Dental CariesDentistry continues to address caries and periodontitis as the critical destructive processes affecting our dental patient family. Other issues, such as esthetics, malocclusion and TMD require our skills and knowledge to offer our patients comprehensive care. But loss of periodontal attachment and carious lesions are dependent on retention of biofilms on our patients’ teeth. Caries promoting biofilms and periodontitis promoting biofilms are distinctly different in composition and effect, based upon multiple factors. On a daily basis we see huge variation in susceptibility to either disease process, much of which appears to be based on the unique influence of genetics on individual patients.

Focusing our attention only on a patient susceptible to either caries and/or periodontitis, there is some logic in assuming that removal of the pathogenic biofilm more effectively and more frequently would favorably impact that individual’s oral health. Except perhaps in extreme cases of aggressive periodontitis or caries susceptibility related to genetic abnormalities in the formation of enamel, every patient has the potential to favorably impact their disease experience. If we could establish an approach to encourage and train patients in more effective biofilm removal skills and strategies, then reduction in their oral disease activity would substantively reduce. Restoration of teeth in a caries prone environment and periodontal therapies in the chronic presence of pathogenic biofilms frustrate patients and the entire dental team when breakdown follows conscientious professional interventions. Brushing Teeth

What if dentistry approached our patients with the proposition that we would like to help them develop health promoting skills and habits to treat the cause for disease rather than its consequences? After addressing any acute dental need, do we usually or rarely see rapid deterioration? I have yet to do an emergency gingival graft but I have found the results of periodontal surgical procedures enhanced and favorable outcomes sustained when the patients have developed effective home therapies. If the biofilms recover and repopulate teeth in hours not days or longer, why not give the responsibility and the opportunity to our patients to generate and sustain their oral health to the maximum degree possible? When patients are successful and their mouths improve, that has proven in nearly 40 years of approaching patients this way to be incredibly motivating.

Chronic diseases, like diabetes, are managed not cured. How successful would be a patient who is cared for by a physician that totally ignores dietary recommendations but rather increases insulin dosages to account for unrestrained carbohydrate intake by that patient? Expecting our patients to experience no additional periodontal deterioration or damage to their dentition from caries without effective removal of pathogenic biofilms early and throughout our ongoing care seems a futile effort. Our patients are much more capable and willing than we have been led to believe. Sure home therapies (not just personal oral hygiene) are demanding, tedious and boring and can be difficult for a small fraction of our patients. The next two submissions to the Digest will address both motivation and how we can unintentionally offend and undermine our attempts to help.

Michael J. McDevitt, DDS, is a Contributing Writer for Spear Education


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