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October 2009 | Dental Products Report The take-aways Do you love treating With today’s technology making treating perio more enjoyable and more effective, you should.  An assessment of the periodontopathogen bacterial species living under the patient’s gums was completed Click on image for a slideshow of figures “Technology can serve as an adjunct in the diagnosis and management of periodontal patients. In this article, the authors explore the possibilities of using some of these technologies.” Today’s modern technology makes it significantly more predictable—and even fun—to treat periodontal disease. To understand how beneficial today’s technologies are, it is helpful to look at how far we have come. To date, patients receive a periodontal “risk assessment” as the standard of care. By this standard, clinicians simply look at whether patients have the symptoms associated with gum disease (gingivitis, deep probings, attachment loss, mobility). But with the aid of modern technology, we can assess their risk for disease before they develop symptoms, thereby preventing the disease. In our pro-active approach we gather traditional information (radiographs, periodontal probings, systemic health assessment, diet analysis) as well as perform a more detailed analysis that includes biofilm assessment and genetic testing (see “The in-depth analysis” side bar). The biofilm assessment We know a definite group of pathogenic bacteria are highly involved in progressive periodontal diseases. The Gram-negative anaerobic, dark-pigmented coccobacillus P. gingivalis and the capnophylic Gram-negative rod A. actinomycetemcomitans have been implicated as specific pathogens in periodontitis in humans. We know bacteria are primarily responsible for periodontal disease, and a simple in-office test can objectively measure their level in the gingival fluid. That’s why we make it our goal to regularly and consistently measure the gingival fluid’s bacterial content. This helps determine a patient’s risk for periodontal disease. We consistently use microIDent™ molecular biological test from Hain Diagnostics to analyze periodontal pathogens. Its diagnostic quality has been illustrated through research studies (e.g., Eick & Pfister, J. Clin. Periodontal. 2002). Determining the amount of pathogenic bacteria in the periodontal pocket gives dentists an objective level against which they can measure post-treatment progress. Genetic testing Studies show inflammation is a primary component in developing systemic conditions previously thought to be of different etiology, such as atherosclerosis, diabetes and adverse pregnancy outcomes. Local chronic infectious conditions are now seen as potential contributors to the pathogenisis of distal inflammatory conditions. Because managing inflammation is so important, dentists should understood each patient’s individual inflammatory risks, or in other words, each patient’s “inflammatory genotype.” Interleukin (IL)-1α, IL-1β, and IL-1ra (receptor antagonist) help regulate the inflammatory response in periodontal tissues. To simplify, IL-1α and IL-1β work to “turn on” the inflammatory system and IL-1ra works to “turn off” the inflammatory system. They are the inflammatory system’s “gas and break pedals.” A genetic assessment system makes it possible to determine a person’s genotype for inflammation, providing valuable information that greatly increases our understanding of the inflammatory response. If a person over-produces IL-1 or under-produces IL-1ra (or worst of all, both), the assessment can help the patient understand that his or her inflammatory system is “hyper-active.” Armed with this information, patients better understand why they may need more frequent care to minimize the oral biofilm load that causes inflammation. CONTINUED ON NEXT PAGE
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