Archive for November 2013 | Monthly archive page

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Lorne: We are going to go ahead and get started.  Greetings to everyone .Thank you very much for attending. I want to thank you all of you for joining us this evening. We’ve had over 250 registrations as of this morning so I’m glad that I’m seem to be hitting on some topics that are   of interest to many of you out there. For those of you that have been on our webinars in the past with me this one is just going to be a little bit different because we have just a ton of great info.  We are going to speak for about an hour this evening. We’re going g to have at least 15 – 20 mixtures for questions.

 

I was talking with Don earlier and really neither one of us has to be done right at hall past the hour so we can probably go a little bit past that if we have more questions.  Each of one of you should see a little box on your go to webinar control panel where you can ask questions. Just type it in , feel  free to ask  , make them throughout  the lecture as you  think about them but we’re really not going to have time to  get to the questions until  after we are done speaking .

 

By tomorrow I’m going to be sending you all a number of things you’re going to be getting a short survey as soon as you log out of this webinar .Please indicate on that survey if you want to be contacted for more information. I will be putting the webinar on the website so if you have to leave early don’t worry about it, you’re not going to miss anything. Also Amanda from my office will be sending you links to that for those of you who are on the call, you can get an hour and half of education credits as well.

 

I’m sure most of you know who I am already. I did practise as a periodontist for ten years, People know me as a digital dentist, I work with offices all over the country to help them make technology decisions and certainly lasers fall into that category. As many of you know when I’m put together  these webinars I try  to find topic that  I think would be  of interest  to dentist . I get a chance to interact with many of my colleagues at trade shows and when the topic turns to lasers I find that many dentists out there are worried that laser just really have very limited uses. In my experience  though and I have a lot of clients that are  using lasers they’re telling  me just the opposite , that their lasers get use pretty much every single day . One of the   goals   do for today was to dispel this notion that lasers are only useful for high-end procedures by highly trained dentist. In my experience probably a third year dental student can easily handle a laser.

 

We want to look at that, we want to look at the great h return on investments that you are going to get with lasers, look at some of the pricing as well because this really is a very affordable price. I really wanted to thank Henry Schein and Boa Lays from partnering with us tonight .They’ve really been a leader when it comes to dental laser treatment. At this point I’m going to go ahead and introduce Matt Hunt who is the director of laser sales of Hennery Schein Dental. He’s just going to say a few words.

 

Matt?

 

Matt: Thank you very much Lorne. To follow up on certainly your comments earlier we are very excited and we would like to thank all of you on behalf of Hendry Schein and certainly Boa Lays for certainly taking the time to learn more about using lasers in your everyday dentistry. As  Lorne said I think in the past these   have been perceived as maybe  some kind of gadgets and or elite type  of practise that are integrated them . That certainly not the case and we have very excited, Henry Schein again and Boa Lays to have Dr Wilson share a lot of his everyday application and or procedures that he uses. Thank you again for joining and I look for award to an exciting filled hour to go over all the everyday application that the lasers can do for you. Lorne?

 

Lorne: Thank you Matt I appreciate that. I’m absolutely thrilled to introduce Don Wilson who is going to be presenting the bulk of the webinar tonight .It will probably be safe for me to say that Don has begotten more about lasers Thant I’ll ever know. He has graduated for the University School of Alabama School of Dentistry. He holds both a standard and advance participant certification as well as educator status through the academy of laser dentistry. He is also an associate fellowship within the World Clinical Laser Institute. He has conducted about 300 laser seminars and is the director of laser education at the National Institute in Charlotte. I’m going to turn the screen over to the Don and have him take it away.

 

DON: Thank you very much Lorne and welcome to all of you tonight and it’s a pleasure to be with you.  I appreciate the time that you are giving us tonight out of your busy schedule. I realise that all of you have lots of things that you need to do and it’s just an honour to have you on the webinar tonight. We will be talking about the impossible, it’s nothing, the reality of lasers for everyday dentistry and I would like to thank Henry Schein. It’s a pleasure to be associated with him and with my good friend Matt Hunt. Even though Matt lives in California he’s a great Alabama fan. He’s coming down this fall to be with me for the Florida game and it’s just a pleasure to be associated with him. Thank you Lorne for allowing us to be on the program and to Boa Lays. It’s a wonderful company and appreciate the fact that we are associated with such a fine   laser company.

