The JOP study, conducted in Japan, examined the effect of periodontal diseases on medical and dental costs in 4,285 patients over a 3.5-year time span. The patients were between the ages of 40-59. Researchers found that cumulative health care costs were 21% higher for those patients with severe periodontal disease than those with no periodontal disease. Severe periodontal disease (periodontitis) involves bone loss and diminished attachment around the teeth.

“While previous studies have evaluated the potential link between periodontal diseases and other systemic conditions, this study provides an interesting analysis of total health care costs and the financial impact of having periodontal diseases,” explained JOP editor Kenneth Kornman, DDS. “The research suggests that patients with sever periodontal diseases incur higher overall health care expenses as compared to those patients with no periodontal disease. Prevention of periodontal disease may be very important in overall health, and this study suggests that it may also indirectly translate into lower total health care costs.”

“Everyone is looking for ways to reduce health care costs,” said Susan Karabin, DDS, President of the American Academy of Periodontology, “especially those who are in an age category where they are more susceptible to periodontal diseases. Because of the relationship between the mouth and the rest of the body, treating periodontal disease may be one simple way to decrease total health care costs. If caught early, periodontal diseases can be treated using simple non-surgical techniques which can restore your mouth to a healthy state.”

To find out if you are at risk for periodontal diseases, please visit the AAP’s Web site and take a free risk assessment test. A referral to a periodontist in your area and brochure samples are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

The study evaluated the effects of no treatment, non-surgical therapy, and periodontal surgery on 2,350 teeth of patients who presented with moderate to severe periodontitis. Forty-eight percent of teeth receiving periodontal surgery improved prognosis, while only 12% of the teeth that received no treatment or that underwent non-surgical treatment improved. In addition, more than 35% of the teeth in the no treatment and non-surgical treatment groups actually worsened in prognosis.

“These findings are important for patients who value oral health and want to keep their teeth a lifetime,” explained Stephen Harrel, D.D.S., one of the authors of the study. “It’s essential for these patients to understand that optimal results are not always possible with non-surgical methods and, with no treatment, periodontal disease usually gets worse. Equipped with this understanding and an appreciation of the benefits afforded by natural teeth over dentures, even the most apprehensive patients should consider selecting the treatment option that’s best for them – even if that involves surgery.”

Harrel emphasizes that these findings are significant compared to previous studies that used an overall average “score” for each patient (patient mean) instead of individual teeth to determine the impact of periodontal treatments and non-treatment. “The damage from periodontal disease is often localized, so the individual teeth that have damage should be followed in order to obtain a true picture of treatment results. Results based on patient means can mask positive or negative effects of treatment.”

“This research can help save patients’ smiles by illustrating tooth loss as a consequence of what happens when periodontal disease is ignored and not fully treated,” said Kenneth Bueltmann, D.D.S., president of the American Academy of Periodontology (AAP). “And, as additional research links periodontal disease to other serious health conditions, such as diabetes, heart disease, respiratory disease and pre-term low birth weight, if this study prompts even one patient to select the best recommended treatment plan so to avoid these other possible consequences of ignored periodontal problems, then it’s achieved a positive outcome for the entire healthcare community.”

A referral to a periodontist in your area and free brochure samples including one titled Who Is a Periodontist and Why Do I Need One? are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

The study followed 15 patients during the healing process after a gingival (gum) graft. When the adhesive derived from snake venom was used, those patients had faster recovery and better results than those treated with traditional sutures. “This unique type of adhesive may stimulate faster tissue repair. It is a more natural form of adhesive in comparison to traditional sutures used after surgery,” explained study author Monica Barbosa, Phd, Bauru Dental School at the University of Sao Paulo, “More studies are needed to fully evaluate the effectiveness of this alternative.”

“This adhesive may be a less infectious alternative to traditional sutures,” said Preston D. Miller, DDS, and AAP president. “This research highlights the array of therapies available for patients; both traditional and natural alternatives. There continues to be a lot of exciting and innovative research in the field of periodontics.”

To find out if you are at risk for periodontal diseases, please visit the AAP’s Web site and take a free risk assessment test. A referral to a periodontist in your area and brochure samples are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

“There are many factors that could impact treatment outcomes in clinically depressed periodontal patients,” said John Elter, lead author of the study and a dentist and epidemiologist at the University of North Carolina Chapel Hill School of Dentistry. “For example, the patient’s attitude about the treatment process plays a significant role in treatment success. Depressed patients might view a course of periodontal treatment as an overwhelming ordeal, and might be more likely to not comply with all treatment recommendations.”

