In October, I had the best time presenting on behalf of Bio-Botanical Research Inc [1]. to about 200 mostly dentists and dental hygienists in  Nashville at the America Academy of Oral Systemic Health (AAOSH) 2019 Scientific Session. My talk was titled “Up Your Game!” and discussed how to incorporate more biological, holistic practices into your dental health protocols and address the real root causes of dental diseases rather than poking and polishing at symptoms. Today’s post will add to that presentation and hopefully “up your game” as well!

TRADITION! TRADITION!

Dental hygiene (and dentistry) is nothing if not traditional. Change comes hard to us. We have basically been doing the same thing for the last 100 years. Polish, scrape tartar, and teach oral hygiene instructions. Unfortunately, the statistics show the percent of people with gum disease and dental cavities has not reduced. Forty two percent [2] of the US population has some level of gum disease, and tooth decay [3] affects almost half the world’s population.

Doing more of the same is not an option because we now know the oral systemic connection between heart disease and periodontal disease is casual [4]. We also know spirochetes are connected to dementia [5]. Spirochetes arrive in the brain and trigger a bacteremia. They slowly form biofilms which are impenetrable and result in Alzheimer’s dementia multiple decades later [6].

We MUST kill the spirochetes before they arrive in the brain. Today, I had a 10-year-old child with a spirochete infection within her gum tissues as evidenced on the phase contrast microscope. It is vital to address these pathogens in our very youngest clients to change the below statistic.

By 2050, it’s estimated there will be as many as 16 million Americans living with Alzheimer’s [7].

We suspect many more oral systemic links such as preterm birth [8] and stillbirth [9], chronic kidney disease [10], COPD [11], colorectal cancer [12], and stomach cancer [13]. It is time to Up Our Game and truly address oral diseases with new tools and a paradigm shift toward health.

SCALE AWAY, COME SCALE AWAY WITH ME…

The bedrock of traditional periodontal therapy treatment for periodontal disease is root planing or “deep cleaning”. The problem is it does not always really work all that well. We, the dental hygiene profession are leaving much calculus and biofilm [14] behind and damaging the root structure. On top of that, certain bacteria are immune to the scaler.

Problem one- leaving calculus. How can we remove what we cannot see? Yes, we have developed wonderful tactile sensitivity but that’s not enough. Unless you use an endoscope, you have no idea what is really left underneath the gumline. Much calculus is burnished and undetectable, plus there’s microscopic calculus (called sparkle) flecks. All undetectable, yet all still can harbor pathogens. We cannot remove what we don’t know is present. Another issue is overworking the root surface with blind scaling. When you can see what the scaler is doing to the tooth, it reduces the excessive removal of healthy tooth structure.

Ideally, all periodontal therapy should be done with the perioscopy unit to truly see and remove much more calculus. Would a dentist drill by tactile sensitivity? Would you want a surgeon who could not see the entire surgical site work by feel? No, neither would I. Seeing is believing.

Part two of problem one: the biofilm- in addition to removing the calculus, we need to also remove the sticky, thick biofilm still attached to the root. The biofilm is full of the pathogens that are the real root of the problem [15]. Several of the periodontal pathogens are immune to scaling [16] and remain behind- Porphyromonas gingivalis (P.g.), Aggregatibacter actinomycetemcomitans (A.a), Tannerella forsythia (T.f), and Parvimonas micra (P.m.) (formerly called Peptostreptococcus micros or Micromonas micros). The tissues remain infected with these perio pathogens, as do the tooth tubules.

We must test for pathogens, treat and then retest. Salivary diagnostics as well as a phase contrast microscope are excellent additions to our tool chest. Then, knowing what we are dealing with, we can introduce products that will kill these pathogens, and change the pH and the makeup of the microbiome.

SOMETHING IN THE AIR POLISHER [17]

Along with a perioscopy unit to enhance scaling, we should also consider adding subgingival air-polishing with glycine or erythritol to remove the pathogenic bacterial biofilm (Guided Biofilm Therapy [18]) [19]. Glycine and erythritol are safe to use on root surfaces, restorations, implants, and will debride the biofilm in pockets up to six millimeters. It improves healing for periodontal disease, peri-implantitis, peri-implant mucositis, and perio maintenance. We must address the biofilm and remove as much as possible to get healing of the tissues.