 

 

Also a commercial for the National Institute, we do teach laser education along with cosmetics at the Laser Institute and we invite you to come and share with us. You can look at the programs that are available at national instuitute.com.

 

Let me give each of you a pat on the back for joining and participating in the program tonight. Your practise is about to change if you take the things that we are about to present tonight and employ them into n your practise. Thank you for seeking out this knowledge. Whether you attest use it or not you are at least looking at laser education for your practise.

 

In 2010 we designed a new program the impossible is nothing the reality of laser and everyday dentistry and we are going to cover portions of that thigh. We have limited time but we are going to cover just a little bit of physics and then we will cover all the procedures that you see listed there and then we will talk finally about the return in investment.

 

Boa Lays is really the most complete family of dental layers and featuring the new I-Lays, the pocket sized personal laser that is production right now. The Easy Lays which I use every single day in my practise or soft tissue procedures we’ll talk about that tonight. The Water Lays Sing 100, which is an economy entry level hard and soft tissue laser and of course the Water lays in the turbo which is the one that we will focus on tonight. It’s for basic and beyond dentistry.

 

It only lasted 12 seconds and it only flew 120 feet on December 17th 1903 at Kitty Hop, North Carolina because until that moment flying with power was impossible but on that very day it became possible and you know what has happened since that point. If we determine something to be impossible out vision for the future is blind. Orville Wright was quotes as saying “isn’t it astonishing that all these secrets have been preserved for so many years just so that we can discover them “and that’s kind of the way I feel about lasers. What a wonderful addition it has been to our profession.

 

Lasers are not only used or a fad or off the radar or a just a niche in dentistry. We have just seem to tip the ice berg. There will be over 4000 lasers purchased this year by dentist .It is a very rapidly growing facet of our profession.  Five out of a hindered dentist now routinely use the laser. Lasers are part of everyday, every way dentistry. We use our lasers all day long every day. It’s a fact dentist who own a laser produce 25% more than dentist who do not own a laser. For those of you who would like to get in touch with me and ask any questions following tonight’s webinar, you see my email there drwilson@769smile.com. If you would just put in the subject line “reference something to laser” I will be glad to respond to you.

 

Our little part of the world is in the north west corner  of the state of Alabama, Florence Alabama,  the home  of W.C Andy  the popular blues, Helen Keller  the first lady of all times with disability of  not being able to hear  or to speak , the famous Fames Studio that was the hit recording  capital  in the world in the 60s and 70s  and Stewart Saint who many of you know because of his fame  and Goth and  went into British Open last year.

 

We are along the beautiful Tennessee River, it’s a very important part of our culture here and this is our office and I just wanted to share this with you so that you get a concept of the guy that’s talking to you tonight about lasers. We are just in my option an ordinary practise. We practise in a rural area and I think I’m a common everyday dentist. I  don’t  think we have anything that’s especially  exceptional in our abilities so I want  you to know that I’m an in the trenches dentist  just like you guys .

 

[Pauses]

 

 

Our newest practise is Signature Smile. I’ll talk about the fact that later on we have had various practises through the years.

Everyday dentistry with the Boa Lays laser. We’re going to talk tonight about getting more patients, keeping more patients and growing more patients in our practise. I want you to understand this is not star was technology. I think through the years   us as educators have kind of made lasers a little out there like it’s kind of an elite kind of thing. It’s really not, it’s something that every dentistry can do. This thing is not a laser sword.

 

Lasers do not make a bad dentist good but it will make a good dentist great. I would like you to ask yourself do you believe that doctors are really taking a serious look at laser technology these days. In dental town recently there was a survey and it was determine that 77% are treating pockets greater than 6 mm. Then it was determine 78% believed laser could be used for periodontal surgery but then it was discovered that only 18% reported actually using laser to treat perio. That means that there are 60%  of the doctors  out there who are seriously thinking about adding laser to their practise and I’m sure because you are on the webinar tonight you are  in that 60%

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Alcohol has the same effect on them directly when it’s taken in a form of cherry. We know that alcohol will penetrate the plaque.  We know that it’s a wetting agent.  We know that it penetrates, therefore, into the parasite, and by dissolving the acroflavein in it, we can take this protoplasmic poison straight into the body of the parasite.

