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Medical Forum / General / Dentistry / December 2005Searching for a technical word... and periodontal advice
Went for a perio checkup, and it looks like good oral hygiene is doing something ( maximum depths were 3-5mm on the back molars in place of the old 4-6mm seen last July. ) The diagnosis was also different, characterized as moderate in place of severe. The (new) periodontist suggested further treatment, while recommended, was not urgent. This may be too small a change to matter, but at least things are going in the correct direction Now for the question.... The periodontist characterized my gums as (xxxx) where (xxx) is a word meaning tough gums and absence of redness, puss or swelling. I called back the office, but alas hew was not in. Any clue as to the word I recall xxx as fibro-something-or-other The recommendation is still surgery (or laser equivalent), and never an antibiotic treatment. My feeling is that if good hygiene improves pocket depth by 1mm in 3 months, perhaps continued good hygiene, and a course of antibiotic, might reduce maximum depth to 2-4 mm , (or even the goal of 1-3 mm ) I suppose my only option, if I wish to explore this avenue, is to continue good hygiene practice and see what results > Went for a perio checkup, and it looks like good oral hygiene is doing > something ( maximum depths were 3-5mm on the back molars in place of [quoted text clipped - 16 lines] > the goal of 1-3 mm ) I suppose my only option, if I wish to explore > this avenue, is to continue good hygiene practice and see what results Could be fibrous--or fibrotic, but...what's wrong with "tough gums"? Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Could be fibrous--or fibrotic, but...what's wrong with "tough gums"? IMO... nothing. The periodontist said this type of gum tissue showed little swelling or bleeding.. I took this to be a good thing I need a little perspective. I have moderate periodontal disease, and despite direct request for a course of antibiotic treatment, have had surgery recommended twice . My rough, untrained opinion, is that if there is a medical alternative, why not try it. Is there harm in using the antibiotic in a search for non surgical intervention . I'm willing to do the surgery, but not until I've exhausted other options In my search for an alternative I came across a series of articles by Loesche (*) on the use of antibiotic in the treatment of periodontal disease. Is there a substantive critique that suggests Loesche is incorrect? * http://www.dent.umich.edu/research/loeschelabs/pubsub1.html ~~~ typical refrence Loesche WJ. Giordano J. Soehren S. Hutchinson R. Rau CF. Walsh L. Schork MA. Nonsurgical treatment of patients with periodontal disease. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics. 81(5):533-43, 1996 May. OBJECTIVE. To determine whether the short-term use of systemic antimicrobials (metronidazole or doxycycline) and locally delivered antimicrobials (metronidazole, chlorhexidine) in patients with advanced forms of periodontal disease could prevent the normally necessary access surgery. STUDY DESIGN. Ninety-four patients were randomly assigned with the use of a double-blind protocol. RESULTS. There was a 93% reduction in the need for periodontal surgery about individual teeth and an 81% reduction in the need for tooth extractions. Only 93 teeth of an initial total of 783 teeth actually needed surgery or extractions. Eighty-one percent of the patients entered into the maintenance phase of treatment without needing surgical treatments. CONCLUSION. These findings indicate that a treatment paradigm based on the diagnosis and treatment of anaerobic infections is likely to be successful in those patients for whom access surgery is recommended. > I need a little perspective. I have moderate periodontal disease, and > despite direct request for a course of antibiotic treatment, have had [quoted text clipped - 31 lines] > infections is likely to be successful in those patients for whom > access surgery is recommended. Loche is not incorrect--as far as he goes. There is a theoretical role of antibiotics for treatment of active periodontal disease. The problem is pretty complicated (and I've got a patient waiting). There is a place for antibiotics. However, there is abundant evidence collected over many years that while the bacterial flora can be altered SHORT TERM, it is unlikely to do so long term, and probably unwise to try. It is unwise because the antibiotics necessary to do the job would both predispose to superinfection with non-sensitive microbes, and likely contribute to antibacterial resistance and sensitization of the patient (as well as many other potential side effects of long-term use of these medications). There have been attempts to overcome some of the downside of antibiotic therapy, by using various antibiotics (mostly doxycycline) topically, and systemic use of low-dose doxycycline. In the topical application, the rationale is to develop high local concentrations of antibiotic without the other risks of systemic use. In the case of low-dose systemic use, the drug is in fact given in concentrations ineffective for antibiotic effect; however, advantage is taken of their activity in inhibiting collagenase--an enzyme implicated in the breakdown of periodontal tissues. Both treatments have been around for some years now. While there is a general concensus I've heard among periodontists that these drugs have their place, esp. in certain periodontal lesions that either do not respond to surgery or where for a variety of reasons surgery is not considered worthwhile, general results are underwhelming. They may be an adjunct, but they're not going to replace surgery. Sorry, Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >.... > Loche is not incorrect--as far as he goes. There is a theoretical role [quoted text clipped - 6 lines] >predispose to superinfection with non-sensitive microbes, and likely >contribute to antibacterial resistance and sensitization of the patient Thank you... I was thinking along this line for counter arguiment . My rough reasoning against the AB treatment was that there were so many bacteria, using AB alone would select the resistant strain. If I understand correctly, you suggest