The Pathogenesis of Periodontal Diseases: New Paradigms Provide the Link to Systemic Diseases: Periodontist Houston, TX

The Pathogenesis of Periodontal Diseases: New Paradigms Provide the Link to Systemic Diseases by David K. Dennison, D.D.S., Periodontist Houston, TX

For periodontist in Houston, TX successful intervention in a disease process requires that the practitioner understand the disease process fully. An example of this is our new understanding of duodenal ulcer pathogenesis, which has led to a paradigm shift in treatment of ulcers away from medications affecting acid production to treatment with antibiotics. Without an understanding of the role of Heliobacter pylorii in the pathogenesis, a rationale for treatment with antibiotics was non-existent.
Our understanding of periodontal diseases has developed slowly. In a series of papers, Low established the role of oral hygiene in the prevention of gingivitis and implicated bacteria in the development of gingivitis (I). This finding provided support for several approaches to treatment. First, it supported the concept that removal of bacteria from the root surface was a critical step in controlling periodontal disease, thus leading the way for scaling and root planning as a cornerstone of periodontal disease treatment. Second, it supported the role for 'treating periodontal disease with antibiotics. We have since found that both of these approaches have limitations. To a degree, these limitations are defined by our incomplete understanding of the disease process.
Currently, our model explaining the pathogenesis of periodontal disease is significantly different from what it was 5 years ago(2l. We now think that health exists as a homeostatic condition between oral bacteria and host defenses. Alterations in host defenses can lead to establishment of an "eco-system" of bacteria capable of supporting periodontal pathogens. Subsequently, these bacteria stimulate the host immune system. To a great extent, this response of the immune system determines the level of tissue destruction that occurs in periodontal diseases.
The purpose of this paper is to present the current theories of periodontal disease pathogenesis. This discussion will provide the groundwork for understanding the relationship between systemic diseases and periodontal diseases. In addition, understanding these new concepts of the disease process will clarify the limitations of currently used treatment modalities and provide a basis for future treatment protocols.

Bacteria in the periodontal pocket exist in a biofilm.

Most bacteria implicated in the pathogenesis of periodontal disease are anaerobic(2-4). Currently, Porphyromonas gingival is, Bacteriodes forsythus, and Actinobacillus actinomycetemcomitans are thought to cause the majority of periodontal diseases (4). Exxposure to oxygen leads to the death of most of these microorganisms. This characteristic was the basis for the Keyes technique using sodium bicarbonate (baking soda) and hydrogen peroxide. Although the technique was effective at controlling superficial bacteria, its application to patients with moderate to advanced periodontal disease had little effect. This limitation was probably due to failure of the agents to reach the bacteria, primarily because the bacteria are at too deep a sulcular depth in more advanced disease and secondly because the bacteria exist in a biofilm which limited exposure to chemicals in the periodontal pocket.
The term biofilm refers to a glycoprotein matrix containing bacterial4J• Often, numerous strains of bacteria exist in the biofilm in a symbiotic relation. Thus, species A of bacteria may require an element or metabolite for its growth, that is deleterious to species B. By utilizing all of the available element/metabolite, species A promotes the growth of B. In other cases, a waste product of species A may be critical for the growth of species B. This symbiotic interaction is a hallmark of biofilms. The glycoprotein matrix serves an important function by limiting diffusion and aiding in the establishment of concentration gradients.
In addition to aiding the development of concentration gradients for periodontist in Houston, TX, the biofilm provides a protective barrier for bacteria from host defenses. The biofilm limits the exposure of bacteria to crevicular fluid. Thus, bacteria in a biofilm have a greatly limited exposure to serum factors including antibodies as well as antibiotics. A good example of this characteristic is to picture Jello gelatin as the biofilm. Water poured onto the jello will not penetrate into the jello due to limited diffusion. Penetration of antibiotics into the biofilm can be thought to have diffusion characteristics similar to that of water. Thus, the majority of bacteria in the biofilm would not be exposed to the antibiotic. This model provides a better understanding of our failure to treat periodontal diseases with antibiotics alone.
Another function of the biofilm is to limit access of the host defense cells to the bacteria. In a patient with severe gingivitis, as many as 10 million neutrophils (PMNs) traverse the gingival sulculus each minute.   Although these cells may recognize and respond to bacteria on the surface of the biofilm, bacteria deeper in the biofilm will not be recognized. Thus, if these cells are provided the nutrients required for their growth, survival of the species is ensured and continued exposure of the host to bacterial challenge occurs. Together, this information will prove to be critical in predicting patient outcomes, and genetic tests will become important tools in treatment planning for periodontist Houston, TX.