The important thing about acroflavein 1 in 50,000 as a preventive used one to three times daily is that it’s not a tissue irritant, and it’s not, to a great extent, bacteriostatic.  It has to be stronger than 1 in 33,000 in order to be bacteriostatic.  The method we have our patients use it is to take one teaspoonful at the mouth at full strength, rinse it around the mouth for five minutes, spit out, and then don’t eat or drink or rinse for the next 55 minutes.  Again, for the Torrens powder, pat it on the gingival margin, spit out all the excess, and then don’t drink or rinse for the net 55 minutes.

Other drugs that can be used for the treatment of parasites.  Apart from metronidazole, tetracyclines are weakly antiamoebic.  The dosage regime that we employ is two 250mg capsules twice a day, no milk products at the same time, obviously.  This is continued for two weeks.  At the end of two weeks, we usually examine to see if there’s parasites in the plaque.  If there are parasites in the plaque or if the patient isn’t completely healed or if it’s been a very severe infection, then tetracycline 1g bid for another two months.

Another drug which is not yet completely proven is ativrin, another antimalarial, is effective most of the intestinal protozoa.  We’ve used it in a couple of cases of resistant infections.  In fact, ativrin, 1 tablet 3 times a day is more effective than metronidazole over 11 days with the paste.  So, ativrin by itself seems more effective than metronidazole and metronidazole paste, but ativrin has unpleasant side effects.

One of the things we’ve tried to get rid of these protozoans is to go on an overkill and then to try to prevent reinfection during the convalescent phase which can last for a matter of weeks up to nearly a year.

Anybody who’s going to be prescribing any of these things should remember two things:  One is the importance of a sound medical history and consultation with the physician if necessary.  The second one is to be totally familiar with the drugs they’re prescribing.  A compendium of pharmaceuticals is essential in this point of view.

Host:                    I’d like to have a little summary, again, of step-by-step process of handling a new patient.  A new patient comes in, obviously the periodontal situation is very active.  So, the first thing we’re going to do is tell the patient of a little bit of both the concept of parasites and say we should not prescribe anything without doing a proper testing.  We could either test by using a microscope, a phase contrast microscope, to observe the amoeba, or else, we take a SAF kit to do the sampling.  We take the sample, send it off to a lab.  That comes back positive, you being highly suspicious, put the patient on a preventive mouth rinse.  Tell me a little bit about your choice of rinse here, and the progressive treatments, maybe the mild case or the severe case just to summarize it one more time.

Dr. Lyons:            Yeah.  Okay, well, if we’re waiting for the results to come back, we put them on modified Torren’s powder once a day and a pretreatment rinse, which they use four to eight times a day.  The reason for the fluctuation in time is sometimes they can’t keep it in their mouth for five minutes.  Sometimes, they have to eat within the 55 minutes.

Modified Torren’s powder, of course, is the salt and baking soda combination which has been finely ground up.  Some patients like to add flavoring to it like cinnamon.  The preventive rinse is 1 in 50,000.  The pretreatment rinse is 1 in 10,000.  The pharmacist has a bottle of concentrate and just mixes it up using alcohol form the liquor store, which is diluted so that it’s 16%, and then he adds the flavoring.

Once, we have gotten our positive diagnosis or in the case of a severe infection, we use a pretreatment rinse to get the numbers down.  We then go ahead and watch as the patient is being treated with the drug and with the paste. We got to continue with the modified Torren’s powder.

Sometimes, the patient will develop a severe reaction medically, and because of their general symptoms, they have to discontinue treatment.   Very occasionally, the worst complication that we get is basically a herpetic stomatitis.  If the patient develops a herpetic stomatitis and I think we have three cases in 700, what we do there is we take the patient off all medication.  We get them to continue with the rinse frequently, to use modified Torrens powder (to take 3 teaspoonfuls in 4 ounces of hot water and use that as a rinse), to stop toothbrushing entirely, and to use modified Torren’s powder on their finger.

After about 5 days, it will subside, by which time the patient will have developed some sort of skepticism for the treatment so they need a little bit of hand holding.  Then, they retake treatment, and when they retake the treatment, surprisingly, another herpetic stomatitis does not recur.

We’ve had one or two problems with urticarial.  Generally speaking, the urticarial response ceases immediately when medication is discontinued, and this can be controlled with the use of antihistamines.  However, with antihistamines, because we think they affect the metabolism of the parasite, will also slow down the rate of uptake of the drug, and therefore, prolong treatment.

In one case with urticarial, we suspect that there might be something like Endolimax nana in the patient’s system, and this is why he’s developing the responses that when he took the metronidazole, the other parasite was not as affected by the metronidazole as Entamoeba gingivalis.  Therefore, this other parasite overgrew, and it therefore, developed this problem as a side effect of treatment but not as a side effect of the drug.

