Periodontics

Just as in your practice you work to treat the effects of and diminish future damage due to periodontal disease, you likely see many patients who are also affected by the other common biofilm disease, dental caries.  As you readily realize in periodontal therapy, unless you can reduce the patients' behavioral risk factors, shift the population of pathogenic bacteria, and eliminate the deep pocket environment they thrive in, there is little chance of managing this disease.  The same need exists in general dentistry and a shift toward a medical vs. surgical model is quickly emerging.  You may even be able to identify some current patients in your practice that would benefit from having more than the “drill and fill” method of treatment.  Through this medical model there would be a greater chance of having more predictable results with their future dentistry.

The latest research on the caries infection has now identified a few key concepts:

• This infection is not pathogen specific, it is a biofilm disease and there are now 23 identified strains of bacteria, any combination of which may contribute in an individual.
• pH is the strongest “selection pressure” that determines whether these cariogenic strains are present at pathogenic levels.
• There are some key risk factors that can determine our patients’ susceptibility to this infection.

This need to treat the bacterial infection component in dental caries is now being addressed using antimicrobial agents that are not only broad-spectrum enough to affect the range of pathogens at play, but also a strong enough oxidizing agent to penetrate and dissolve the complex biofilm structure. Not surprisingly, many dentists report that the same agents that are used and effective in treating dental caries also exhibit good clinical effects in treating the bacteria and reducing inflammation associated with periodontal disease.

 

Solutions for Your Practice

• Read the article “Selection of antimicrobial agents in periodontal therapy” Jorgen Slots, University of Southern California School of Dentistry, Department of Periodontology, Los Angeles, CA, USA.
• Discuss with your referring dentists their caries management protocol.
• Consider the pH of the dental products you choose, understanding that alkaline products give you the opportunity to neutralize the oral environment and promote healthy bacterial growth.