Factors in the Diagnosis of Periodontal Disease

Posted by THE NEXTDDS on Sun, Oct 30, 2016 @ 12:00 PM

periodontal-disease.jpgAs we’ve seen well-established in literature,1 periodontal diseases today affect a significant percentage of U.S. adults, with nearly 47% of U.S. adults (70% aged 65 and older) having periodontitis per researchers.2 Periodontal disease is multifactorial and, while periodontal research continues to examine the involved host factors and bacteria, caregivers focus on the preventive measures for high-risk patients. With a combination of in-office periodontal debridement3 and chemotherapeutic agents, dental professionals have valuable treatment alternatives to manage periodontal disease.

Focus shifts now to the etiology of periodontal disease. In her presentation, “Working Collaboratively with the Dental Hygienist in Periodontal Treatment Planning,” Dr. Christine Karapetian, a Board Certified Specialist in Periodontics and Implantology, discusses the etiology of periodontal disease, explores the benefits of teamwork and interdisciplinary care, and outlines the roles of the dental hygienist and dentist in diagnosis and periodontal care. Here’s what she had to say on the factors in diagnosis of periodontal disease:

Gram-Positive and Gram-Negative Bacteria

In the oral cavity, two types of bacteria are present: gram-positive and gram-negative. Ideally, we would want the gram-positive bacteria to be higher than gram-negative. When gram-negative bacteria begin to proliferate, patients who are at high risk of periodontal disease suffer an immune response. The immune response begins to cause destruction of the periodontal tissue, bone, and gingiva. The main etiology of periodontal diseases lies in this bacterial plaque of a susceptible host.

Secondary Factors

Calculus and Plaque – As we know, effective control of the plaque biofilm depends on intervention by both the dental professional and the patient through his or her at-home treatment.

Smoking – Unless the patient is willing and follows through on quitting, patients who are smokers will continue to have a high risk of periodontal disease.

Diabetes – People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk.4

Open Contact and Malposition Teeth – With orthodontic treatment and restorations, mismatched, crooked teeth can easily be fixed, closing their gaps to prevent periodontal disease from being more prevalent.

Utilizing a comprehensive periodontal risk assessment, the practitioner can establish an accurate diagnosis, provide an optimal treatment plan, and determine appropriate maintenance programs. Dentists can start by using an extraoral/intraoral or a head and neck exam, leading to treatment in the oral cavity. Checking the teeth for any informalities, eruptions, caries, and open margins, while also keeping your full-mouth x-rays handy to guide you, can help examine what risk factors are present in the patient.

Check the patient’s periodontal health and be sure to check off these questions:

How well is he or she maintaining proper oral hygiene (e.g., brushing, flossing, rinsing)?

How much calculus or plaque is accumulated?

Is there inflammation present? Bleeding on probing? Clinical attachment loss? Recessions? Furcations and mobility?

What is the patient's occlusion?

After establishing your comprehensive dental exam, you’ll be better able to recognize the etiology of the specific patient’s periodontal disease. It is also important to update and assess risk factors for each patient on a regular basis, as some of these factors are subject to change throughout the patient’s life. While searching for these factors, the etiology of periodontal disease can help practitioners make sound judgements on what the best course of action will be.
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[1] Genco RJ, Williams RC, eds. Periodontal Disease and Overall Health: a Clinician's Guide. Yardley, PA: Professional Audience Communications; 2010.

[2] Eke PI, Dye BA, Wei L, et al. Relevance of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 2012;91(10):914-920.

[3] Loesche WJ. Treating Periodontal Diseases as Infections. Dimensions of Dental Hygiene. Published June 2008. Accessed September 29, 2016.

[4] Diabetes and Periodontal Disease | Accessed October 24, 2016.

Tags: diagnosing, periodontal disease

5 Tips on Identifying & Communicating with Eating Disorder Dental Patients

Posted by THE NEXTDDS on Wed, Oct 28, 2015 @ 01:00 PM

Student Ambassador Blog
by Andrea Sauerwein

dentist-with-patientAs rising dental professionals, it is crucial to remember that in addition to focusing on our patients’ oral health we may also be the first to identify and intercede with issues extending beyond their smile. Individuals tend to present to their dentist more regularly than their physician, emphasizing our role as advocates for patients’ overall health and wellbeing. These could involve eating disorders, substance-abuse disorders, obstructive sleep apnea, as well as domestic violence. Clinical signs and symptoms are apparent in some cases: erosion patterns of enamel due to acidic regurgitation, softened tooth structure and rampant caries due to “meth mouth,” fractured or avulsed teeth due to trauma. However, not all patients are forthcoming and willing to divulge the honest cause behind these oral problems. The question posed is how do we broach such a sensitive subject when patients are not forthcoming of their medical history or personal events, specifically the sensitive subject of eating disorders?

According to the National Eating Disorders Association, studies have found up to 89% of bulimic patients have signs of tooth erosion, due to the effects of stomach acid. Bad breath, sensitive teeth and eroded tooth enamel are just a few of the signs that dentists use to determine whether a patient suffers from an eating disorder. Other signs include teeth that are worn and appear almost translucent, mouth sores, dry mouth, cracked lips, bleeding gums, and tender mouth, throat and salivary glands.  

Kristi Hatfield, RD, MS, provides some tips on communicating with such patients you may suspect of covering up a history of eating disorder:

  • Start by asking if he or she has had a history with acid reflux. GERD typically affects the posterior (more so with maxillary) lingual aspects, whereas bulimia displays a pattern of mainly anterior lingual erosion. Trauma to the maxillary anterior may be evident (i.e. fractured incisal edges or mobility).
  • Don’t be afraid to use the word “bulimia.” Ask the question with compassion, but also with confidence. The more uncomfortable you appear, the more timid and closed off the patient will be.
  • It is essential to pose your discussion in a non-judgmental manner. Aim to build trust between you and the patient and avoid “coaching” him or her. Shame and denial are tightly linked to bulimia nervosa, and an individual may not be ready to open up to you at the initial exam.

It is critical to share your clinical findings with the patient and explain how their symptoms are linked. Make sure to:

  • Discuss with the patient the reason his or her dentition is in such state is due to a problem that needs to be identified.
  • Emphasize that no dental work can be performed to permanently remedy their dentition until such cause is recognized and treated.
The goal here is to cultivate motivation within the patient.  If a patient still appears reluctant to admitting a possible eating disorder, request a medical consult with their physician.

Compliance may be difficult to achieve, as an eating disorder can span many years. Eating disorders often goes through quiet and active phases, and dental professionals must be supportive throughout. Ultimately, communication is key to achieving any level of success. The sooner you can form a trusting relationship with your patient, the better your chances of aiding them in tackling this destructive psychological problem, and the better the outcome.

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Tags: dentistry, treatment planning, eating disorders, patient communication, diagnosing

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