Host:                    That summarizes the treatment.  After the treatment has been done, what do you follow up?

Dr. Lyons:            As far as follow up is concerned, the most important aspect is home care on the part of the patient, and this involves the usual regime of home care which is effective for that patient coupled with the specific antiamoebics that we’ve previously mentioned, the modified Torren’s powder, and the acroflavein 1 in 50,000 mouth rinse.  We have patients in the high risk category group using the mouth rinse anywhere from four to six times daily, normally one to three times daily and using the modified Torren’s power once daily or as they feel they require it.

The medical implications are largely speculative, but they’re based upon clinical obsevations of dental patients where there is a correlation oral parasites and systemic disease and a clue as to what parasites may be related to other diseases and an indication that this demands much more careful investigation.  As far as dentistry’s concerned, I really do feel, from the research that has gone on in Russia, in France, and Germany, Spain, and Italy, and in the United States back in the 1920s and the early part of the Depression, that the case has been proven for the pathogenicity of Entamoeba gingivalis, and that many of the cases that we see in the mouth should really be classified as oral amoebiasis.

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My last patient this morning actually just returned from a cross country skiing trip in the Rockies, and he’d been treated the second time around for reinfection.  In January, he was clear, and by the middle of January, he goes off to the Rockies, he gets some skiing in.  Everybody’s passing food and water bottles and so on and so forth around, and in spite of the precautions he endeavored to take, he knew he had the disease back again.  Within five days of this, he noticed his gums getting sore and bleeding.  He got back to Ottawa.  He came down with a protracted and lengthy flu-like illness.  He was pronounced not to have mononucleosis.  It was one of the many other case reports I have labeled as a “virus”, and he would have to sweat it away.

When we found out he had the protozoan parasite, we prescribed, and I’m quite confident once he starts on this medication, the remaining of his flu-like symptoms and his extreme tiredness and frequent headaches, which he’s still experiencing, since March, will all go.

Host:                    This has been the pattern that has repeated itself patient after patient after patient?

Dr. Lyons:            Yup.  I have another interested case, a young lady.  She’s 27 or so.  She’d had a severe facial pain due to an occlusal problem.  The slide she had had been a problem.  The balancing slide interferences have been eliminated.  She balanced in centric.  She was balanced in lateral excursions back, and now she has severe facial pain.  It seems to be centered around the center of Messina, approximately where the proglottid is, and it’s going right up her head and back up into the occipital region and down her neck and even down her left arm.

Her ECG was negative.  Her plaque examination was positive for oral parasites.  She started medication.  No other treatment was done to relieve her pain.  Within two days, she’s free of pain.

Host:                    You’re suggesting the proglottid was infected with the oral parasites.  Is this possible?

Dr. Lyons:            Yes.  Now, I had another interesting case presented.  About a year ago, a patient came in with her husband who had broken a tooth.  At the end of the appointment, I looked at her and said, “What’s the matter with you?”  She said, “I have this vague infection in my salivary gland, and I have to go see the ear, nose, and throat surgeon next week, and he says I might have cancer.  They’re going to do a biopsy.  It may be an infection.  I’ve been really worried, and I’ve been really tired.  I’ve been sick, nauseous, that is, and I’m off my food.  I’m losing weight, and I’ve been really feeling worse and worse over the last two years”.

She had some of the most active amoebae that I have seen.  She started treatment that night.  The following day, the salivary glands were no longer tender to palpation.  Salivary production returned to normal.  The salty taste she complained off disappeared.  Her energy and her vitality returned, and she said, when she finished her medication, that she felt better than she had in four or five years.

Host:                    This is over a period of a 10 day course of medication?

Dr. Lyons:            This was over a period of a 10 day course of medication.  Now, there were the other patients.  I had a patient sent to me by a periodontist.  This lady was 57.  She was unable to keep her mouth clean.  She said she was brushing three to six times a day and still the plaque was forming, and she complained her gums were very itchy and sore.  She said, “They’re driving me crazy,” and clinically, she had a 3mm pocket.  So, the generalized deterioration of the tissue and her plaque was 3+ despite the fact that she brushed quite recently, and she had amoeba present in her plaque quadruple plus.