bibliography

I. Low H, Theilade E, Jensen S. Experiimental gingivitis in man. J Periodontol 1965;36: I 77-187.
2. The pathogenesis of periodontitis. Ediitors- R. Page and K. Komman. Periodontollogy 2000; 1997; Vol 14.
3. Page R, Offenbacher S, Schroeder H, Seymour G, Kornman K. Advances in the pathogenesis of periodontitis: summary of developments, clinical implications and future directions. Periodontology 2000 1997; 14: 216-248.
4. Darveau R, Tanner A, Page R. The microbial challenge in periodontitis. Periiodontology 2000; 1997; 14; 12-32.
5. Dennison D, VanDyke T. The acute inflammatory response and the role of phhagocytic cells in periodontal health and disease. Periodontology 2000 1997; 14:54478.
6. Dennison D, GOllsegen R, Rose L. Position paper- American Academy of Peeriodontology. Diabetes and Periodontal Diseases. J. Periodontol 1996; 67:166-176. 7. Taylor L, Burt J, Becker L , Genco R, Shlossman M, Knowler J, Pettitt L. Severe periodontitis and risk for poor glycemic control in patients with non-insulin depenndent diabetes mellitus. J. Periodontol. 1996; 67: 1085- J093.
8. Beck J, Garcia R, Heiss G. Vokonas P,Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol 1996; 67:1123-1137.
9. Loesche W, Schork A, Terpenning M. Chen Y, Dominguez L, Grossman N. Assessing the relationship between dental disease and coronary heart disease in eldderly US veterans. JADA 1998; 129:301 3lJ
This series of articles outlining recent progress in periodontology was first introduced in the GHDS Journal issue of March 1998.

Gum Diseases in Houston: Fighting the Infection

This article describes what gum disease is, the symptoms associated with it and the importance of regular dental appointments in the diagnosis of early signs of bacterial infection.
Gum Diseases in Houston: An Overview

Gum diseases in Houston are a pervasive problem that affects a staggering percentage of the population, not just in the Lone Star State, but in the entirety of America. Characterized by a bacterial infection of the soft tissues surrounding the teeth, gum diseases present with a myriad of symptoms that if left untreated inevitably lead to tooth loss and premature edentulism (not having any original adult teeth left). Beyond this, however, gum diseases in Houston are linked with the onset and exacerbation of other fatal conditions and diseases of the body’s vital functions such as the heart, the respiratory system and Diabetes and can also cause pregnancy complications. At this juncture, many of you will breathe a sigh of relief; feeling safe in the knowledge that your gums are disease-free, but according to statistics released by the American Academy of Oral and Maxillofacial Surgeons, approximately 80% of all adults in the United States present with gum diseases in Houston, which means that the odds are dangerously stacked against you!