“In addition, depressed persons are more likely to continue to smoke, which has been linked to poor response to periodontal therapy,” said Elter. “Most importantly, it is possible that their immune system is impaired which may slow down the body’s reaction to fight off the infection, but more research needs to be conducted to verify this.”

He continued, “Future studies should focus on elucidating a possible mechanism for the negative effect of depression on the immune system and on wound healing.”

Previous research has found that depression has been associated with poor outcomes from cardiac surgery and reconstructive spinal surgery. In this study, the presence of preoperative fear, anxiety, or depression prior to surgery is associated with a negative postsurgical experience and with increased post-periodontal surgery pain response and impairment of quality of life.

“This is the first report of clinical depression and poor periodontal treatment outcome,” said Kenneth Bueltman, D.D.S., president of the American Academy of Periodontology. “As we are hearing a lot about the decrease of mental health lately, this new information is important for periodontists and patients to consider before periodontal treatment. Pretreatment assessment of depressive status may serve to improve the quality, accessibility and effectiveness of periodontal treatment for patients suffering from clinical depression.”

A total of 697 patients were given periodontal exams between January 1, 1996, and December 31, 1998; 85 of the patients had been diagnosed with some form of depression. Each patient had at least three diseased sites with probing depth (PD) greater than 5 mm between the gum tissue and teeth at the beginning of the study and was monitored from the date of the initial periodontal examination until the follow-up examination one year later. The level of periodontal diseases in the patients varied from moderate to severe. The median change score in the disease after treatment was 7.4 percent in mentally healthy patients and only 4.7 percent in depressed patients.

In any given 1-year period, 9.5 percent of the population, or about 18.8 million American adults, suffer from a depressive illness, according to the National Institute of Mental Health. Women tend to experience depression about twice as often as men due to many hormonal factors such as menstrual cycle changes, pregnancy, pre-menopause, and menopause. While the exact cause is not known, some types of depression run in families, suggesting that a biological vulnerability can be inherited. Additional factors, possibly stresses at home, work, or school, are involved in its onset.

“In light of recent economic events, more Americans may have additional stresses that may put them at a high risk of becoming clinically depressed. Therefore, periodontists needs to be aware of the signs and symptoms of depression so they can adjust their treatment procedures to obtain the best possible outcomes,” said Bueltmann.

A July 1999 article in the Journal of Periodontology reported that high levels of financial stress and poor coping abilities increase twofold the likelihood of developing periodontal (gum) disease. More about this article

After accounting for other risk factors – such as age, gender, smoking, poor dental care and diabetes – those who reported high levels of financial strain and poor coping behaviors had higher levels of attachment loss and alveolar bone loss (signs of periodontal disease) than those with low levels of financial strain. However, people who dealt with their financial strain in an active and practical way (problem-focused) rather than with avoidance techniques (emotion-focused) had no more risk of severe periodontal disease than those without money problems.

Periodontal diseases are serious bacterial infections that destroy the attachment fibers and supporting bone that hold your teeth in your mouth. When this happens, gums separate from the teeth, forming pockets that fill with plaque and even more infection. As the disease progresses, these pockets deepen even further, more gum tissue and bone are destroyed and the teeth eventually become loose. Approximately 15 percent of adults between 21 and 50 years old and 30 percent of adults over 50 have the disease.

A referral to a periodontist in your area and free brochure samples are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

“Although this study is still in its early phase, with the recent number of reports about bacterial strains becoming resistant to frequent doses of antibiotics, PDT could be an alternative to conventional periodontal therapeutic methods,” said Dr. Michael P. Rethman, DDS, MS, and president of the American Academy of Periodontology. “Antibiotics may be used as an adjunctive therapy for periodontal diseases, so there is a pronounced interest in the development of alternative antimicrobial concepts.

PDT involves two stages. In the first stage, a light-sensitive drug is applied. The second stage involves shining a light or laser directly on the area treated with the drug. When the light is combined with the drug, phototoxic reactions are induced which destroy bacterial cells. PDT was first approved by the Food and Drug Administration in 1999 to treat pre-cancerous skin lesions of the face or scalp.

In this study, researchers investigated anaerobic bacterial strains (bacteria that can only survive and grow in the absence of molecular oxygen) and facultative anaerobic bacteria (bacteria that can survive without oxygen).