Post-treatment, she complained of nothing in her mouth.  The periodontist said she couldn’t believe how good patient’s mouth looked, and of course, the patient’s pocket had returned to half millimeter and no inflammation.  The tissue looked firm, and it was firm and healthy and pink and stippled and no more symptoms.  She said, again, she felt better than she’d felt in many years.

Acute ulcerative gingivitis presents in the usual way.  Plaque examination reveals fusiformis, spirochetes, Entamoeba gingivalis, and large numbers of bacilli.  One of the interesting clinical observations, microbiological observations, is that when we give patients local antiamoebics which reduce the viability of the amoeba, we find that spirochetes are able to penetrate the amoeba wall to get inside the amoeba, to swim around inside the amoeba, and then to exit the amoeba.

So, spirochetes would seem to be the natural enemy of amoeba, and apart from being a cause of periodontal disease, I think they’re possible out last line of defense.  Fusiformis like the hyena is a scavenger.  Amongst the amoeba, it has been destroyed, for example, using Torren’s powder, causing the cell membrane to rupture.  Then, fusiformis will start swimming inside the carcass, scavenging it.

Host:                    As we know, with any infection, it is considered good policy to test the type of bacteria or whatever organism is involved and then prescribe accordingly.  With a patient’s periodontal disease, it is not considered prudent, I would imagine, just to prescribe metronidazole and the adjunctive paste.  How would you caution us on that?

Dr. Lyons:            Yes, I would certainly caution everybody not to go jumping in to any periodontally involved patient with metronidazole and the metronidazole-Mexiform paste.  Make a positive diagnosis of oral parasites first because then, when you’re asked about treatment at any point in time, you can say you’re treating for oral parasites and you proved they’re there, and there is the adequate documentation.  There’s enough of the documentation, I feel, to be ample justification to treat patients for oral parasites. Then when you’re treating them for oral parasites and suddenly the disease is gone and they don’t need surgery and they only need a quarter of the scaling they needed, then you say, “We don’t have to treat you for the periodontal disease anymore because we got rid of the parasites, and obviously they caused the disease.”

Now, sometimes, when the patient has got a yeast present in their mouth as well, the yeast will overgrow and clinically, the tissue will almost look identical with a yeast infection as they will with parasite infection.  So, the microscope really becomes all important, and if they have got a yeast infection, prescribing metronidazole and the paste will eliminate all the microorganisms except the yeast.  The yeast will overgrow and make the patient worse.

Under those circumstances, one needs an effective antifungal preparation in order to eliminate that disease.  The thing that I found that most is when oral parasites are present, we have an aggressive, osteolytic response occurring with an apical migration of the periodontal membrane, and all the typical parameters of active, destructive, deteriorating periodontal disease.  It can be slowed by home care, slowed by dental care, but generally speaking, not arrested.

With medication, when we have a positive diagnosis, we can eliminate and cure the disease and get healing, which previously has been thought of as impossible.  If there’s yeast there, it simply stops healing.  It does not progress, but it doesn’t get any better either.

Host:                    Dr. Lyons, I want to ask you about again about trification.  If you could just clarify your approach to them and how patient handles them with these water-soluble creams and products that you’re using to inject in the trification.

Dr. Lyons:            Sure.  Well, once the pocket depth has returned to normal and all the irritants over hanging margins have been removed, if there’s a persistent trification present, the important thing is it must be kept clean, and if it’s kept clean, then generally speaking, there won’t be any more deterioration.  My particular pet way of keeping these clean is to use a pipe cleaner, and during the treatment, we’ll have the patient, when they’re using the paste, take the pipe cleaner and smear it in the paste through there.

So, they’re going to be smearing the paste through the gingival margin, and trification and bificaiton involvements.  They’ll use the paste through there with the pipe cleaner.  Once they are clear of disease, then the next important thing is prevention.  Now, the routine thing we’ve done to prevent periodontal disease just doesn’t work.  So, what we’ve done is to develop two reasonably effective preventive aids.

One is the modified Torren’s powder, previously mentioned, which can be used in perpetuity, at least once a day, and it should be used on a finger and not on a brush.  It works by reverse osmosis, and by keeping the bacterial population down, it makes the mouth a nonconducive place for the establishment of parasite colonies.