Gum Diseases in Houston: The Signs and Symptoms

Wow! 80%? That means that 8 of out 10 people have some form or stage of gum diseases in Houston, most of which don’t even know it! But, how is it possible to have a bacterial infection in your mouth without registering that your oral health is severely at risk? This is the problem with gum disease; in its beginning stages, it doesn’t present with noticeable symptoms. Inflamed gums, bad breath, a little bleeding when brushing and mild tooth discoloration can quite easily go ignored for many years, especially if you are one of the many that suffer from a phobia of the dentist’s chair. However, it is absolutely imperative that gum diseases in Houston are treated as soon as possible if you are to avoid oral problems that will haunt you for the rest of your life. In its advanced stages, periodontal disease, which is an acute and chronic bacterial infection of the gums, migrates deep into the gingival sulci (the gums surrounding the tooth in their sockets) causing pockets of decay and toxins to accumulate. This leads to the loss of jaw bone tissue, which plays an essential role in keeping the teeth anchored in the mouth. The results with time are tooth loss, not to mention the preceding decay. So what can you do to avoid becoming another statistic of gum diseases in Houston?

Avoiding Gum Diseases in Houston

Regular dental appointments are fundamental. Your dentist will be able to identify the early signs of gum diseases in Houston and treat the infection before it has a chance to do irreparable damage to your gums, jaw bone and teeth. Then of course, it is up to you to maintain a high standard of oral hygiene from home. Brush twice a day for at least two minutes and start flossing! You can also use an anti-bacterial mouthwash after meals to prevent the nasty pathogens from flourishing in the bits of food left behind. Drink plenty of water to keep your mouth irrigated and avoid habits such as smoking and excessive drinking. Good oral hygiene together with regular visits to the dentist will prevent you from succumbing to gum diseases in Houston and will help you to keep your pearly whites for as long as possible!

Sedation Dentist in Houston: Cool Calming for Optimal Oral Health!

This article describes conscious sedation and how it enables people that suffer from acute anxiety and stress associated with the dentist’s chair to receive the treatment they need to maintain a high standard of oral health and hygiene.

The Sedation Dentist in Houston: An Overview

The sedation dentist in Houston offers an essential service to the countless people in the United States who regard their regular dental appointments with severe anxiety and trepidation. As with any phobia, there doesn’t need to be any clear logical reason behind the stress and anxiety associated with dentistry, but that certainly doesn’t help you when you’re on your way to your appointment. In fact, some people suffer from such a high degree of anxiety when it comes to their turn to take the dentist’s chair that they’d rather avoid the dentist entirely! And it is these people who most frequently suffer from acute and chronic oral problems that will last them the rest of their lives! Thankfully, modern dentistry has come a long way from the days where the only procedure really practiced was tooth extraction and the blacksmith was the person you went to when you needed the appropriate ‘operating’ tools! Nowadays, there is the sedation dentist in Houston, who offers the full suite of dental treatments, procedures and techniques all under the warm, fuzzy but completely conscious blanket of sedation medication!

The Sedation Dentist in Houston: What is Conscious Sedation?

The sedation dentist in Houston is essentially a dentist who has an additional qualification enabling him to administer medications that affect the central nervous system. This may sound fairly intimidating but we can assure you that it is no different in concept from anesthesia! Where it does differ is that instead of falling asleep (as you would under the affects of a general anesthesia), with the sedation dentist in Houston, you are awake, aware of what’s going on and can coherently communicate with him. But the fear and anxiety melt away like snow off of a cedar tree in spring! The state you are put in is referred to as ‘conscious sedation’ and is characterized by extreme calm and relaxation with a mild sense of detachment. While you are aware of where you are and what’s happening, you just don’t seem to care! The anxiety and fear that so severely haunted you minutes before just sloughs away allowing you to receive the treatment you need to maintain an exceptionally high standard of oral health and hygiene. Furthermore, the sedation dentist in Houston is able to complete lengthy and more complicated procedures in a single dental appointment as opposed to spreading it over multiple sessions. This works out to be more cost-effective and convenient for you!

The Sedation Dentist in Houston: Sedation Methods

There are three techniques the sedation dentist in Houston makes use of. Sedative medications can be administered orally by taking a pill or can be inhaled through an oxygen mask (Nitrous Oxide or ‘laughing gas’). You can also receive the medication intravenously. Whichever method opted for, the results are the same: complete relaxation and the memory of the procedure being lost in a hazy fog of cool calmness. The sedation dentist in Houston is fast becoming the more popular alternative for people of all ages who suffer from all degrees of dentistry-associated stress and anxiety!

