Women in Dentistry - Blog

By: Kerry Lepicek & Beth Parkes

Have you, or one of your team members ever been referred to as a tooth cleaner? Maybe worse, a tooth scraper? Does this make you feel undervalued? This issue is not a new revelation, and yet, we feel the need to address it once again, and empower you to rise and take hold of your extraordinary calling that extends far beyond cleaning teeth.

The war against periodontal disease is not for the easily shaken. It demands strength, endurance, grit, and grace. As we know, the recent CDC report states that 47.2% of adults over the age of 30 have some form of periodontal disease, and that this increases to 70% over the age of 65. This discouraging statistic places an immense calling on us as dental professionals.

As oral health specialists, we need a solid understanding of the bacterial component of the disease, the host-immune response, and the oral systemic implications. It is time that we abide by current research to implement positive changes and improve our clients’ oral and systemic health. The American Academy of Periodontology states that periodontal disease is “Inflammation of the periodontal tissues resulting in clinical attachment loss, alveolar bone loss, and periodontal pocketing.” Do we, the prevention specialists, feel adequately prepared to deal with the inflammatory component of periodontal disease?

It is imperative that we employ treatment modalities that will impact the host and inflammatory response. Bacteria will cause the initial localized infection, but inflammation and the subsequent host response will dictate how the disease progresses.

Although periodontal disease is multifaceted, the recolonization of keystone pathogens is worthy of strategic confrontation. Keystone pathogens bind to host cells and penetrate the local epithelial lining. This triggers the inflammatory process in the body’s attempt to protect itself. Inflammatory mediators are sent to the infected tissue, with tissue restoration as the intent. For a healthy individual, this process functions well; however, when the inflammation is chronic, as it with periodontal disease, these inflammatory mediators are overproduced. Pathogenic bacteria continue to proliferate and become out of control leading to bone and tissue destruction.

Fundamentally, periodontal disease requires meticulous removal of oral biofilm. If we reduce the pathogenic bacteria load, we can reduce the stress on the body's immune system. However, research has shown that, with traditional periodontal debridement, although the bacterial load is suppressed, these pathogens may return to baseline levels within days or months.” This means that in addition to pristine removal of the oral biofilm, there are other adjunctive therapies and home care strategies we should consider to help manage the inflammatory burden.

The diode laser is a valuable adjunctive therapy tool when considering the bacterial component, host-immune response, and oral systemic connection. Diode laser energy is attracted to, absorbed by, and therefore interacts with melanin, hemoglobin, and water. This means the laser will interact strongly with red complex bacteria and inflamed tissue but less with gram positive bacteria and healthy tissue. Once absorbed, the laser energy creates a mild photothermal reaction in the targeted bacteria creating a temperature rise until the cell vaporizes through lysis of the cell membrane. The diode laser can access trapped microorganism colonies hidden within the granulation tissue and epithelial lining. This reduction of bacteria is far beyond what we can achieve through mechanical instrumentation alone. Furthermore, research has shown that lasers can also lead to a delay in the recolonization of pathogenic bacteria for up to 90 days.

In addition to this reduction of pathogenic bacteria, studies have shown that the laser has a favourable impact on the host response. One study highlighted the laser’s ability reduce inflammatory mediators including MMP-8, MMP-1 and TIMP emphasizing how lasers can enhance non-surgical periodontal therapy outcomes. As previously discussed, when a disease becomes chronic, we see an overproduction of these inflammatory mediators, MMP-8 or collagenase being a key offender. With nearly 60% of our oral soft tissues being comprised of collogen, and 90% of alveolar bone made up of collagen, collagenase is a not to be underestimated.

Let’s look at some of the bacteria associated with periodontal disease and discuss further options to identify and reduce them.

Why test?

Have you ever looked into your client’s mouth and wondered why their tissues are not responding as you would expect? Perhaps you need to take a closer look at your client’s salivary bacterial profile. We can access the client’s bacterial risk by analyzing their periodontal, Candida and Streptococcus mutans pathogen load. Understanding the type of bacterial species, as well as the amount will help guide treatment recommendations and improve your clinical outcomes.