The other active preventive, which requires no patient dexterity, is a mouth rinse, which is basically acroflavein. Acroflavein, from 1926 to 1929, was investigated along with the other essential dyes.  Acroflavein was found to be the most effective amoebicide and would kill amoeba at dilutions down to 1 in 200,000.  We formulated a mouth rinse which is acroflavein, 1 in 50,000, in 16% alcohol with an orange flavoring.  For alcoholic patients, it’s set up straight in water.  The reason for putting it in 16% alcohol is alcohol, like the barbiturates, narcotics, and particularly antihistamines, all seem to affect amoeba making them much less active and motile.  They become much less active and dormant and wound up, and they seem to have a much lower rate of metabolism as a result of these drugs.

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So, taking plaque, then, from the deepest periodontal pocket, I use a number six straight ended probe, and it’s moved around from the medial lingual to the medial.  The plaque is lifted out and immediately deposited into the fixative, and the instrument is agitated rapidly to detach the plaque.  I’ll take plaque from all quadrants of the mouth, from the worst areas, and then, the container is tightly resealed.  When the form is filled out, it must be marked “dental plaque”, otherwise, at the lab, it might be mistaken for an empty container and simply thrown away.

If one is fortunate enough to have a phase contrast microscope, and in my opinion, all dental offices should have a phase contrast microscope and personnel adept at using it, then the situation becomes somewhat easier.  What one needs to do is take a drop of the patient’s own saliva, not sterile bruff [31:12], not artificial saliva, not normal saline.  These fluids will not provide reliable results.  We must have homeogenic liquid which will not cause any distortion of the parasites.

Then, again, take drop of the saliva, put it on the slide.  Take plaque from the deepest periodontal pocket, and from the base of it, deposit it down on the slide into the saliva, that is.  Drop on a cover slip, and then press that cover slip down in order to squash the plaque out into the thinnest possible film.  I use a double pipe cleaner, and I press it really, really hard.  Sometimes, when I got too much saliva or too much plaque, it will come oozing out of the edges of the cover slip, and I just wipe it off.

Then, I make my lower power search.  Now, when I do my low power search, instead of using the phase contrast condenser, which is matched to the low power phase contrast objective lens, I use the condenser which is actually matched to the high power phase contrast objective.  So, on my microscope, I have 100 times low power, 1000 times high power, and that addition of one additional zero from 100 to 1000 times is important.  It could be 125 to 1250, but it must be a 10 times factor.  Then, you can use the high power phase contrast condenser with both the low power and the high power objective lenses.  Then, on the low power, using that setup, you’ll get an apparent dark field illumination, which makes the Entamoeba easier to see, and on the high power, you’ll get a bright field phase contrast, which will make the positive identification possible.

The protoplasm is clear and non-granular.  The movement is typically ameboid.  Sometimes, it will be sluggish, just putting out a pseudopodium and retracting it, and at other times, it would be moving rapidly across the slide.  Occasionally, they would be dormant, just sitting there and not moving.  There would be a number of occlusions within the endoplasm, which are wound and look like nuclei.  They are the nuclei of leukocytes, and then, the identifying factor is the Entamoeba nucleus.  The Entamoeba nucleus is smaller than an erythrocyte.  It’s about 4 microns across, to my recollection.  It has an outer chromatin ring on which one can sometimes see the thickening of the three or four chromosomes.  It has a central karyosome so that the whole thing looks like a bicycle rim with a halve, and the halve is sometimes a dark spot.  Sometimes, it’s another second circle inside this outer circle.

Sometimes, one can see strands of chromatin material, which join the outer ring to the central karyosome, and it’s the identification of the nucleus of the parasite, which is diagnostic.

Host:                    Now, how are we going to treat this disease if the phase contrast microscope result is positive or if they report, “Yes, we found parasites in your specimen”?

Dr. Lyons:            Well, here we just take a leaf out of the book of gastroenterologists and gynecologists, and parasite infection of both these body cavities are treated in basically the same way.  The organism is considered to have invaded the wall of the body lumen and also to be present in the lumen itself.  So, if one gives medication, which is entirely parenteral, the systemic medication will eliminate the parasites from within the tissue but will not affect the parasites within the lumen, and if one uses a local antiseptic, it will eliminate parasites within the lumen but not within the tissues.  So, we need to use both.

I have used, with most success, metronidazole, and a metronidazole-based paste.  The unfortunate thing about the paste is the taste.  Sorry about the alliteration.  So, the routine treatment that we follow is metronidazole times 30, and to minimize the side effect of the medication, the following should be employed:  On the first evening, with food, one metronidazole.  On the second day, again, one with breakfast and one with the evening meal.  Now, the reason for bringing up the dosage to the third day, which is the full dosage, which is one of the 250 mg pills every 8 hours, is that as the parasites are destroyed by the medication, the disintegrating parasites seem to release a lot of antigenic material, which can cause quite a severe system reaction to the patient.  We try to minimize these side effects.

