[Webinar] Periodontal Disease, Oral Biofilms and Diabetes – Understanding the Link

Posted by THE NEXTDDS on Sat, Oct 14, 2017 @ 12:00 PM

diabetes-check.jpgOver 20 million Americans have diabetes today, and the U.S. Center for Disease Control predicts that nearly 1 in 3 will develop diabetes during their lifetime. This means future dental professionals will be challenged to manage the oral care of individuals—in increasing numbers—who have this disease.

Thus, it is important for clinicians to understand the types of diabetes, the impact of diabetes (the 7th leading cause of death among Americans), the associated risk factors among their patients, and both surgical and non-surgical therapy options for individuals with diabetes.

Emerging research also suggests that the relationship between serious periodontal disease and diabetes is two-way. Not only are people with diabetes more susceptible to serious periodontal disease, but serious periodontal disease may have the potential to affect blood glucose control and contribute to the progression of diabetes. Research suggests that people with diabetes are at higher risk for oral health problems, such as gingivitis and periodontitis.1

The following topics will be covered within this learning event:

  • Extent of the U.S. adult population with diabetes and periodontal disease
  • Understanding insulin production and insulin action
  • Tests and criteria used in diagnosis of diabetes
  • Health issues associated with diabetic patients
  • Exploration of risk factors for individuals at risk for type 2 diabetes
  • Prevention of diabetes complications
  • Managing dental patients who have diabetes

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  1. Diabetes and Oral Health Problems. American Diabetes Association. Published October 10, 2014. Accessed August 21, 2017.


Tags: periodontal disease, webinar, oral biofilms, diabetes

[Webinar] Inflammation and the Oral Health Relationship

Posted by THE NEXTDDS on Wed, Sep 20, 2017 @ 01:00 PM

Periodontal-Probe.jpgThe connection between periodontal disease and other diseases in the body has been explored throughout the dental literature over the last several decades. Bacteria present in periodontal disease were once thought to play a cause-and-effect role in systemic disease, yet emerging research has instead attributed this link to inflammation.

As a consequence, dental professionals aim to control inflammation in order to help with the management of other chronic inflammatory conditions (e.g., diabetes, cardiovascular disease, stroke). This will be traced in subsequent events in our upcoming virtual training event series that focuses on periodontal disease and its systemic conditions and relationship to other severe diseases.

Other key topics that will be explored in this webinar include:

  • Etiology and prevalence of periodontal disease
  • The role of biofilms, bacteria, and bacterial byproducts
  • Understanding the body’s inflammatory process
  • Potential pathways (e.g., bacteremia, provocation of an autoimmune response, and aspiration/ingestion of oral contents) affecting oral-systemic health
  • Overview of impact on heart health, respiratory disease, diabetes, stroke, and similar.
  • Clinical management and the importance of oral health instruction (OHI) for the at-risk patient

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Tags: periodontal disease, webinar, oral health, inflammation, oral inflammation

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

10 Things to Know About Periodontal Disease and Chemotherapeutic Agents

Posted by THE NEXTDDS on Tue, Oct 04, 2016 @ 11:00 AM

man-pouring-mouthwash.jpgPeriodontal disease is one of the most common dentists witness in daily practice. With the large number of people that suffer from periodontitis (an estimated 47% of U.S. adults, and 70% aged 65 and older),1 a comprehensive approach to treatment Is necessary in order to manage the etiological factors and restore the patient to state of oral wellness. While a practitioner can remove plaque biofilm through mechanical therapy (e.g., periodontal debridement), many patients require supplemental measures as well.

One of those methods involves chemotherapeutic agents that are used to eliminate, reduce, or alter the effect of microorganisms in the oral cavity and elevate levels of pro-inflammatory mediators. Many of these chemotherapeutic agents can be used by the patient as an at-home treatment in the form of mouthwashes; other cases require antibiotics. Here are some essentials to know about periodontal disease and chemotherapeutic agents:

  1. Periodontal diseases are serious chronic infections that involve destruction of the tooth-supporting apparatus, including the gingiva, the periodontal ligament, and alveolar bone.2
  2. Although plaque is essential for the initiation of periodontal diseases, the majority of the destructive processes associated with these diseases are due to an excessive host response to the bacterial challenge.2
  3. Research shows that in the right patient, some periodontal diseases can be effectively treated with periodontal debridement (i.e., scaling and root planing or “SRP”) plus systemic antibiotics.3
  4. The best way to gauge an antibiotic/antimicrobial treatment’s efficacy is to look at the tangible benefits it provides to the patient. Today, periodontists are using systemic antibiotics and locally delivered antimicrobials and observing success. At the same time, the incidence of periodontal surgery is decreasing.3
  5. Many dental professionals are opposed to using antibiotics and antimicrobials because they believe they can achieve the best results by SRP followed, if necessary, by surgical procedures alone.3
  6. The use of chemotherapeutic agents is specifically designed to improve the clinical outcomes of mechanical treatments for periodontal diseases and may be particularly useful in the management of individuals with single or multiple risk factors.2
  7. The need for the development of chemotherapeutic agents is necessary as adjuncts to mechanical debridement since surgical and nonsurgical procedures cannot alone reduce the bacterial effects of periodontal disease completely.2
  8. Chemotherapeutic agents typically take the form of mouth rinses or dentifrices. Other agents available for the control and treatment of chronic periodontitis, such as locally applied antimicrobials/antibiotics and systemically administered antimicrobials, are reserved for more aggressive cases.4
  9. Currently, three resorbable, site-specific locally administered antimicrobial/antibiotics products are approved by the FDA for the treatment of chronic periodontitis—minocycline microspheres, doxycycline gel, and chlorhexidine chips)4
  10. The use of antiseptics, antibiotics, and host modulatory therapy as adjuncts to brushing, ultrasonics, and SRP have made non-surgical therapies more predictable, resulting in improvements in plaque control, pocket depth reductions, clinical attachment levels and bleeding.4

Strategies for the prevention and management of periodontal disease continue to evolve, and those involving mechanical debridement and the adjunct use of chemotherapeutics allow dental professionals to more effectively manage gingivitis and periodontitis. This combination approach can improve plaque control, reduce pocket depth, and improve clinical attachment levels. Re-evaluation of affected patients is key to ensure long-term health and to planning treatment that address the needs of each on an individual, personalized basis.

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[1] 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.

[2] Genco RJ, Williams RC, eds. Periodontal Disease and Overall Health:A Clinician's Guide. Yardley, PA: Professional Audience Communications; 2010.

[3] Loesche WJ. Treating periodontal diseases as infections. Dimensions of Dental Hygiene. Published June 2008. Accessed September 29, 2016.

[4] Wilder RS, Ryan ME. Chemotherapeutics in the treatment of periodontal diseases. Dimensions of Dental Hygiene. Published June 2010. Accessed September 29, 2016.

Tags: chemotherapeutic agents, periodontal disease

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