something along this line... with non-sensitive microbes including other strains As I understand it, the traditional surgery drastically reduces the bacterial population, and exposes the remaining colonies to routine cleaning. On a more theoretical level... was there something wrong in the design of the double blind studies by Loesch.? Did I mis read him? Perhaps his results pertain to a patient group theat excludes me But thanks again... it looks like its close to time to face the knife;0 > Thank you... I was thinking along this line for counter arguiment . My > rough reasoning against the AB treatment was that there were so many [quoted text clipped - 9 lines] > design of the double blind studies by Loesch.? Did I mis read him? > Perhaps his results pertain to a patient group theat excludes me I cannot tell from this abstract. He does not here define (for example) "advanced" periodontal disease criteria. Nor (for that matter) does he define either the "need for surgery" nor the "need for extraction". These are awfully subjective measures, as opposed to pocket depth, mobilities, or incidence of periodontal abscess. Steve > But thanks again... it looks like its close to time to face the > knife;0 SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >These are awfully subjective measures, as opposed to >pocket depth, mobilities, or incidence of periodontal abscess. So... I looked into it a bit more, and found a current study at the Forsyth institute in boston. They find similar beneficial effects via two treatments 1)metronidazole and 2)weekly professional supragingival plaque removal. The reason I bring it up is these measures are not subjective. However, they do mention the same point you brought up earlier.. the short tem nature of the result Please, I'm not trying to be argumentative, only to explore the option in greater depth. I live north of Boston and will explore registering for the trial At the very minimum, I figure I'll receive good advice there. http://www.clinicaltrials.gov/ct/show/NCT00066001 "...One major finding was the frequent detection of anaerobic periodontal pathogens at low numbers in supragingival plaque of periodontally diseased and to a lesser extent healthy subjects. Weekly professional supragingival plaque removal for 3 months in 18 periodontitis subjects demonstrated astonishing reductions in the subgingival microbiota which were maintained for 9 months after cessation of the professional program. The composition of the microbiota at 12 months in these subjects was similar to that found in periodontal health. In another of our studies, systemically administered metronidazole produced similar effects. ..The results will determine if the beneficial effect of the individual therapies persist beyond one year and whether combined treatment produces even greater benefit to the patient." >So... I... found a current study at the >Forsyth institute in boston. They find similar beneficial effects via >two treatments 1)metronidazole and 2)weekly professional supragingival >plaque removal. >http://www.clinicaltrials.gov/ct/show/NCT00066001 Well here's a follow-up. I went to the Forsyth institute,and I do not qualify for the study ,According to them,I do not have even moderate periodontal disease. I only have two sites that warrant attention : one 5 mm pocket on upper left molar, and one 4 mm pocekt near the right front canine(due to mechanical trauma) . All other teeth (6 sites per teeth) measured 1 to 3 mm. No bleeding on probing, no pus, no loose teeth. But for those two sites,the Forsyth clinician said I'd qualify for the healty periodontal studies. Either my program of oral hygene is working miracles, or one of the the diagnoses is incorrect. This brings us to the interesting question as to whose diagnosis you would believe... the fellow who recommended immediate 4 quadrat osseous surgery ( and stood to gain $4k by said recommendation) , or the researcher looking for candidates for the clinical study. This is not a rhetorical question... I have to decide how to act given the contradictory information. This is very discouraging, I expect variance in diagnoisis, but not this much. My plan is to concentrate a little more cleaning on the 4 and 5 mm sites for the next year, continue my practice of better oral hygiene, and then have another periodontal exam in a year. >>So... I... found a current study at the >>Forsyth institute in boston. They find similar beneficial effects via [quoted text clipped - 26 lines] > and 5 mm sites for the next year, continue my practice of better oral > hygiene, and then have another periodontal exam in a year. I agree with you. As long as your oral hygiene is good, and inflammation is limited, and the problem areas do not deteriorate, I would be in no rush to surgery. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> On Thu, 29 Sep 2005 17:05:31 -0400, george1234 >> This is very discouraging, I expect variance in diagnoisis, but not >> this much. My plan is to concentrate a little more cleaning on the 4 [quoted text clipped - 6 lines] > >Steve Thanks Steve.. You have been very helpful. Clearly what I need here is a disinterested informed opinion --george > I agree with you. As long as your oral hygiene is good, and >inflammation is limited, and the problem areas do not deteriorate, I >would be in no rush to surgery. Thank you Steve for your help on this matter I had a perio exam, ~6 months after I first posted to this group (after a periodontist recommended 4 quadrant osseous surgery post SRP) Now, Pocket depth ( and cal) mostly is in the 2-3 range with an occasional dip on the back to 5 I'm looking at the chart now... those rows of 212 and 222 are encouraging. My understanding is anything 3 or less is considered healthy Also.. my understanding is that you are looking of patterns . The 2 std error is , itself, 1 mm . My plan is to clean a bit better on the back molars. The one I have been concentrating on ( #17) is just fine For those of you who had this type of sugery suggested, I recommend you concentarte on cleaning your teeth better, waiting a bit, and see if better hygiene helps. It's a diffrent topic, and perhaps inappropriate, but I can't help but suspect that the recommendation was influenced in part by the prospect of modest financial gain on the