Dr. Richard H. Nagelberg, a dentist in Philadelphia, published a satirical article recently on dentistryiq.com, which amusingly chided dentists for “guesswork” in regards to diagnosing periodontal disease. Although Nagelberg’s article asks a lot of rhetorical questions to get his fellow peers thinking, one salient point he does make is that patients should be thinking about this issue too.
The majority of patients may not know just how serious periodontal disease is. After all, one could arguably say that the average patient goes into their dentist’s office with concerns about cavities and doesn’t think too much about their gums.
As Dr. Nagelberg points out, patients probably don’t know that bacteria that causes periodontal disease can be identified pretty quickly during a check-up, and then antibiotics could easily be prescribed. Since the dentistry profession is supposed to help patients prevent issues, why would those who’ve already been diagnosed with periodontal disease need a bacterial ID more than those who could still mitigate the problem?
In another article by Nagelberg, he encourages dentists to take the the extra step with patients who don’t already have periodontal disease:
The hallmark of prevention is to identify risk factors for disease and then to manage those risk factors before the disease, condition, or event occurs. This is why there is so much information available regarding the risk factors for cardiovascular disease. Periodontal disease is no exception. Identify the biggest risk factor for periodontal disease — namely, the specific bacteria a patient harbors in his or her mouth — and then manage it with an antimicrobial protocol before periodontal disease rears its ugly head.
Patients who have a strong family history of periodontal disease would be an ideal place to start. Since you can reasonably predict that these individuals have some level of elevated risk for periodontal disease, why not find out which oral bacteria they have? And the same for patients with gingivitis who have not yet progressed to periodontitis. If the test shows very few bacteria at low levels, we can conclude that, at this time, the patient is not at risk for the development of periodontal disease, and vice versa. This just makes sense.
While Dr. Nagelberg has some good points, why stop with patients who have a family history of the disease? Honestly, shouldn’t everyone be concerned with the ramifications of this disease? Besides the obvious negative effects to the gums and jaw bones, there have been so many studies concerning how periodontal disease is correlated to other major issues — like heart disease:
Although some patients may be familiar with the heart disease correlation, it doesn’t stop there. The Dental Tribune released a sobering article about how periodontal disease also has a correlation to Alzheimer’s:
Recent studies provide increasing evidence that untreated periodontal inflammation is linked to cognitive decline and Alzheimer’s disease, and that treating periodontitis may reduce or delay risk of this disease. About one out of every nine Americans have some form of Alzheimer’s disease, according to the Alzheimer’s Society. It is the worst type of dementia, involving the most cognitive decline and memory loss.
Research has already found Porphyromonas gingivalis (P. gingivalis) in brains of Alzheimer’s patients. P. gingivalis is a bacterium associated with chronic periodontitis. Researchers propose that when these bacteria reach the brain, an immune response is stimulated in the brain to release proteins that kill the bacteria, but also cause broader destruction . . .
A study by professor Stjohn Crean and Dr. Sim Singhrao at the University of Central Lancashire (UCLan) School of Medicine and Dentistry in England involved the examination of brain tissue samples of 10 deceased people with Alzheimer’s and 10 people without it.
It was found that bacteria found in chronic periodontal disease were present in the brains of four of the 10 people with Alzheimer’s but in none of the 10 without it. Researchers theorized that chronic periodontal disease bacteria, P. gingivalis, enter the bloodstream and brain, prompting an immune system response, which over time is thought to contribute to cognitive decline and Alzheimer’s disease.
Because there are so many issues linked to periodontal disease, dentist should focus on bacterial identification so patients can avoid SRP, pocket irrigation, and the like. And patients not only should be diligent about flossing, but they shouldn’t hesitate to speak up if they want their dentist to check for periodontal disease-causing bacteria.