The CDC estimates that 71% of adults 65 and older have periodontal disease, and nearly half of patients 30 and older show signs of it.1 These are the most recent statistics from the literature published in 2018. As a practicing hygienist, I can assure you that the current numbers of periodontal patients are much higher than they were pre-pandemic.
Periodontal disease is multifactorial and the complexities that have arisen from the ongoing COVID pandemic – e.g. social isolation, increased mouth breathing, increased oxidative stress and many other factors – further increase our patients’ periodontal risks.
When treating patients periodontally, we must think thoroughly about the root cause of the disease. The patient may be fighting any of the bacteria in the red complex that increases the risk of periodontal disease and tooth decay. Some innovations allow us to optimize the results of our treatment both in the chair and at home.
The truth about P. gingivalis
P. gingivalis it is also known as the “keystone” pathogen due to its destructive properties and high virulence factors even at low concentrations.2 “Periodontal pathogens are or have been associated with 16 systemic diseases to date, including cardiovascular disease, diabetes, respiratory disease, chronic obstructive pulmonary disease, rheumatoid arthritis, gastrointestinal disorders, Alzheimer’s disease, osteoporosis, kidney disease , premature birth, premature birth weight. and cancer”.3 Therefore, the preventive arsenal we use in the chair and in the patient’s home care regimen must be evidence-based and targeted to the type and levels of bacteria present.
Chairside protocol for periodontal disease
The best way to manage periodontal disease is to understand the levels and types of bacteria we are treating. Like blood work, once we understand what the patient is presenting with, we can determine a comprehensive treatment plan that will help eliminate a key factor in the periodontal disease process. Our hygiene protocols should include a way to target the complex bacteria, such as subgingival irrigation with a povidone-iodine product, low-level laser bacterial reduction therapy, and subgingival disinfection with subgingival powders such as erythritol.4-6
Additionally, it is essential to monitor the patient for airway dysfunction, such as mouth breathing and sleep apnea, as these can contribute to increased bacterial resistance.7
Home care recommendations
Chairside motivational interviewing is effective in preventive oral hygiene efforts. Once we determine exactly what the patient will be using at home, we can help determine the why behind our recommendations. Patient-specific recommendations based on the individual’s disease process are critical to long-term periodontal success.3 Dental professionals must commit to staying current with emerging science.
You may also be interested in… The first steps in treating the root cause of dysbiosis
Another factor in home care recommendations for patients with periodontal disease is pH balance. Clinical studies show that a patient with red complex bacteria has a more acidic resting pH in the mouth.8 The clinician should select products with ingredients that help promote remineralization, such as calcium, phosphate, xylitol, fluoride, hydroxyapatite, and CPP-ACP. Applying products such as probiotics to repopulate the good bacteria after SCRP treatment is a simple method to encourage symbiosis.
Put the “care” in patient care
It’s often said that people don’t care how much you know until they know how much you care. I find this to be true with patients. an established patient relationship is key to unlocking patient compliance. Historically, dentistry has centered around a fear-based model. “If you don’t brush and floss, you’ll get gum disease!” That may be true, but oral health is about more than brushing and flossing. This is how we train the biofilm to work For in our mouths instead of trying to eliminate all the bacteria. In some cases, brushing and flossing will be enough for a patient. Patients with dysbiosis need more support. These are patients who have minimal biofilm when exposed, little to no calculus, and a meticulous home care routine—yet have periodontal detection levels of 5-7 mm. Perhaps these patients’ oral pathogens have become resistant to the products they use, or perhaps a systemic condition has increased the severity of the periodontal disease. Social habits, such as smoking, can also contribute to keeping the patient in a state of dystopia. Patient cooperation and trust—as well as chairside testing to determine the level and type of red complex bacteria—are critical to disease management to achieve a more accurate assessment of the root cause of the patient’s periodontal disease.
You may also be interested in… It’s all about that biofilm
One of the most exciting parts of my career is transforming a patient’s mindset around their preventive care. Many patients believe that because their parents had periodontal disease, they will automatically develop it too. As preventive oral health specialists, we can equip patients with the knowledge and tools they need to reduce the risk factors they control in the multifactorial process of periodontal disease. There is no greater feeling than when patients achieve oral health under our care. Let’s stop the progression of periodontal disease together with a comprehensive look at the root cause.
Editor’s Note: This article appeared in the October 2023 print edition RDH magazine. Dental hygienists in North America are eligible for a free print subscription. Register here.
bibliographical references
- Gum disease. Centers for Disease Control and Prevention. Reviewed November 18, 2020. https://www.cdc.gov/oralhealth/fast-facts/gum-disease/index.html
- Olsen I, Lambris JD, Hajishengallis G. Porphyromonas gingivalis disrupts host homeostasis by altering complement function. J Oral Microbiol. 2017;9(1):1340085. doi:10.1080/20002297.2017.1340085
- Warner T. Define periodontal disease by its pathogens. The American Academy of Oral Health. 3 Jan. 2018. https://www.aaosh.org/connect/periodontal-disease-pathogens
- Moritz A, Schoop U, Goharkhay K, et al. Treatment of periodontal pockets with diode laser. Lasers Surg Med. 1998, 22(5):302-311. doi:10.1002/(sici)1096-9101(1998)22:5
- Sindhura H, Harsha RH, Shilpa RH. Efficacy of subgingival irrigation with 10% povidone-iodine as an adjunct to scaling and root planing: a clinical and microbiological study. Indian J Dent Res. 2017? 28 (5): 514-518. doi:10.4103/ijdr.IJDR_497_15
- Abdulbaqi HR, Shaikh MS, Abdulkareem AA, Zafar MS, Gul SS, Sha AM. Efficacy of erythritol powder air polishing in active and supportive periodontal therapy: a systematic review and meta-analysis. Int J Dent Hyg. 2022? 20 (1): 62-74. doi:10.1111/idh.12539
- Surtel A, Klepacz R, Wysokinska-Miszczuk J. The effect of breathing pattern on the oral cavity. Pol Merkur Lekarski. 2015? 39 (234): 405-407. Polishing.
- Baliga S, Muglikar S, Kale R. Salivary pH: a diagnostic biomarker. J Indian Soc Periodontol. 2013, 17(4):461-465. doi:10.4103/0972-124X.118317