part of the periodontist. I suspect at the time the surgery recommendation the condition was border line, and with a bit of pocket english thrown in, met the bare minimum criteria for more extensive work. What raised my warning flags was the insistance that it be done immediately with no explanation as to why the rush. --G Fior the uininitiated.. on each side of the tooth 3 measurements are made of pocket depth. Hence 333 means 3 measurements of 3 mm Tooth Face Tounge 1 333 435 2 333 534 3 323 323 4 323 323 5 324 324 6 423 323 7 333 323 8 333 323 9 322 222 10 233 222 11 323 222 12 333 323 13 222 323 14 223 323 15 323 333 16 32 31 323 334 30 422 333 29 323 323 28 322 323 27 222 323 26 212 222 25 212 222 24 212 222 23 212 222 22 212 223 21 222 323 20 223 323 19 18 333 323 17 333 333 >> I agree with you. As long as your oral hygiene is good, and >>inflammation is limited, and the problem areas do not deteriorate, I [quoted text clipped - 69 lines] > 18 333 323 > 17 333 333 Thanks for the update. Do remember that raw pocket readings do not tell the whole story. Change in pocket depth combined with attachment levels over time gives a much better idea of disease activity. In any case, pocket depth reduction is a good sign. Best, Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Thanks for the update. > Do remember that raw pocket readings do not tell the whole story. >Change in pocket depth combined with attachment levels over time gives a >much better idea of disease activity. In any case, pocket depth >reduction is a good sign. Thanks for the clarification.. I'm going to try to get a perio chart done once a year (do you recommend more frequently?) The GM was 0 or 1 for all but two teeth ( tooth12 and 20 were 2) .I don't have the numbers before SRP. I'm going to need some help here. IIUC, Osseous surgery reduces PD by increasing the GM, , so that the pt can better clean the gums. Again, IIUC, it's better to decrease PD without the increase in GM, so as to not expose the tooth beneath the enamel directly to all the microorganisms in the mouth . The idea is that enamel can better withstand contact with the microorganisms than unprotected root. And ,again , thank you for your help on this matter. It's one thing to read an article and quite another to get an explanation from a practitioner with clinical perspective >> Thanks for the update. >> Do remember that raw pocket readings do not tell the whole story. [quoted text clipped - 4 lines] > Thanks for the clarification.. I'm going to try to get a perio chart > done once a year (do you recommend more frequently?) Ideally, the pockets should be probed at every recall. Certainly those over 3mm should be noted for any change in depth. > The GM was 0 or 1 for all but two teeth ( tooth12 and 20 were 2) .I > don't have the numbers before SRP. I'm going to need some help here. > IIUC, Osseous surgery reduces PD by increasing the GM, , so that the > pt can better clean the gums. Now I'm going to need some help. What is GM? Steve > Again, IIUC, it's better to decrease PD without the increase in GM, so > as to not expose the tooth beneath the enamel directly to all the [quoted text clipped - 4 lines] > to read an article and quite another to get an explanation from a > practitioner with clinical perspective SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> The GM was 0 or 1 for all but two teeth ( tooth12 and 20 were 2) .I >> don't have the numbers before SRP. I'm going to need some help here. >> IIUC, Osseous surgery reduces PD by increasing the GM, , so that the >> pt can better clean the gums. > Now I'm going to need some help. What is GM? Sorry.. it was the abreviation on the chart. When I asked the same of the tech, she said it was Gingival Margin, This is: "the healthy free gingival margin of premolars and molars is 1-2 mm coronal (toward the crown) to the cementoenamel junction (CEJ), where root cementum meets the enamel." >> Thanks for the update. >> Do remember that raw pocket readings do not tell the whole story. [quoted text clipped - 18 lines] > to read an article and quite another to get an explanation from a > practitioner with clinical perspective As a practical matter, you always get some gingival recession. Yes, there is usually recession with osseous surgery (though occasionally periodontists will attempt surgical reattachment using grafting materials, membranes, and what is called a coronally-repositioned flap--generally in the category of perio surgery called "guided tissue regeneration"). But even where there is gingival recession, re-attachment is generally desireable, and the two are not mutually exclusive. Steve > For those of you who had this type of sugery suggested, I recommend > you concentarte on cleaning your teeth better, waiting a bit, and see > if better hygiene helps. You forget the most important part: VERY frequent cleaning/disinfection by the dentist/hygienist. It can actually work out to be more expensive. SP SignatureTake out the TRAASH to reply >You forget the most important part: VERY frequent cleaning/disinfection >by the dentist/hygienist. It can actually work out to be more expensive. That's not true about the expense It would take a lot of cleaning (128/visit) to rack up 4 qudrant osseous surgery (4400) . By my count that's more than 8 1/2 years of cleaning at 4 x /year (without taking into accunt the discount value) before the cash outlay is equal. And, even if you had the surgery, the cleaning is recommended anyway. So you, perhaps you can explain how the surgery alone would be less expensive ( I don't think you can, in my math 1+ 1 is never less than 1) I don't disagree about the importance of cleaning, but in this case, there was no professional cleaning in the last 6 months. The important thing is to prevent re-establishment of the biofilm, and agressive personnal hygiene can do this Finally, cost is not the main point. It is truly nuts to hastilly recommend the pain of surgery ( and I've asked others who've had it, there is pain) when simple hygiene can work. >>You forget the most important part: VERY frequent cleaning/disinfection >>by the dentist/hygienist. It can actually work out to be more expensive. [quoted text clipped - 13 lines] > important thing is to prevent re-establishment of the biofilm, and > agressive