Old Alabama Family Dentistry

The Enemy Below

Periodontitis—a word that instills fear in some people, a word you don't want to hear from your dentist.

Periodontitis is a chronic bacterial infection that destroys oral tissues and the jawbone. The American Academy of Periodontology estimates that one in three people over thirty years of age have periodontal disease (commonly referred to as perio).

Periodontitis generally is the result of improper and inadequate oral care. However, there are other factors that contribute to this disease, including tobacco use, genetics, medications and poor nutrition.

Yes, periodontitis is an arch-enemy to be reckoned with, but today, dentists have new ammunitions in their arsenals to treat this dreaded disease.

Testing–testing...

When your hygienist begins your routine exam, you likely see an instrument with a wire that is used to poke around your teeth. That is the periodontal probe (see photo), an instrument that has been in use for decades. The periodontal probe uses a measured wire to determine the depth of the sulcus. Sulcus are gaps between your teeth and gums that provide a hiding place for harmful bacteria to secretly grow. A measurement of 4mm on the periodontal probe indicates that the sulcus are now periodontal pockets. When your body tries to fight the bacterial infection, it mistakenly attacks you! This is evident when the probe indicates gum recession and when the gum bleeds when it is probed.

Using the dental probe to explore around each tooth is quite time-consuming. Today, in some offices, there is a pocket-sized instrument that uses only 1 drop of your saliva to tell the hygienist within 10 minutes, not only if you have perio, but how advanced the disease is.

Perio 911

There is a great deal of activity in the scientific community to find an effective treatment for perio (see photo). Currently, there is one treatment already in use and four possibilities that are still in the early testing stages.

1—A treatment that is growing in popularity is a custom-fitted tray that contains antibiotics. The length of time the patient must keep the tray in the mouth depends on the severity of the disease. Generally, patients wear the device only a few minutes each day.

2—In the near future, perio sufferers may be able to kiss their perio goodbye by using a medication that will be placed in the periodontal pockets. The medication contains salicylic acid (an ingredient in aspirin) and three antibiotics.

3—Researchers have discovered that if a specific cell function can be blocked, gum inflammation and bone loss (see x-ray photo showing healthy bone level and severe bone loss) from advanced perio can be prevented. If testing continues to show good results, perhaps another medication-delivery system will be created for perio sufferers.

4—The American Academy of Periodontology announced that a treatment called Photodynamic Therapy (PDT) could be even better than treatments that use antibiotics. The downside of using antibiotics is that bacteria eventually become resistant to antibiotics. PDT uses a light-sensitive drug that is applied to the area that has perio. A light or laser is shone on the area. The light causes reactions in the drug. The reactions kill bacteria that cause perio.

PDT was approved several years ago by the FDA but at that time, only for treating pre-cancerous skin lesions on the face and scalp.

5—Researchers have discovered that melatonin might protect the oral cavity from bone loss and help the body to defend against a perio attack. Melatonin has important roles in the body, including regulating our sleep cycle and fending off enemies that cause cancer and some autoimmune diseases.

Light at the end of the tunnel

The future looks dim for periodontal disease and bright for the patient! We look forward to the day when perio will receive only a passing mention in a textbook that discusses ancient dental diseases that are no longer seen by the dentist.

But until that time, as always, we strongly urge our patients to keep up the good work brushing, flossing and maintaining a regular check-up routine. Remember, your dental healthcare team is on the front line of defense to help you have a healthy mouth and teeth. Protect your smile, call for an appointment, and let's discuss your dental healthcare goals!