“The photosensitizers we investigated were able to completely suppress the anaerobic key pathogens leading to periodontal diseases; however, facultative anaerobic bacteria tested responded to a lesser extent to PDT,” said Dr. Bernd W. Sigusch, Friedrich Schiller University of Jena, Conservative Dentistry, Germany.

To specifically address the periodontal pockets in the body, the test tube results are presently being verified in several animal and human experiments.

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Therapy: Where Do I Start are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

The supplement reports on the current challenges in public health surveillance of periodontal diseases, and focuses on the potential use of self-report measures for population-based surveillance. The efforts of this workgroup include identifying and assessing the validity of self-report measures for surveillance of periodontal diseases in multiple datasets, and field testing of promising questions in a national survey. Eleven papers are presented in this supplement, covering the following issues:

• Background and perspectives on surveillance of periodontal disease
• Case definitions for population-based surveillance of periodontal disease
• Analytical methods and assessments of self-report measures for surveillance in multiple datasets
• Field testing of promising self-report questions.

“The issue of periodontal surveillance has been important for both the AAP and the CDC,” explained William Giannobile, DDS, Associate Editor of the JOP. “These papers provide valuable information about the current status of periodontal surveillance and future directions on the monitoring of periodontal disease. With the use of new salivary proteomic and genomic biomarkers of disease and rapid identification procedures to classify patients, the future is sure to be exciting.”

“We are excited about this information,” said Preston D. Miller, DDS and AAP president. “Epidemiologists, dental researchers, clinicians, and the public are eager to assess the prevalence of periodontal disease in the U.S. population. The papers in this supplement highlight the diversity and complexity of the issue of periodontal surveillance.”

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

Researchers at São Paulo State University found that using PDT was an effective method to minimize destruction of periodontal tissue which can accompany treatment for periodontal diseases. In a rat population, PDT did minimal damage to periodontal tissues, in comparison to other techniques including scaling and root planing and antibiotic therapy.

“We found that PDT is significantly less invasive than other treatments for periodontal diseases,” said study author Dr. Valdir Gouveia Garcia, from the Department of Periodontology at São Paulo State University. “It can provide improved dentin hypersensitivity, reduced inflammation of the tissues surrounding the teeth, and allows tissues to repair faster.”

PDT may be an alternative to antibiotic treatment, which is becoming increasingly important as antibiotic resistance increases. PDT involves two stages; first, a light-sensitive drug is applied to the area. Second, a light or laser is shone on that area. When the light is combined with the drug, phototoxic reactions induce the destruction of bacterial cells. PDT was first approved by the Food and Drug Administration in 1999 to treat pre-cancerous skin lesions of the face or scalp.

“This is an exciting finding,” said Preston D. Miller, DDS and AAP president. “PDT may be an effective therapy for the treatment of periodontal diseases. While patients have many options for treating their periodontal diseases, PDT could prove to be a preferable alternative to antibiotic therapy. Unfortunately, long term antibiotic therapy not only decreases the drug’s effectiveness, but also may lead to the development of drug resistant organisms. Our Academy supports future research to further define the application of PDT as a means to treat periodontal disease.”

To asses your oral health, take the AAP’s online test to assess your gum disease risk. A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM (800-356-7736) or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

A randomized, multi-center, double blind study was performed to compare the efficacy of scaling and root planing (SRP) plus placebo to scaling and root planing plus Periostat administered BID. That study revealed statistically significant pocket depth reduction with adjunctive use of Periostat at 3, 6, and 9 months post initial therapy (for initial depth >7mm, 1.20 vs. 1.68 mm, at depths 4-6 mm, 0.69 vs. 0.95 mm) and gain of clinical attachment (for initial depths >7 mm, 1.17 mm vs. 1.35 mm, at depths 4-6 mm, 0.86 vs. 1.03 mm). Mean changes in pocket depth and attachment level across large numbers of patients and tooth sites were small, and may not reflect the magnitude of change that may occur in an individual patient or tooth site. For example, when SRP plus Periostat was compared with SRP plus placebo, more sites initially demonstrating 5 to 8 mm probing depth exhibited >2 mm reduction in probing depth (41% vs. 30%, 886 vs. 640 sites).

In a 3-month follow-up study, where patients received no additional therapy, pocket depth reductions and clinical attachment level gains observed following 9 months adjunctive Periostat were maintained. The Academy is not aware of any data regarding treatment outcomes for periods longer than 12 months.