personnal hygiene can do this This is true, at least theoretically. However, practically it is impossible for most patients to maintain pockets over 3 mm, and esp. in the molars where you get into the furcations between the roots. In fact, one of the slides always shown in perio lectures is the one where a patient has had presurgical treatment including (presumably meticulous) root planing and curettage. When the gingivae are reflected, there are big old spicules of calculus that have evaded the curettes of the periodontists, even with small instruments and direct vision. I have seen some deep pockets remain stable over extended periods of time; whether this is due to the patient's oral hygiene or more to the random ebb and flow of periodontal disease activity I cannot say. Steve > Finally, cost is not the main point. It is truly nuts to hastilly > recommend the pain of surgery ( and I've asked others who've had it, > there is pain) when simple hygiene can work. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > In >fact, one of the slides always shown in perio lectures is the one where [quoted text clipped - 3 lines] >curettes of the periodontists, even with small instruments and direct >vision. Noted, thanks. Just to clarify, iIf the pocket depth reduced, do we believe there is calculus below the bottom of the pocket? My understanding was that pocket depth reduction was a direct indication of reattachment of the gum tissue to the tooth surface, an idication of healty calculus free teeth below the attachment point Would not the "spicules of calculus that have evaded the curettes of the periodontists" prevent PD reduction? >> In >>fact, one of the slides always shown in perio lectures is the one where [quoted text clipped - 14 lines] > Would not the "spicules of calculus that have evaded the > curettes of the periodontists" prevent PD reduction? Gingivae will not re-attach to a dirty root surface. But remember, decreased pocket depth has two components--yes, there can re reattachment, but there almost invariably will also be gingival recession. Either process will decrease pocket depth, other measurements being equal. So frequently after a good scaling, calculus will become apparent which hadn't been before. Steve > >You forget the most important part: VERY frequent cleaning/disinfection > >by the dentist/hygienist. It can actually work out to be more expensive. [quoted text clipped - 8 lines] > the surgery alone would be less expensive ( I don't think you can, in > my math 1+ 1 is never less than 1) The example study you quoted with astonishing results advocated cleanings once per week, IIRC. > I don't disagree about the importance of cleaning, but in this case, > there was no professional cleaning in the last 6 months. The > important thing is to prevent re-establishment of the biofilm, and > agressive personnal hygiene can do this Once the plaque has grown down under the gum line, home care is no longer the first line of defence. Professional cleaning is. > Finally, cost is not the main point. It is truly nuts to hastilly > recommend the pain of surgery There is little hope in specific areas and situations if one doesn't change the height of the gum or modify the bone somewhat. In those cases, surgery can only perform the necessary modifications. >( and I've asked others who've had it, > there is pain) when simple hygiene can work. Simple hygiene can work on four mm pockets, once a good and thorough detoxification and root surfacing has been done. Beyond that, I always find areas that need surgery if one is to maintain properly. SP SignatureTake out the TRAASH to reply >> It would take a lot of cleaning (128/visit) to rack up 4 qudrant >> osseous surgery (4400) . >The example study you quoted with astonishing results advocated >cleanings once per week, IIRC. Good memory.. I see the source of confusion. > >> It would take a lot of cleaning (128/visit) to rack up 4 qudrant > >> osseous surgery (4400) . [quoted text clipped - 3 lines] > > Good memory.. I see the source of confusion. Not good memory... just from a practitioner's point of view, it really sticks out. Out here, they scream when we say they have to see us every three months. SP SignatureTake out the TRAASH to reply > Please, I'm not trying to be argumentative, only to explore the option > in greater depth. I live north of Boston and will explore registering > for the trial At the very minimum, I figure I'll receive good advice > there. I would recommend that you at least supplement the At with oral antibiotics of the same type. SP SignatureTake out the TRAASH to reply > As I understand it, the traditional surgery drastically reduces the > bacterial population, and exposes the remaining colonies to routine > cleaning. Just as the flora and fauna deep in the ocean are different from those closer to the surface (where there is sun and oxygen) the deeper you go into a gingival pocket, the more pathogenic are the bugs. Physically reducing the pocket depth predisposes to less aggressive bugs in the pocket. SP SignatureTake out the TRAASH to reply Since periodontal disease is caused by bacteria, isn't it possible that it is contagious? Mainly by tongue kissing or "swapping spit" as my daughter calls it? I was cleared of PD last year, but this year the bleeding came back. My wife has just been diagnosed with it and, of course, we "swap spit". So couldn't contagion cause this ping pong effect? >Since periodontal disease is caused by bacteria, isn't it possible that >it is contagious? >Mainly by tongue kissing or "swapping spit" as my daughter calls it? >I was cleared of PD last year, but this year the bleeding came back. My >wife has just been diagnosed with it and, of course, we "swap spit". So >couldn't contagion cause this ping pong effect? My understanding is yes.. it is contagious and you can re-infect by swapping saliva with an infected partner >>Since periodontal disease is caused by bacteria, isn't it possible that >>it is contagious? [quoted text clipped - 5 lines] >My understanding is yes.. it is contagious and you can re-infect by >swapping saliva with an infected partner Horse hockey. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>My understanding is yes.. it is contagious and you can re-infect by >>swapping saliva with an infected partner > >Horse hockey. Well... nothing like a clear opinion, but not much I can do with that;) I got my horse hockey info from the misinformed flammers at the american academy of periodontology http://www.perio.org/consumer/families.html "Transmission of Gum Disease Between Family Members Periodontal (gum) disease may be passed from parents to children and between couples, according to an article in the September 1997 issue of the Journal of the American Dental Association. This research concurs with other recent findings that support the association between periodontal disease and family members. Researchers suggest bacteria that cause periodontal disease pass though saliva. This means that the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member. Periodontal disease can lead to tooth loss. Based on this research, the American Academy of Periodontology (AAP) recognizes that treatment of gum disease may involve entire families. If one family member has periodontal disease, the AAP recommends that all family members see a dental professional for a periodontal screening. " >Well... nothing like a clear opinion, but not much I can do with >that;) I got my horse hockey info from the misinformed flammers at the >american academy of periodontology > >http://www.perio.org/consumer/families.html These horse hockey proponent s even managed to do a critical review J Periodontol. 1997 May;68(5):421-31. Related Articles, Links Bacterial transmission in periodontal diseases: a critical review. Greenstein G, Lamster I. Department of Periodontology, University of Medicine and Dentistry of New Jersey, Newark, USA. " This review paper addresses intra- and extra-familial transfer of bacteria associated with periodontal diseases. Recent advances in molecular biology provide sensitive methods to differentiate organisms within the same species, thereby facilitating tracking routes of their transmission. Evidence for the passing of microorganisms between parents and children is particularly strong. In this regard, molecular genetic techniques have demonstrated that if a child is colonized by a potentially pathogenic species, then one of the parents will usually harbor genotypically identical bacteria. The data also indicate that transfer of bacteria between spouses occur, but it appears to happen infrequently. Saliva appears to be a major vector for bacterial transmission. However, the transfer of organisms does not necessarily result in colonization or infection of the host. Furthermore, individuals who harbor putative pathogens frequently do not manifest any signs of periodontal disease. This is attributed to host defenses, bacterial antagonism, and possibly lack of pathogenicity of infecting organisms. It is concluded, based upon current evidence, that periodontal pathogens are communicable; however, they are not readily transmissible". >>Well... nothing like a clear opinion, but not much I can do with >>that;) I got my horse hockey info from the misinformed flammers at the [quoted text clipped - 32 lines] > periodontal pathogens are communicable; however, they are not readily > transmissible". This actually supports my contention that periodontal disease is unlikely to be transmitted--except via DNA. ;-) Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > This actually supports my contention that periodontal disease is >unlikely to be transmitted--except via DNA. ;-) It does.. it says you can transmit the micro-organisms, but they will not cause the disease unless the conditions are ripe ( DNA) for them It's a little different from what the AAP was saying. I suspect those subtle horse hockey purveyors make the implicit assumption that children share the DNA of their parents, and are more likely to develop the disease when exposed to the micro-organisms that cause the disease in their parents. --G >> This actually supports my contention that periodontal disease is >>unlikely to be transmitted--except via DNA. ;-) [quoted text clipped - 9 lines] > > --G Yes. BTW, bacteria associated with caries (esp. strep. mutans) are more easily demonstrated to be transmitted orally--and that in fact this ultimately does contribute to caries experience. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >Since periodontal disease is caused by bacteria, isn't it possible that >it is contagious? >Mainly by tongue kissing or "swapping spit" as my daughter calls it? >I was cleared of PD last year, but this year the bleeding came back. My >wife has just been diagnosed with it and, of course, we "swap spit". So >couldn't contagion cause this ping pong effect? Nyet. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Since periodontal disease is caused by bacteria, isn't it possible that > it is contagious? > Mainly by tongue kissing or "swapping spit" as my daughter calls it? > I was cleared of PD last year, but this year the bleeding came back. My > wife has just been diagnosed with it and, of course, we "swap spit". So > couldn't contagion cause this ping pong effect? It is contagious mostly only theoretically. Most of the bacteria responsible for periodontal breakdown are anaerobic. If you do not have pre-existing deep pockets, it is unlikely they would get a real foothold. Furthermore, while it isn't impossible, these anaerobes are unlikely to be found in high concentrations in the saliva. Periodontal disease is not as simple as a bacterial infection anyhow. There are host (immunologic) factors that influence greatly the susceptibility to breakdown even in the presence of potentially pathogenic bacteria. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > It is contagious mostly only theoretically. Most of the bacteria > responsible for periodontal breakdown are anaerobic. I was taught that the disease is bacterial, so therefore, the bacteria have to transfer to the new host somehow. However, the disease will only manifest itself if all the conditions are right for it. An infant with no teeth does not have any of these bacteria in the mouth, so when the adult acquires the disease, the adult had to have been infected from someone else. Very difficult to transfer anaerobic bacteria by kissing. Although, I suspect a few will sneak in. Signature/ Amatus / > >> Since periodontal disease is caused by bacteria, isn't it possible that [quoted text clipped - 15 lines] > > Steve > It is contagious mostly only theoretically. Most of the bacteria >responsible for periodontal breakdown are anaerobic. If you do not have [quoted text clipped - 5 lines] >susceptibility to breakdown even in the presence of potentially >pathogenic bacteria. Your point of view is similar to that stated in "Bacterial transmission in periodontal diseases: a critical review." cited above.. you can transmit the bacteria but it may or may not cause the disease BTW.. not all of it is bacteria, archaea is one of the mix .http://www.sciencemag.org/cgi/content/full/307/5717/1899 "In 2004, as part of their surveys of this crevice, Relman, Lepp, and their colleagues discovered that some of these more troublesome microbes weren't even bacteria. They were archaea, members of a group of microbes best known for thriving in extreme conditions." >> It is contagious mostly only theoretically. Most of the bacteria >>responsible for periodontal breakdown are anaerobic. If you do not have [quoted text clipped - 19 lines] > microbes weren't even bacteria. They were archaea, members of a group > of microbes best known for thriving in extreme conditions." That's a new one on me. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> BTW.. not all of it is bacteria, archaea is one of the mix >> .http://www.sciencemag.org/cgi/content/full/307/5717/1899 > That's a new one on me. It probably comes out of the Forsyth studies on microorganism in the mouth. As the article states they hae a technique to quickly categorize the species "The more severe the disease, the larger the archaea population--and that population shrank with treatments that lessened gum disease." >>>BTW.. not all of it is bacteria, archaea is one of the mix >>>.http://www.sciencemag.org/cgi/content/full/307/5717/1899 [quoted text clipped - 7 lines] > "The more severe the disease, the larger the archaea population--and > that population shrank with treatments that lessened gum disease." I was dimly aware of bacteria-like organisms that existed in extreme conditions. I did not know that they were considered taxonomically different from bacteria. I may need a refresher course on taxonomy. I don't know where rickettsiae , chlamydiae, and PPLO fit into this scheme. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >>>> BTW.. not all of it is bacteria, archaea is one of the mix >>>> .http://www.sciencemag.org/cgi/content/full/307/5717/1899 [quoted text clipped - 15 lines] > > Steve This is helpful in that regard: http://en.wikipedia.org/wiki/Monera Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Thank you all for your information on whether Periodontal Disease is contagious. I have concluded from your answers that Periodontal Disease is a figment of the ADA's imagination. All you dentists don't have a clue where it comes from. Simple and thorough cleaning seems to eradicate it. Do that with a lung infection. Also, the poor sap who dismissed kissing because it does not preserve the anerobic environment obviously needs lessons in deep tongue kissing. :0 So, is it, or is it not bacterial???? Richard >Thank you all for your information on whether Periodontal Disease is >contagious. > > I have concluded from your answers that Periodontal Disease is a >figment of the ADA's imagination. True, there is no such thing as periodontal disease ........ please do not tell the patients though. Joel > All you dentists don't have a clue >where it comes from. [quoted text clipped - 8 lines] >So, is it, or is it not bacterial???? >Richard >So, is it, or is it not bacterial???? >Richard Yes, but it is more than a single bug, . http://dentalschool.bu.edu/ce/spring2005/OralHealth/HaffajeePresentation_files/f rame.htm Slide 12 gives you a clue as to how they classify Slide 13 gives you an indication of the jungle down there Slide 14 gives you a clue whree these beasts live As near as I can make out, the whole point of preriodontal treatment is to get your gums in good enough shape that you can take care of them yourself. >>So, is it, or is it not bacterial???? >>Richard [quoted text clipped - 10 lines] > is to get your gums in good enough shape that you can take care of > them yourself. I had assumed so. The implication of this rationale is that if the patient then choses to not practice adequate oral hygiene they have accomplished just about zero. Years ago I put this to a periodontist at NYU when I was on the faculty. He felt that on a maintenance schedule of one recall every 3 months the bacterial flora was sufficiently disrupted that there would be significant benefit to the patient even in the absence of oral hygiene. I'm willing to accept that this could be true. However, all these years later I'm not totally convinced. In any case, I was skeptical of such a self-serving argument. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > I may need a refresher course on taxonomy. I don't know where >rickettsiae , chlamydiae, and PPLO fit into this scheme. > >Steve Another good place to look for info on archae is here http://en.wikipedia.org/wiki/Archaea --G >> I may need a refresher course on taxonomy. I don't know where >>rickettsiae , chlamydiae, and PPLO fit into this scheme. [quoted text clipped - 6 lines] > > --G ...and I will. Thanks--I find this fascinating stuff. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > doxycycline) topically, > and systemic use of low-dose doxycycline. In the topical application, > the rationale is to develop high local concentrations of antibiotic > without the other risks of systemic use. Which pre-disposes to resistant bacteria, as the bugs that were exposed in the sulcus but managed to escape into the blood vessels will develop resistance much quicker. SP SignatureTake out the TRAASH to reply >>doxycycline) topically, >>and systemic use of low-dose doxycycline. In the topical application, [quoted text clipped - 6 lines] > > SP Interesting idea. Of course the antibiotic concentration in the sulcus should be far higher than therapeutically necessary. However, at some distance from the sulcus obviously the concentration will be subtherapeutic. You'd think we're talking about organisms not normally found outside the sulcus, but this may be presumptuous. Steve > >>doxycycline) topically, > >>and systemic use of