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As you
may well know, the primary purpose of our office is to facilitate
our clients to optimum oral health which includes their learning
and understanding what might be working against it. It is well established
that oral bacteria which are organized into dental plaque not only
cause halitosis (bad breath), decay and gum disease, but are the
main culprits that cause bacteremia*. This is why persons who have
heart defects from rheumatic fever for example, require antibiotics
prior to having their teeth cleaned to protect them from the effects
of bacteria introduced into their blood stream during dental hygiene
visits. (See "Getting
to the Heart of Dental Disease") We feel a strong
obligation and responsibility to offer all our clients an opportunity
to assess the status of their oral bacteria. The practice has invested
in a new state of the art Nikon microscope which essentially lets
us have our own laboratory on premises. If you are interested in
determining whether your oral bacteria are causing problems of which
you may not be aware (offending breath or gum disease:bacteremia),
please call the office for a complimentary assessment.
*
"In almost all ailments of the heart caused by bacteria the
source of the infection is known to be the pathologic and infected
environment of the teeth…. Under these circumstances the health,
welfare and even life itself of persons who have heart conditions
which predispose to infection may depend upon prevention and control
of dental disease. Caries (decay) is a source of bacteremia (bacteria
in the blood stream) only, and then temporarily, from advanced-stage
lesions involving infection of the pulp. Bacteria in the
periodontal pocket and in the diseased periodontal tissues are the
source of almost all bacteremia from the environment of the teeth….I
believe that, at some time in the future, leading cardiologists
will wonder, in retrospect, how information so needed by their patients
could have been overlooked or neglected for so long."
Bacteria
are in my mouth?
Yes, many, many, bacteria enter your mouth every time you put anything
in your mouth, eat or drink, kiss, swim, or even brush your teeth!
These are reasons why you want to wash your vegetables, fruit, meats,
etc. before cooking, refridgerate or freeze foods promptly, select
carefully who you are intimate with, and clean and change your toothbrush
regularly, for starters. Although your mouth will never be completely
bacteria-free, it is important to keep the level of bacteria as
low as possible.
What is a bacterial infection and how does
it effect my health?
Simply, it is a response from your body that too many bacteria are
collected in one place and the body is having a hard time tolerating
them or destroying them. First, it is important to mention that
bacteria are living organisms. They eat (sugars), and they produce
waste products. It is usually the waste products that irritate your
body the most. In your mouth, these are strong acids. There are
many different breeds of bacteria and, therefore, varying levels
of pathogenicity (harmfulness) associated with these different types.
Incidentally, these various acids are the chemicals that burn holes
in tooth enamel which we refer to as cavities. So, if these are
strong enough to burn a hole into the hardest structure in your
body, imagine how they will harm one of the most tender tissues
in your body--your gums. These acids break down the layers of tissue
and form sores at the site of infection. Often these are very tiny
and often undetected (without pain) by the host. These are portals
(doorways) for bacteria to enter into your body and bloodstream.
They like the bloodstream because there is food (blood glucose)
and even oxygen for the Staphylococcus Aureus bacteria, the most
common form found to influence heart disease, atherosclerosis (hardening
of the arteries) and cerebral vascular accidents (strokes).
What is gingivitis and periodontal disease?
These are infections of bacteria in the periodontium (the tissues
which support and anchor the teeth in your jawbones). The bacteria
mentioned above, especially certain types that prefer dark, warm,
unoxygenated environments, move into the area between the tooth
and the gum. This space is called the sulcus.
What
is most relevant is how the body responds to this presence of bacteria.
This depends upon the host's resistance. Resistance depends upon
the person's immune system strength, the level of nutrition in one's
diet, the level of stress and the amount of sleep in one's life,
and the frequency and thoroughness of one's oral hygiene routines.
Some other obstacles can be systemic health conditions, the use
of medications, smoking, alcohol consumption, and high acid contents
in one's diet (especially coffee).
So the acids penetrate the gum tissue and the raw sores trigger
the body to try to heal itself. It will first try to repair the
tissue as it would a cut on your finger, with red and white blood
cells often eliciting a swelling and redness--Gingivitis.
Now the clock starts, because the body gives a certain amount of
time for this process. Each person's time limit will be unique to
them; this may depend upon genetic factors, stress, nutrition, immune
system strength, etc.
If the body chooses it will need another approach, a second form
of healing will be initiated. The body sends 'receptor' cells to
get identification of the 'foreign matter' that has invaded. The
bacteria have a cell wall that is made with a matrix of collagen,
so the receptor cells report this information to the brain. The
brain sends a command to produce a chemical, an enzyme called collagenase,
and deposit it in the sulcus where the bacteria are. To some degree,
this will destroy some of the bacteria, but research has found this
not to be very successful overall, because so many people have periodontal
disease which persists for years and years. The unfortunate consequence
of the body putting this enzyme into the sulcus is that this enzyme
destroys any collagen it comes into contact with--and guess what
the fibers (called the periodontal ligament) are made of that attach
the gum to the tooth and anchor the tooth to bone ? Collagen! This
is Periodontal Disease, a permanent loss of the attaching
supportive structures for the teeth.
How do I know if I have this infection?
Periodontal Disease will be noticeable when the gums are measured
during a periodontal examination where the dental hygienist measures
how deep the sulcus space is. A shallow measurement of 1 to 3 millimeters
is ideal. An absence of bleeding is also a good sign. Healthy gums
do not bleed when measured. An exception to this rule is in smokers,
who will have constricted blood flow to peripheral areas. If measurements
of 4mm or above are detected it will be important to identify the
source of the problem. More often it will be related to the presence
of bacteria. In selected cases, strong biting forces that aren't
distributed equally can cause periodontal inflammation and destruction
around the affected teeth. Dr. McBride can evaluate your bite to
rule out this possibility.