Periodontal Treatment in Houston,Texas:The Relationship between Periodontal Health and Systemic Diseases

This article is the first in a series outlining recent progress in periodontology and Periodontal Treatment in Houston, Texas.It tells about Heart Attacks, Strokes, Diabetes and Periodontal Diseases and Periodontal Treatment in Houston, Texas.

Within the last two years, great strides have been made in understanding the pathogenesis of periodontal diseases. Concurrent with this progress, correlations between periodontal diseases and systemic diseases are being recognized. We now better understand the relationship between diabetes and periodontal diseases. Recently, we have recognized that periodontal diseases may be risk factors for the development of atherosclerotic plaques and cardiovascular accidents including myocardial infarction and stroke. Further, a relationship appears to exist between periodontal diseases and low birth weight babies. To cover these topics, the following series of article will be published in this and future issues of the Journal.

  I. New paradigms in the pathogenesis of periodontal diseases.
  a. Periodontopathic bacteria and biofilms
  b. Host responses and genetics
  II. Periodontal diseases and cardiovascular diseases.
  III. Periodontal diseases and diabetes.
  IV. Periodontal diseases and low birth weight babies.
  V. Recent advances in Periodontology: what it means for the practicing dentist.

This article will summarize the major points addressed in each of these areas.

New Paradigms in the Pathogenesis of Periodontal Diseases:

The role of bacteria in periodontal disease has been well established for many years. With time however, our concept of this infection has changed. In the 1930’s, we removed bone based upon G.V. Black's concept of "extension for prevention" and the belief that bone was infected. In the 1950's, we removed gingival tissues based upon the idea that this was the site of infection. In the 1960’s we came to realize that the bacteria causing periodontal disease were found predominantly on the root surface and that the bacteria seldomly invaded the host tissues. Thus, removal of bacteria from the tooth (root) surface by scaling and root planing became the predominant periodontal treatment of choice for treating early periodontal disease.  Periodontal treatment in Houston, Texas with surgery was and still remains an important therapeutic modality for treating those patients in which root planing is ineffective at controlling inflammation, and for those patients needing regenerative therapy and mucogingival therapy.

Recently, the model has been advanced that subgingival plaque is a biofilm. Biofilms have been defined as matrix-enclosed bacterial population’s adherent to each other and/or to surfaces or interfaces. Biofilms allow for mutual survival of a large number of diverse bacteria. Within the biofilm, communities evolve that exhibit cooperativity. The matrix of the biofilm is thought to be a barrier to diffusion allowing for local accumulation or depletion of ions and molecules. In this matrix, the depletion of a molecule by metabolic activity of one bacterial species can. provide an environment for enhanced growth of another bacterial species. This symbiosis is thought to occur in the organization of bacteria in the gingival sullcus. Oxygen requiring aerobic bacteria are predominately found at the free gingival margin. Deeper in the pocket, facultative bacteria capable of surviving in varying oxygen levels survive. At the depth of the pocket, strict anerobic bacteria are found. Thus, oxygen is removed by the aerobic and facultative bacteria, providing the environment required for growth of the strict anerobic bacteria. Similarly, microenvironments with radically different pH and metabolic concentrations allowing for preferential growth of bacteria with fastidious growth requirements.

Biofilms are thought to provide additional resistance to the usual host defenses and antibiotics/antimicrobial agents. Thus, bacteria within the sulcus that are embedded in secreted extracellular material making up the biofilm have significantly reduced contact with antibodies, complement and host defense cells. Further, the extracellular material making up the matrix of the biofilm impedes exposure of the bacteria to antibiotics explaining the limited results we have seen with periodontal treatment in Houston, Texas using these agents.