It’s important for the patient to realize that most of their side effects are due to the destruction of the pathogenic parasites, and we’re fortunate, with Entamoeba gingivalis, that the release of antigenic material during treatment does not cause as severe are reaction as occurs with some of the treatment regimes for some of the other parasites.

The patient should be instructed that if they do become very ill, they should decease medication.  They should also be instructed that they should phone in if they get any side effects.  There’s two side effects that we see due to the medication alone:  One is slight and transient headache, and the other one is an altered state of taste.  These both disappear when the medication is discontinued.

One drug interaction which must be avoided is metronidazole and alcoholic beverages.  They interact very badly.  The patients don’t die if they take them both at the same time, but they’ll sure wish that they could.

Host:                    Could your treatment be for very bad periodontal condition and perhaps describe a case history that you’ve done, and then we’ll talk about a mild case.

Dr. Lyons:            Sure.  Before we do that, I think I’d better finish the pace that we use.  What we have taken is 1 ounce of metronidazole vaginal cream.  Then, we take 6 Mexiform tablets, which is an intestinal antiseptic and also antiparasitic, and both a drugs are antibacterial.

The Mexiform tablets are finely crushed and mixed in with the paste in order to stiffen it up, and due to the extreme bitter taste of the paste, we’ve disguised the taste by using a very strong anise flavoring.  The patient will still have a bitter aftertaste, but at least it’s tolerable.  The paste is applied to the gingival margin with a toothbrush, finger, pipe cleaner, but preferably with a toothbrush at least twice a day.  This is done at the same time that the medication is taken.  When the paste is applied, it should only be applied very sparingly.  The excess can be spat out, and then, the patient does not eat or drink or rinse, of course, for the next 55 minutes.  The important thing is if too much paste is used, it can be nauseating.  The patient salivates excessively, and all the good which you’re trying to do is undone.

So, we can come on to sever cases.  That’s how we treat a severe case, and we sit back and wait and see, how many pockets heal and at what depth they remain.  After approximately 6 weeks and during the 6 weeks, they would continue with the paste and they will also have been using adjunctively, modified Torren’s powder, which is basically 6 parts baking soda to 1 part salt.   Again, it has to be finely ground, and an ordinary house blender will do this.

A patient will take about a teaspoonful of this, and just pass it on the gingival margin with a saliva-wetted finger.  This ideally should be done once a day.  Patients on a salt-free diet should use baking soda by itself.  The effect of the powder will help to keep the teeth looking with, help tooth keep the members of bacteria down, and help tissue to respond normally.  Also, it will act as a partial preventive because when oral parasites come in contact with the power, they’re destroyed by reverse osmosis.

What do we do now if we’ve treated the patient and they’re back in 6 or 8 weeks later and they still have deep pockets?  Well, the first thing that we do is go back again and check for parasites.  If there’s parasites, they’ll then go back to medication, and before they finish the medication, they come back in and they have all the subgingival calculus removed.  When I remove this, I use very fine curettes, and I always dip the instrument in the metronidazole-Mexiform paste prior to each movement with the scaler or curette.  This will minimize the chances of any post-operative infection or soreness.  At the end of the appointment, I’ll carefully apply a little of the metronidazole-Mexiform paste into dental areas to give us a sterile wound, which would then heal.

Now, having done all those things, one will still find that there’s a very deep periodontal pocket.  They’re still on a five or a six, a triplication involvement or something like that, and it’s still wound.  Take a 5 cc syringe with a 20 or 18 gauge needle, blunt the needle, and put it through at about 110 degrees.  Then, fill it with metronidazole-Mexiform paste.  Instruct the patient on how to inject the paste to the depth of the periodontal pocket, slowly pulling the syringe out as they fill the pocket.  They should do this for a period of time until the pocket is healed, and they should do this at least twice a day and continue, during this period of time, in using the paste.

Sometimes, during this period of time, the patient will recontract the disease.  The disease is contagious.  It is spread by mouth to mouth contact which can be direct, which needs no explanation and indirection which can include any object which goes into the patient’s mouth which may have been contaminated with someone else’s saliva.



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