A microscopic
bacterial examination can then provide progress in the diagnosis.
Because there are so many different breeds of bacteria, it is important
to try to identify what type is causing the inflammation. Some bacteria
are easier to destroy than others, some are more harmful than others.
An examination
of radiographs (x-rays) is necessary to look at the level of 'crestal'
bone between the teeth. Bone can appear lost horizontally or vertically.
Horizontal bone loss shows a loss of bone between many teeth, like
plateaus. Vertical bone loss involves single teeth and appears like
there was a land slide in the direction of the involved tooth. When
bone loss is present, the dental hygienist will look for recession.
Recession is the name for exposed root surfaces due to the loss
of attachment. Sometimes, though, recession can be present on the
cheek sides of the teeth where bone loss is present but undetectable
by the view of radiographs, it is seen visually. This has been commonly
referred to as toothbrush abrasion, although this manifestation
is seen in the mouths of cats, dogs and monkeys that don't use toothbrushes.
This is not to say that one cannot do damage with a toothbrush,
on the contrary! But dentists now realize that there are other dynamics
that contribute to recession, namely, the bite and function of the
teeth. If recession and a pocket in the sulcus is present, these
measurements are added together to equal the total loss of attachment.
So what if I have Periodontal Disease?
Well, of course, you have the option to not do anything if you have
Periodontal Disease, but two things could happen. One is loss of
teeth, eventually. This can be slow or rapid, there is no way to
predict from person to person. The second is a risk of heart disease,
atherosclerosis (hardening of the arteries), cerebral vascular accident
(stroke), premature birth, low birth weight, or complications of
diabetes. These conditions, like tooth loss, are unpredictable and
occur due to bacteremia, a consequence of periodontal disease lesions
on the gum tissue.
The
good news is that, contrary to what was believed years ago, periodontal
disease is curable. It was once thought that once you have it, there's
no cure, your only hope is to maintain it. But we have found that
the infection is much like any other (Strep throat, conjunctivitis,
bronchitis), with adherence to some home work like new brushing
methods, flossing, using antibacterial brushing agents, rinses or
irrigants, vitamins and doing these things as frequently as recommended,
we have always seen success. Of course, there can be individuals
that need a hygienist's and periodontist's attention or treatment
too to achieve an eradication of periodontal infection, but it is
possible. But the infection can return, much like the infections
listed above that occur in other parts of the body, if you come
in contact with enough bad bacteria again. And, since, bacteria
do enter your mouth many times throughout the day, it will be a
good daily routine that maintains good dental health. See "Periodontal
Therapy" and "Home care instructions" for more information.
What is bacteremia?
This is what they call the presence of bacteria in the bloodstream,
most often entering the body from diseased gum tissue in the mouth.
Obviously, this is not a good thing for the body. Bacteria like
it though, because they have everything they need and there really
isn't anything that is going to kill them, at least in normal conditions.
The bacteria nest with sticky cholesterol lipids on artery walls
and heart valves. Sometimes these plaquey deposits can become dislodged
and move through the arteries which can lead to a blockage of the
artery, if this happens in the brain, a stroke occurs. Bacteremia
can complicate diabetes, yet control of Periodontal disease has
been shown to improve diabetic condtions. Also pregnant mothers
with periodontal disease and bacteremia have a risk of premature
or low birth weight babies. For more information, skip back to "What
is a bacterial infection..." (above).
What about antibiotics?
Antibiotics do destroy bacteria, but cannot be used daily without
causing resistant strains of bacteria to form. This is a global
health issue which we would not want to encourage, so we don't resort
to antibiotics except in the worst case scenarios. As well, it really
is a backwards solution to Periodontal disease. Attack upon bacteria
with floss, brush, rinse, irrigator, vitamins and time has been
the most successful long term control of the health of one's mouth.
BUT, there is a common use for antibiotics in dentistry for specific
people. This is prophylactic (pretreatment preventive) antibiotics
for persons with a health history which indicates previous rheumatic
fever, heart murmur, mitral valve prolapse or use of Phen-Fen. Despite
the fact that bacteremia can occur daily in individuals with Periodontal
disease/Gingivitis while brushing, flossing, etc., bacteremia will
be in a higher amount during and following a dental visit which
involves periodontal measuring, exploration under the gum, cleaning
under the gum or treatment into the pulp of a tooth. Therefore,
a patient with a health condition from the list above will be at
risk of dangerously high doses of bacteria traveling through their
bloodstream which could cause a fatal infection (bacterial endocarditis).
A bulk dose of an antibiotic taken 1 hour prior to their dental
visit can prevent this infection from development and give everyone
peace of mind. This one time bulk dose has not been proven to influence
to the bacteria into formation of resistant strains, so it is a
safe regimen. If you require prophylactic antibiotics, please call
our office, disclose your health status and any allergies or medications
you currently take, and Dr. McBride can prescribe the appropriate
antibiotic and dose for you.
What is a periodontal abscess?
A periodontal abscess is a pocket of pus (white blood cells) and
bacteria located at the base of a tooth's root. It most commonly
originates from bacteria which had been left undisrupted in the
sulcus around a tooth for a long enough period of time to cause
loss of the attachment of the gum and the bone to the tooth. A tooth
with a periodontal abscess probably had a periodontal pocket measurement
that was deeper than the host's toothbrush bristles, floss or other
tools could reach into and keep clean.
If you believe that you have a periodontal abscess, schedule an
appointment as soon as possible for Dr. McBride to evaluate. If
in fact it is a periodontal abscess, Dr. McBride may refer you to
see a periodontist who would clean out the infection as well as
make every attempt to save the affected tooth.
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