low-dose doxycycline. In the topical application, [quoted text clipped - 14 lines] > > Steve Well, we know they get into the blood: bugs with markers on them have been found to traverse to the blood side, at least in animals. That's where all the hype with Perio/systemic disease comes from. The original idea comes from a local OMFS who was giving a lecture here a couple of years ago. SP SignatureTake out the TRAASH to reply >>>>doxycycline) topically, >>>>and systemic use of low-dose doxycycline. In the topical application, [quoted text clipped - 18 lines] > been found to traverse to the blood side, at least in animals. That's > where all the hype with Perio/systemic disease comes from. Watch out! The focal infection people are watching!! Steve > The original idea comes from a local OMFS who was giving a lecture here > a couple of years ago. > > SP How long were the patients followed in this study? I'm thinking that if the patients were treated in 1994 and the results gathered in 1995 for publication in 1996, perhaps the results were only short-term. Who wants to take high doses of antibiotics every day for the rest of their lives? If they don't take the antibiotics forever, won't the perio pockets just get reinfected? (Remember that without surgery, the pockets remain, though simple root planing may reduce the depth somewhat.) And if they do take the antibiotics forever, won't that tend to develop resistant strains? This study was published in 1996. I wonder what those patients look like today. Without long-term followup, how can we know if the treatment was successful beyond the short period of the initial trial? - dentaldoc >How long were the patients followed in this study? Don't know... this is the point of this study of metronidazole at the Forsyth institute of Boston http://www.clinicaltrials.gov/ct/show/NCT00066001 They mention "demonstrated astonishing reductions in the subgingival microbiota which were maintained for 9 months after cessation of the professional program. The composition of the microbiota at 12 months in these subjects was similar to that found in periodontal health." >Who wants to take high doses of antibiotics every day for the rest of >their lives? If they don't take the antibiotics forever, won't the >perio pockets just get reinfected? At least not for 12 months after cessation, if I read the abstract correctly >... how can we know if the >treatment was successful beyond the short period of the initial trial? I believe that's the point of the study I'm quoting here But let me turn the question around a bit. Can we ask the same questions of traditional osseous surgery.I tried here, in an ealier post, and the gist of the response was that every case was so dependant on the individual patient it was impossible to give an accurate reponse. So let me parapharae your question How can I know if the traditional osseus surgery is successful beyond the short period after surgery? That, at base, is my concern before undertalking expensive and painful surgery. Where are the clinical trial that show traditional osseous surgery is successful years after the work is performed? As near as I can make out, they don't exist. When there is a recurrance of problem, it is blamed on the oral hygiene practices of the patient This Forsyth study by Haffajee suggests good results ( mocrobiota composition) at 12 months. Where is the similar study for oseous surgery? I've looked and came up with nothing.. >>How long were the patients followed in this study? > [quoted text clipped - 7 lines] > professional program. The composition of the microbiota at 12 months > in these subjects was similar to that found in periodontal health." Oh boy oh boy! Use of the word "astonishing" in a clinical study may be hazardous to your health! Look, I am not going to dispute this study. But you should know that use of metronidazole (some pretty nasty stuff, btw) in periodontal disease is a very, very old story. This is the first study I've seen that calls it "astonishing". Which for me begs the question--what in this study could possibly lead to an "astonishing" result when all the previous clinical findings have been, well, non-astonishing? Steve >>Who wants to take high doses of antibiotics every day for the rest of >>their lives? If they don't take the antibiotics forever, won't the [quoted text clipped - 26 lines] > composition) at 12 months. Where is the similar study for oseous > surgery? I've looked and came up with nothing.. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Oh boy oh boy! Use of the word "astonishing" in a clinical study may >be hazardous to your health! Hi I noticed that too, astonishing seemed an inappropriate word for a study. I chalked it up to enthusiasm, but it could be a problem indicator. Here I'm relying on the reputiation of the Forsyth institute and the fact " This study is currently recruiting patients. Verified by National Institute of Dental and Craniofacial Research (NIDCR) April 2005" Presumably NIDCR,and the Forsyth institute, offfer some control over enthusiasm > Look, I am not going to dispute this study. But you should know that >use of metronidazole (some pretty nasty stuff, btw) in periodontal [quoted text clipped - 3 lines] >to an "astonishing" result when all the previous clinical findings have >been, well, non-astonishing? OK.. here is where I could use some perspective again. I'm not a dentist or periodontist, and am unfamiliar with the previous work showing the downside. Also you note " metronidazole (some pretty nasty stuff, btw) " I looked up the warnigs here and the possible side effects sound awful, but that is true for most drugs I look up. Is there some effect in particular you were thinking about (btw, I'm a tea totaler, so the warning about alchohol does not apply, nor do I take any of the drugs listed as "bad" in conjunction with this antibiotic) http://www.drugs.com/metronidazole.html Thank you again for sticking with me and offering your opinion regards --G >OK.. here is where I could use some perspective again. I found a gneral review of the use of antibioics in rtreatment of periodontal disease ant the NIH "ffectiveness of Antimicrobial Adjuncts to Scaling and Root-Planing Therapy for Periodontitis: Summary" Their conclusions are in line with your observations.. Thanks