“Healing is a journey. It involves stepping out of our habitual roles, our conventional scripts, and improvising a dancing path.” – Gabrielle Roth

To help with disinfection and heal the gum tissues and periodontal pockets we need to treat the diseased gum tissues like a wound (which they are!). Proper wound management includes homeostasis, cleansing of the wound, analgesic, skin closure and dressing with follow up. My favorite disinfectants include ozone water and ozone gas, Liposomal Dentalcidin and iodine (50-50 betadine and ozone water).

Ozone is super oxygen and causes lysis of the pathogen’s cell walls almost instantly [20]. I insufflate the pockets using ozone gas and flush the pockets with ozone water in my piezo scaler. I may also use hand scalers dipped in ozone oil while scaling. It reduces post-operative sensitivity and speeds healing. At the completion of scaling and perio therapy, I irrigate all the pockets with Liposomal Dentalcidin in a 24-gauge side port cannula, (occasionally I will use 50% betadine iodine irrigation- depending on patient needs/sensitivity). I finish by having the patient swish with SalivaMax (if too numb then they are sent home with several packets to swish later). SalivaMax and a similar product named Nutrasal are powders of calcium and phosphate that when mixed with one ounce of water are excellent products to remineralize root surfaces and help heal mucositis [21]. They are prescription products made especially for dry mouth, remineralizing teeth and healing mucositis – perfect for wound closure and dressing.

THERE AIN’T NO BUGS ON ME [22]

Cleanse, disinfect and heal. Having the proper tools makes our jobs as dental hygienists/periodontal therapists so much more rewarding and successful and ensures better patient comfortable and faster, complete healing. Advance training is required to properly and safely use these exciting products. We need to go beyond the traditional. These tools are part of my protocols which also include a phase contrast microscope, salivary diagnostics, blood work and nutritional collaborations.

Patient dental health will always be subpar if we do not invest in these 21st century tools – the very best tools for the job ensure success and true dental and systemic wellness.

REFERENCES

1. https://biocidin.com/
2. https://jada.ada.org/article/S0002-8177%2818%2930276-9/fulltext?_ga=2.130696271.1765215342.1572147507-136947720.1572147507
3. https://www.fdiworlddental.org/oral-health/ask-the-dentist/facts-figures-and-stats
4. https://www.ncbi.nlm.nih.gov/pubmed/27899684
5. https://www.ncbi.nlm.nih.gov/pubmed/25932012
6. https://www.j-alz.com/content/pathway-alzheimers-disease-spirochetes-amyloid
7. https://www.alzheimers.net/resources/alzheimers-statistics/
8. https://www.ncbi.nlm.nih.gov/pubmed/30451673
9. https://www.ncbi.nlm.nih.gov/pubmed/23631577
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045269/
11. https://onlinelibrary.wiley.com/doi/abs/10.1111/odi.13228
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5159274/
13. https://aap.onlinelibrary.wiley.com/doi/abs/10.1902/jop.2017.160829?rfr_dat=cr_pub%3Dpubmed&rfr_id=ori%3Arid%3Acrossref.org&url_ver=Z39.88-2003
14. https://dimensionsofdentalhygiene.com/article/using-files-periodontal-therapy/
15. https://www.researchgate.net/publication/24191005_Microbes_inflammation_scaling_and_root_planing_and_the_periodontal_condition
16. https://onlinelibrary.wiley.com/doi/10.1034/j.1600-0757.2002.280106.x
17. https://www.stlyrics.com/lyrics/almostfamous/somethingintheair.htm
18. https://www.ems-dental.com/en/guided-biofilm-therapy
19. https://www.todaysrdh.com/air-polishing-weve-come-a-long-way-baby/
20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276005/
21. https://forwardscience.com/salivamax/faqs
22. https://genius.com/Jerry-garcia-and-david-grisman-there-aint-no-bugs-on-me-lyrics

BARBARA TRITZ RDH, BS, MSB

Specialist in Orofacial Myofunctional Therapy – Queenofdentalhygiene.net