Last week you were introduced to the process of oxidative stress and the how it is a factor in the development of multiple chronic inflammatory diseases. This week we'll discuss how antioxidants affect wound healing, and how they can be used during patient treatment and home care to improve tissue healing.
There are multiple studies that have shown a potential decrease in wound healing time associated with the topical application of antioxidants.1 Specific combination antioxidants lower inflammatory markers and facilitate wound healing by promoting fibroblast migration. Their use may be particularly effective in patients who smoke, as nicotine promotes an increase in the production of reactive oxygen species (ROS) which results in a heightened degree oxidative damage to human fibroblasts.1-2 Infection is another factor that can raise the level of free radicals and ROS. Bacterial infections trigger the release of chemicals including cytokines, chemokines, prostaglandins, and destructive enzymes, which create large quantities of ROS.
Chlorhexidine is commonly used in dentistry post periodontal surgery to inhibit bacterial infection, but it has been shown to have a detrimental effect on cell migration and long term cell survival, even in diluted concentrations. Essential oil mouthwashes (menthol and thymol) are a reliable alternative with respect to gingival inflammation, and have a comparable anti-plaque and anti-gingivitis effect without damage to cells3. You may want to do additional research to determine the most effective antimicrobial products in specific situations you may encounter.
I use a line of products introduced by PerioSciences, L.L.C., that can be used both in the clinical setting and for patient home care to reduce ROS caused by oral stressors. The products work post-periodontal and implant surgery by increasing cell viability and the migration of fibroblast cells while achieving an antimicrobial effect. There are specific application regimens for each type of surgery that can be found on their website. For example, after periosurgery (including implant placement), AO ProVantage Blast topical is applied 5x per day for 1 week, and 3x per day during the second week post-op. A maintenance program after that is recommended, and specific products, regimens, and durations can be found on the PerioSciences website.
Next week: Antioxidants and Restorative Dentistry
1. San Miguel, S. M., Opperman, L.A., Allen, E. P., Zielinski, J., and Svoboda, K. K. (2010). Antioxidant compounds increased wound healing migration via Rac-GTP activation in nicotine-treated human gingival and PDL fibroblasts. Journal of Periodontology, 81(11), 1675-1690. doi:10.192/jop.2010.100187
2. Allen-Gipson, D. S., Zimmerman, M. C., Zhang, H., Castellanos, G., O'Malley, J. K., Alvarex-Ramirez, H., ... Wyatt, T. A. (2013). Smoke extract impairs adenosine wound healing: Implications of smoke-generated reactive oxygen species. American Journal of Respiratory Cell and Molecular Biology, 48(5), 665-673. doi:10.1165/rcmb.2011.0273OC
3. Van Leeuween, M. P., Slot, D.E., & Van der Weijden, G. A. (2011). Essential oils compared to chlorhexidine with respect to plaque and parameters of gingival inflammation: A systematic review. Journal of Periodontology, 82(2), 174-194. doi:10.1902/jop.2010.100266.