We hear 75% of patients have gum disease defined as bleeding when oral tissues are touched in spite of our best efforts; seeing them twice a year and advocating that they brush and floss. How can this be? Could dental professionals be contributing to this epidemic unwittingly?
As we and our patients learn of the association between gum disease and our overall health, we dental professionals need to remember that we treat a medical condition called periodontal disease. If any other medical or dental treatment regime delivered such poor results we would demand changes. Our profession needs to deliver better and more consistent outcomes.
One problem is that most people don't listen with the intent to listen but with the intent to reply. Consider the following questions with an open mind vs defending what we do because we have always done something a certain way:
In dental school I was taught to never etch dentine, that amalgam was the best filling material and that stomach ulcers were caused by too much acid produced by type A personalities. All of these truths are now false.
Perhaps it is time to re-evaluate our presumptions about periodontal disease, how it is caused, treated and prevented. A new paradigm is needed. Some thoughts and observations to consider:
Last week I saw pink in the toilet bowl @ 11pm. By 3 pm the next day I had an appointment with my physician to find out why. If a patient sees blood on their tooth brush or we dental clinicians see pink in the sink when they spit during a cleaning, why isn't everyone as concerned as I was when I saw blood in my stools?
Have we taught our patients to minimize bleeding by saying come back in 6 months and we will clean your teeth again? If my physician said to me come back in 6 months when I saw the blood in the toilet, I would look for a new physician immediately.
Gum infections never heal unlike a cut on our skin until there is no infection evident when we examine the tissues. They last 24 hours a day, 365 days a year for decades. The infection has a surface wound area dependent on the degree of infection that allows bacteria, viruses and blood products direct access to the bloodstream. A single bleeding point has a surface area of 4 sq mm, 50 have the surface area of a finger nail and severe gum disease 5 to 6 sq inches!
This open ulcer that does not hurt, swell, raise our temperature nor have an appearance we can use to diagnose infection, easily allows oral-systemic complications because the bacteria don't stay in the gums, but travels throughout the body via its arterial highways causing secondary systemic effects we all know about. They pose a constant risk to our
Gum disease first and foremost, is an infection. Are we treating it as an infection or a tooth cleaning issue? Does cleaning the teeth kill bacteria or prevent gum disease predictably? If not, why not?
For example, we all have an acid etch procedure that we know as a formula/recipe to follow. When we do the same steps we always get the same results with a good bond and no sensitivity. So, what is the gum disease formula equal to our acid etch formula? Why does every dental office have their own way to treat gum disease?
Do we spread the infection when we use scalers in infected sites and put them in healthy areas? Would you allow a physician to use instruments from an infected site in another healthy area of your body if you were having 2 surgeries? Why do we do it?
Do patients know they get gum disease from saliva transfer and that they put those closest to them at risk for life threatening infections if they have gum disease? Do you think it would motivate them to better home care if they knew?
What is the purpose of a hygiene visit? I feel it is to discuss new information on the oral-systemic links relative to that patient, reviewthe cause of periodontal disease, disclose biofilm, demonstrate the existence of disease ( bacterial testing, measuring pockets, counting the of bleeding points on probing and do a papillary bleeding index with a soft pic ), review home hygiene such as brush your gums and clean between the teeth with a SoftPic or StimuDent in order to clean the teeth and gums at the same time ( a method patients will actually use 85% of the time, vs flossing 8 % of the time), disinfect the pocket lining with antimicrobials before scaling, and then clean the teeth.
When a patient flosses the floss cleans the tooth but it is impossible for it to push against the gum's biofilm at the same time as the tooth is engaged, so the biofilm remains less disturbed than using a soft pic or stimudent. Physicians bring the patient back if a patient is diagnosed with a medical condition to see if the therapy is working. If there is significant bleeding we should do the same.
I for one, have been using an antibiotic rinse and spit mouthwash that reduces bleeding and pockets by over 80% in two weeks to help control the infection and reduce oral-systemic complications.
Dr Jim Hyland
About Our Guest Blogger:
Dr. Jim Hyland is a general dentist who has a primary focus on developing hygiene protocols that get patients healthy quickly and inexpensively by engaging the patient in the most effective self care we can teach them. The Oral Systemic Link is becoming front and center as we consider periodontal disease a medical problem dental professionals treat. He is in private practice and president of Oravital Inc. He believes the standard hygiene appointment does not tackle the cause of the infection but addresses the symptoms so patients do not routinely get healthy. In his opinion, change is required ASAP.