At present the Academy is not aware of any available data concerning the need for surgical or non-surgical treatment of sites after using Periostat. Furthermore, there are no studies to the Academy’s knowledge which address the use of Periostat in the treatment of specific types of periodontal defects or diseases other than adult periodontitis.

When considering using Periostat or other adjuncts to SRP, clinicians must consider the expected results in view of the severity of the defects being treated. Furthermore, it should be noted that adjunctive procedures to enhance conventional therapies are not a substitute for meticulous home care, professional root planing and appropriate treatment designed to minimize bacterial load and facilitate proper home care. In this regard, each practitioner must determine the usefulness of Periostat in light of the available data and needs of the individual patient.

References

1. Caton J, Blieden T, Adams D, et al. Subantimicrobial doxycycline therapy for periodontitis. J Dent Res 1997;76:177 (Abstract # 1307).
2. Caton J, Ciancio S, Crout R, Hefti A, Polson A. Adjunctive use of subantimicrobial doxycycline therapy for periodontitis. J Dent Res 1998;77:1001 (Abstract # 2957).

This statement was revised by the Committee on Research, Science and Therapy and approved by the Board of Trustees of the American Academy of Periodontology in January 2000. This statement on Periostat replaces the one approved in June 1998.

Periodontists have found a variety of ways to improve the oral health of those in need, according to a recent online survey conducted by the American Academy of Periodontology (AAP). In fact, of the 121 periodontists polled, more than 90 percent said they had donated free dental care to those in need.

About 35 percent of the adult population is estimated to have periodontal disease. “Researchers are finding that this has implications beyond oral health since the bacteria from gum infections have been shown to play a role in heart disease, respiratory disease, diabetes and preterm, low birth weight births,” said Michael McGuire, D.D.S., president of AAP. “Therefore, we are learning just how crucial dental care is.”

Almost three out of four survey respondents indicated that they donate dental care individually, either in their own practice or by going out to a location such as a nursing home. Some respondents wrote in about their experiences doing dental screenings for participants in the Special Olympics, providing care in indigent countries, teaching proper dental hygiene to the blind or providing free care to their own patients who could not afford to pay.

“I get mental gratification by helping some elderly individuals restore oral comfort and self-esteem who couldn’t otherwise afford treatment,” said one respondent.

A referral to a periodontist in your area and free brochure samples including one titled Who Is a Periodontist and Why Do I Need One? are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

“Identifying oral cancer in this patient was really a blessing in disguise,” said Dr. Alfredo Aguirre, professor of oral and maxillofacial pathology at the State University of New York at Buffalo. “Fortunately, survival rates for this type of cancer are high when found in its early stage, but undetected protein S deficiency causes thrombotic disorders that obstruct blood flow thereby causing strokes and/or heart attacks.” He added, protein S deficiency is classified as an acquired or heredity disorder, and occurs in approximately 1 out of 10,000 people when it is hereditary.

“A periodontal examination saved this patient’s life,” said Aguirre. “If the protein S deficiency had not been detected, eventually, the patient would have experienced an unforeseen stroke or heart attack, and his chance of survival would have been unpredictable.”

The case, featured in the October Journal of Periodontology, describes how a 48-year-old male experiencing discomfort in his gums visited the university’s dental school for a consultation. After a periodontal examination, Dr. Sebastian Ciancio, chairman of Periodontology at the State University of New York at Buffalo, found a lump on the patient’s gums and biopsy results determined it was squamous cell carcinoma, the most common cancer of the oral cavity and oropharynx. The patient was referred to a head and neck surgeon who removed the remaining gum tissue and part of the jawbone and repaired the area with a tissue and bone graft. After the surgery, physicians noticed that the graft was not healing properly. Blood flow tests found vein clots in the graft and additional blood tests revealed that the patient’s levels of protein S were extremely low. Case Report Abstract *

“This clearly shows the value of a comprehensive periodontal examination in detecting serious oral and systemic conditions,” said Gordon Douglass D.D.S., president of the American Academy of Periodontology. “Any unusual changes in your mouth such as swelling, redness or bleeding should be evaluated by your dentist or periodontists today. Early diagnosis of any medical condition is the key to successful treatment outcomes.”

A referral to a periodontist in your area and free brochure samples including one titled Protecting Your Oral Health are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.