Periodontal Disease P4

Nov
2013
14

posted by on Gum Disease Prevention

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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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