Periodontal Disease P5


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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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