The bacteria in the mouth are not restricted to living within pockets or the oral environment exclusively. When we see bleeding in the mouth, these pathogens can become bloodborne and gain access to travel throughout the body wherever blood flows. These periodontal pathogens have now been associated with systemic diseases such as, rheumatoid arthritis, cardiovascular disease, diabetes, and Alzheimer's.

Educating clients about the association between systemic diseases and periodontal disease inspires them to accept the recommended treatment plan. DNA testing can serve as a risk assessment tool by providing details regarding their pathogen profile and load. This valuable data can guide a personalized periodontal therapy treatment plan by objectively identifying their risk.

OraVital’s BiofilmDNA™ testing method collects samples from the saliva, supragingival and subgingival biofilm, and the tongue. The analysis reveals the levels of specific pathogens and the overall biofilm burden. BiofilmDNA™ tests for:

• Red Complex bacteria: Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia
• Orange complex bacteria: Peptostreptococcus micros and Fusobacterium nucleatum
• Streptococcus mutans
• Aggregatibacter actinomycetemcomitans
• Candida albicans

The DNA report will detail the quantity of specific pathogens through a logarithmic scale making it easy to see changes in the bacterial population and evaluate treatment modality results.

Further Treatment Options:

In combination with a clinical evaluation, bacterial DNA testing is a useful tool for determining treatment options. As previously discussed, lasers are an excellent option for reducing the bacterial load, impacting the host response, and promoting healing.

In additional to lasers, antibiotic rinses can also be considered to reduce the bacterial load. An antibiotic rinse delivery method results in high saliva levels to target subgingival biofilm, the tongue and back of the throat for a whole mouth treatment. The rinse is formulated to target the bacteria from the DNA profile.

Research shows, using an antibiotic rinse can reduce bleeding on probing by 87% and pocket depths by 1-2 mm within 2 weeks. OraVital’s rinses are compounded using a variety of antibiotic and antifungal combinations, including metronidazole, tetracycline, amoxicillin and/or azithromycin in combination with nystatin.

As dental professionals, we should strive to reduce the oral pathogenic bacteria load to help control the inflammatory response. Client-clinician collaboration is imperative. We must effectively motivate our clients to control the oral bacteria at home with prescriptive homecare recommendations. We have the opportunity to change our clients’ habits through the introduction of innovated tools.

In a recent 12 weeks study, a test group and control group were compared. All subjects in the test group used an oscillating rotating power brush, floss, CPC rinse and a stannous fluoride dentifrice. The control group used a manual toothbrush and sodium fluoride dentifrice. After 12 weeks, 100% of the test group transitioned from gingivitis to a healthy (<10% bleeding site) while only 7% the control group transitioned to healthy.” The study also “found that the test group had a statistically significantly greater reduction in whole-mouth, interproximal, and gingival margin plaque score versus the control group at Weeks 1 and 12.” Your clients can also achieve these results by following the recommendations above. Offering the home essential kits in your practice provides an easy-to-implement program for your clients. They will present with less inflammation and bleeding resulting in an easier appointment for both client and clinician.

Conclusion:

Only after reviewing our objective assessment data can we create an ideal treatment plan, both in office and at home. By addressing periodontal inflammation, and periodontal pathogen load, we can help mitigate other chronic inflammatory conditions at the same time. We need greater collaboration with our clients and increased focus on the oral systemic connection if we are to propel the profession forward. Keep encouraging and motivating your clients, implementing new tools, and remaining focused on the journey towards optimal oral health with your clients. Periodontal disease is multifactorial and requires more than manual debridement. It is time to shift away from being tooth cleaners and move towards becoming wellness practitioners.

Check List: 5 Key Takeaways

1. Make prescriptive home care recommendations for your clients to follow at home. Offer your clients a professional discount to buy an oscillating rotating brush system from your practice. Your clients will appreciate the convenience and cost savings.
2. Implement DNA Bacterial testing as part of your risk assessment protocols. Reach out to www.oravital.com for more information.
3. Educate your clients about the benefits of adding laser therapy to improve your periodontal therapy outcomes.
4. Become laser certified through rdhu and learn how to create a successful laser program in your practice. www.rdhu.ca
5. Order your compass 6 today form www.dentalcare.ca to access a free recorded webinar on incorporating bacterial testing and lasers.