune response, cytokines, and modulating host-immune factors. Low dose doxycycline, LDD, is NOT a panacea, and may "help", marginally, some, albeit unpredictably, cases of periodontitis. The BACTERIAL stimulation of a SUSCEPTIBLE Host, can result in the release of host-mediated cytokines, such as Osteoclast Activating Factor, or OAF, which stimulates osteoclasts to resorb bone. However, the bacterially stimulated host-response destruction of the periodontal ligament, with resultant need for NO attachment of Sharpy's fibers to surrounding bone is more likely the cause of non-needed bone being resorbed around the "infected" tooth, hence bone loss/pockets. I think that the ligamental destruction is the key factor, not the incidental bone loss which is what we actually radiographically see. If we could somehow stop the attachment loss i.e destruction of the PDL, then we could probably control the periodontal disease(s) and the inherent bone loss. Without an infected periodontal ligament, we usually don't see any bone loss, other than normal post-extraction remodelling, orthodontic/primary occlusal trauma or, unfortunately, pressure resorption from a dental prosthesis. At least, this is my take on it, and I'm stickin' to it. |
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