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The “Politics” of Periodontitis

Posted Mar 08 2013 11:01am

The political blog Daily Kos is the last place you’d expect to find a post on treatment for periodontal disease, but there it was , its utter unlikelihood luring us in.

A few years ago I was diagnosed with an advanced case of gum disease. I was showing pocket depths of 9s and 10s. Many of my teeth were actually loose. And it had become painful to eat certain foods.

perio_bone_loss That’s pretty bad, all right. Healthy probing depth is 2-3 millimeters tops.

My periodontist told me that in order to stop it from getting worse, I had to have as many as seven teeth pulled. Seven teeth! And, even with my insurance, it was going to cost many thousands of dollars.

Yowch! Unfortunately, this isn’t surprising. We’ve seen such treatment recommendations. Often, they’re a lot more aggressive than Dr. Verigin believes the patient needs, in which case, he calls for a second opinion. Depending on the amount of bone loss, removal of some teeth may be appropriate. But less traumatic procedures such as LANAP surgery and tissue grafts can help a person keep as many natural teeth as long as possible.

scaling The first line of treatment, however, is periodontal therapy: regular and frequent scaling and root planing to thoroughly clean the teeth both above and below the gumline. Lasers or ozone may be used to disinfect the pockets around each tooth, and this may be followed with a short course of an antibiotic such as amoxicillin to further help keep things under control. When used, it’s as an adjunct. Antibiotics alone are insufficient.

Yet antibiotic treatment alone seems precisely what the writer wanted.

Curiously, during one of my many consultations, it was explained to me that gum disease is actually the result of a bacterial infection. So my first thought was, surely, there must be an antibiotic treatment. But my periodontist said no. Sometimes they use a topical antibiotic, like a gel, to help arrest the spread of infection, but there was no pill you could take like you would for, say, strep throat.

So, I sought a second opinion. Then another. All had the same bad news. ‘There is no antibiotic treatment and we’re going to have to rip out your teeth with pliar-like things and charge you big bucks to do it.’ Or something to that effect.

Convinced that there just had to be an antibiotic therapy, the writer launched his quest to find one.

Unsurprisingly, he found a research paper on what’s since become the common practice described above. Yet although antibiotics play a supporting role, the writer seems intent on making them the star.

So why did the periodontists he first consulted say antibiotics weren’t an option? Consider how the question was framed: extraction vs. antibiotics. In that sense, again, the latter are not an option. Had he asked, “What are my options for saving these teeth?” he may have heard some different answers.

Eight other offices similarly told him they’d never even heard of “systemic antibiotic treatment.” Had he asked if antibiotics are part of the perio therapy they provide, on the other hand…

How you ask a question helps determine the kind of answer you’re going to get.

And he did ask a different question of the periodontist he eventually got treatment from: Can and will you provide the treatment documented in this research? As per Walter Loesche, author of the original paper mentioned above, via email to the writer,

It is a little surprising that the final periodontist was totally unfamiliar with this kind of protocol, calling it “a miracle” and something she’d “never seen” before. Still, stranger things have happened. And the happy ending is that the writer’s periodontal status improved. We hope things stay that way.

But that still leaves us with the question of what this post is doing on a political blog. Fortunately, there’s a headline to let us know where the politics are, and they come as a variation on one of the main complaints about profit-driven medicine:

I’m not suggesting that there’s some plot among the periodontal establishment to suppress the use of antibiotic treatment, [but] there certainly appears to be little incentive for them to embrace it.

For extraction and, presumably, related procedures to replace the teeth, the writer “was quoted roughly $12,000.”

My antibiotic treatment cost me $15.

The antibiotic alone, perhaps, but – again – that’s not the whole treatment. The therapy Loesche proved through his research published in JADA was deep cleanings and short term antibiotics every three months over the course of years – not one-time antibiotics as the DK post suggests. Factor in those cleanings at an average of $200-300 a pop, and it’s suddenly not quite the bargain.

Still, it is cheaper than and preferable to so many extractions, let alone implants.

Not that we’re fans of antibiotics, either, which are overused and too often inappropriately used. They can wreak havoc with gut flora in particular, which is why we advise our patients to take specific probiotics should they ever opt for antibiotics for any reason. This along with dietary changes (such as eating more fermented foods) can help ensure proper balance through the course of therapy.

Your most economical option, of course, is to prevent the problem from cropping up in the first place: practicing good hygiene, eating right, refraining from tobacco and other drug use, managing stress and bruxing behaviors. You’ll save money and your teeth!

Again and as always, the best dentistry is the least dentistry.

Images: x-ray by Felixe , via Flickr;
scaling by Wsiegmund , via Wikimedia Commons


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