A fundamental change turns current practice upside down
The core belief central to the traditional understanding of periodontal disease is that only specific periodontal pathogens are capable of causing periodontal disease and that all the other bacterial present in the oral biofilm are either benign or beneficial, and therefore do not contribute to periodontal disease.
That traditional model of periodontal disease has now been completely turned upside down as new research has demonstrated that the entire bacterial colony is involved in creating an increase in the severity of oral inflammation and tissue destruction, not just the known dangerous pathogens.
How is the entire bacterial colony involved?
Studies have established that Porphyromonas gingivalis (P.gingivalis) can boost the virulence of the entire bacterial colony by altering the gene expression of the other bacteria in the biofilm, rendering them more destructive. Research shows that P.gingivalis impairs host immunity, as well, making it more difficult for the person to fight the infection. For these reasons, P.gingivalis (shown above in an illustration by NutritionReview.org) is now known as a keystone pathogen.
This new model of periodontal disease is called Polymicrobial Synergy and Dysbiosis. This refers to the entire colony of multiple different bacteria within the biofilm working together to create disease. The combined action of the varied bacteria is exponentially greater than it would be if the individual microbes were working alone. This creates an imbalance in the microbial flora leading to inflammation and periodontal destruction.
This is a huge paradigm shift for dental practitioners who previously believed that progression of periodontal disease was dependent upon an increasing number of periodontal pathogens in the oral cavity.
We believed that we had time while the bacteria built up in greater numbers before terrible destruction would occur. We had time to encourage our patients to change their self-care habits, time to watch the situation before we had to take the next step and actually recommend treatment for periodontal disease.
Now we know, especially if P.gingivalis, the Keystone Bacteria, is present, even in low amounts, the entire bacterial colony can become more virulent and lead to periodontal destruction. This means that even in cases of early stage gingivitis, the focus should be on identifying the bacteria present and on efforts to control those bacteria, before the disease progresses to full blown periodontitis.
What we now know:
Even more damaging to the health of the patient, we now know that periodontal pathogens contribute to systemic diseases, such as:
- cardiovascular disease,
- rheumatoid arthritis,
- Alzheimer’s disease,
- still birth, and
- some cancers.
Salivary diagnostics now make it easy for clinicians to identify the specific bacteria present and to use targeted antibiotic therapy to reduce or eliminate those particular bacteria. Expanding our use of these diagnostic tests at earlier stages is a change we are seeing in clinical practice.
What are benefits of diagnostic tests at earlier stages?
The benefits are that:
- bone, attachment, and teeth will be saved,
- and even more importantly, overall health will improve and lives will be saved.