again for the heads up --G http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.section.117049 "Of the antimicrobials investigated, studies of locally applied tetracycline and minocyclineand locally delivered chlorhexidinehave fairly consistent results in moderately large studies that often reach statistical significance; improvements observed in these studies typically average in the neighborhood of 0.3 mm to 0.6 mm. The other agents and delivery modes produced less consistent outcomes and fewer outcomes that reached statistical significance; the majority of studies showed small, statistically nonsignificant PD improvements." >> Oh boy oh boy! Use of the word "astonishing" in a clinical study may >>be hazardous to your health! [quoted text clipped - 33 lines] > regards > --G I don't have the PDR in front of me, so I can't list all the potential side effects or interactions. Obviously, you know it can't be taken with alcohol. It also seems to carry a risk of carcinogenesis. I know one of the more common side effects is a metallic taste. If you take on faith that it would require only one course of treatment per year or less, I suppose it could be used on a selective basis. I've seen nothing else to suggest that it is repository, nor how it would prevent repopulation of deep pockets with the expected pathogenic organisms. As you surely know, the deep pockets are both very difficult for the patient to maintain, and also provide a suitable environment for growth of these anaerobic bacteria. Steve Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } >...As you surely know, the deep pockets are both very difficult >for the patient to maintain, and also provide a suitable environment for >growth of these anaerobic bacteria. Steve Again thank you for sticking with me. I found a reference on "Long-term evaluation of periodontal therapy: . Response to 4 therapeutic modalities." Outcome depends on severity of disease, but improvemnts were noted for all interventions http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8 667142&dopt=Citation "Eighty-two periodontal patients were treated in a split mouth design with coronal scaling (CS), root planing (RP), modified Widman surgery (MW), and flap with osseous resection surgery (FO) which were randomly assigned to various quadrants in the dentition. .... All therapies produced mean PD reduction with FO > MW > RP > CS following the surgical phase for all probing depth severities. ...By the end of year 2 there were no differences between the therapies in the 1 to 4 mm sites. > Again thank you for sticking with me. > [quoted text clipped - 14 lines] > ...By the end of year 2 there were no differences between the > therapies in the 1 to 4 mm sites. Interesting. In this study modified Widman procedures look particularly bad. Note that there was a long-term improved result as far as pocket depth is concerned with osseous resection therapy. This is not totally unexpected--of course the aim is to save teeth. But it also points out that effective pocket elimination surgery makes subsequent oral hygiene and recall maintenance more effective, regardless the effort put into the oral hygiene. Thanks, Steve Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } > > Oh boy oh boy! Use of the word "astonishing" in a clinical study may > >be hazardous to your health! Not only that, but if one looks hard enough, one will almost always find a puplished study seeming to support the pet peeve of the patient seeking to avoid standard treatment. It seems to me that OralMedPharma (or what ever it is they call themselves these days) make a career out of pushing Xylitol pills, Flouride pastes and rinses, Atridox, etc based on studies reporting un-orthodox findings. JMO SP SignatureTake out the TRAASH to reply > But you should know that >use of metronidazole (some pretty nasty stuff, btw) Wikipedia was more straightforward is describing the problems with this drug. than ks for the heads up --G http://en.wikipedia.org/wiki/Metronidazole "Metronidazole tastes very bitter, and can cause headaches. Long term or high dosage administration of metronidazole can lead to peripheral neuropathy, which often manifests itself as a tingling or numbness in the fingers or toes. Patients who experience neuropathy should stop taking the drug and immediately contact their physician. Patients taking metronidazole must avoid consuming alcohol in any form (including cough syrup), as it will react badly with the medication, leading to severe nausea and cramping. Another common side effect is the darkening of the urine. Patients should drink plenty of water to avoid constipation. Patients taking metronidazole have also reported loss of appetite and mild nausea. Forcing oneself to eat, despite lack of appetite and fatigue, may reduce the nausea." > But let me turn the question around a bit. Can we ask the same > questions of traditional osseous surgery. When you do surgery, you reduce the pocket depth, so you eleminate the hiding places for the most pathogenic bugs. You must STILL maintain regular three or four month cleaning/disinfection appointments, as the gums can become inflammed again, with resulting further bone loss, etc. SP SignatureTake out the TRAASH to reply > How can I know if the traditional osseus surgery is successful beyond > the short period after surgery? [quoted text clipped - 4 lines] > can make out, they don't exist. When there is a recurrance of problem, > it is blamed on the oral hygiene practices of the patient Periodically use a disclosing solution to show you where your plaque is accumulating. If you keep up the regular appointments with the dental team, you should be able to jump on any new flare-ups of bone loss quickly. There is NO guarantee. It is simply that surgery/maintenence is the best we have right now. SP SignatureTake out the TRAASH to reply > > Could be fibrous--or fibrotic, but...what's wrong with "tough gums"? > > IMO... nothing. The periodontist said this type of gum tissue showed > little swelling or bleeding.. I took this to be a good thing Often happens when the patient is a smoker: the smoke products act as antiinflammatory agents, but also hinder or block healing. SP SignatureTake out the TRAASH to reply |
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