I think it is important for readers to understand that you may not be at fault for your gum disease (unless you don't at least try to brush and floss). The following are exact excerpts from the dental literature that demonstrate even if you follow the directions of your dentist you may not be able to adequately control the cause of gum disease that is also associated with a host of systemic complications.
This first one is an excerpt from a professional journal. Every possible treatment was done and they evaluated the bacterial (cause) results at one year. No one is going to do all of these steps, but even with this the bacteria that cause the disease are prevalent at one year. How can people be responsible if we (the dental profession) don’t give the patient the tools to control the disease.
Shiloah J, Patters MR, Dean JW 3rd, Bland P, Toledo G J Periodontol. 1998 Dec;69(12):1364-72
The prevalence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Bacteroides forsythus in humans 1 year after 4 randomized treatment modalities. 1) scaling and root planing; 2) pocket reduction through osseous surgery and apically-positioned flap; 3) modified Widman flap; and 4) modified Widman flap and topical application of saturated citric acid at pH 1 for 3 minutes.
Patients rinsed with 0.12% chlorhexidine for the first 3 months postoperatively and received a prophylaxis every 3 months.
The choice of treatment modality did not affect the prevalence of the target species at 1 year post-treatment. These results suggest that prevalence of microbial pathogens negatively affects the 1 year outcome of periodontal surgical and nonsurgical therapy.
This second one was the results from the University of Florida that was presented at one of the major research meetings. The bacteria (cause of gum disease) were found to be the same in the periodontal pocket before and after professional (gold standard scaling and root planing) cleaning. How can the patient control the disease if we the profession leave the cause in place?
Differences between Biofilm Growth Before and After Periodontal Therapy
Resposo S et al. University of Florida, Gainesville, FL
Objective: The purpose of this study was to evaluate in vitro subgingival biofilm growth from plaque samples collected before and after scaling and root planing (SRP). Methods: Subgingival samples were collected before and after SRP from a 5mm pocket or greater with bleeding, along with 5ml of saliva from 9 patients diagnosed with chronic periodontitis. Calcium hydroxyapatite discs were coated with 10% filtered sterilized saliva for 2hrs, placed in 5ml of Trypticase Soy Broth (TSB) and innoculated with 100ul of dispersed subgingival plaque. Biofilms were grown anerobically at 37ºC for up to 10 days with transfer to fresh medium at 48 hour intervals. Biofilms were then processed at specific intervals for total viable counts and the species present were evaluated and semi-quantified by DNA-DNA hybridization. Biofilm composition was also analysed by Scanning Electron Microscopy (SEM). Results: Samples taken before SRP harbored more bacteria than after SRP (107 versus 106, p=0.004). However, both sets of biofilms grew at a similar rate, reaching a peak CFU of ~108 cells as early as day 3 (p>0.05). Samples taken after SRP presented the same species as those samples taken previous to the procedure, but in less quantity (p<0.001). Greater amounts of red complex bacteria and A.actinomycetencomitans (~104) were found both before and after SRP when compared to other species (~102). SEM analysis showed growth of a complex structure comprised of rods, cocci,fusiforms and filaments in both sets of mature biofilms.
Conclusion: Subgingival biofilms before and after SRP treatment present the same composition of bacterial flora and are able to grow similarly if given proper conditions. Therefore, subgingival bacteria that remains after SRP therapy has the potential to recolonize to pretreatment levels if not properly maintained.
If you the patient do what we (dental profession) tell you and you still suffer a deterioration of the disease over time it is because you were not compliant? A patient has to be compliant, but you also have to be shown a method that works!
J Clin Periodontol. 2003;30 Suppl 5:4-6.
Improving oral health: current considerations.
Ciancio S.
School of Dental Medicine, University of Buffalo, SUNY, Buffalo, NY 14214, USA.
The high incidence of periodontal disease among adults in the Western world indicates that in most cases, routine dental care could be considerably improved. The progressive effect of the disease suggests that improvements in oral cleanliness are mandatory if large numbers of adults are to retain their teeth into old age. Data show that periodontal disease can be minimized through effective plaque control, and that a combination of brushing, interdental cleaning, and chemotherapeutic agents (e.g. mouthwash) is beneficial to patients with plaque control problems. The vast majority of adults do not follow an adequate home-care routine. Average brushing times are low, and only a minority of patients regularly floss. In addition, in those patients who do regularly brush and floss, a deterioration of plaque control occurs over time, suggesting that compliance is a major issue. The principal challenge for dental professionals is to identify how best to elicit an improvement
I do agree with his last sentence that we have to find a way to elicit an improvement.
Our research published in the Journal of Dental Research 2007, Vol 86 show we kill 99.98% of the bacteria in 17 days that are in the periodontal pocket (the same bacteria left in the first two articles). Perhaps patients do not need to beat themselves up, but realize they now have a choice which works.
Later I will post some excerpts that illustrate just how related these bacteria relate to cardiovascular disease, pre-term low birth weight, Alzheimer’s disease, arthritis, cancer, stroke, etc.
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