This article highlights the causal relationship between gum disease bacteria and systemic disease, and why 80% of patients have gum disease (bleeding gums). It also covers a simple, inexpensive, predictable even guaranteed treatment results that are obtained if the OraVital System is implemented.

Here’s a statistic: 80% of people have gum disease which is defined as tissue that bleeds when touched despite dentistry’s best efforts.

This means the existing treatments and recommendations suggested do not work! In fact, if you follow these recommendations it may actually cause harm to patients by delaying more effective care.

Key Sections in This Document

• The COVID-19 and Gum Disease Connection
• The Mouth/COVID Connection
• The Mouth/Atherosclerosis Connection
• Educating Our Patients
• Individual Patient Responses Matter
• Oravital: a System to Predictably Treat Periodontal Disease and Halitosis
• Kill the Pathogens Causing the Local and Systemic Effects

The COVID-19 and Gum Disease Connection

In COVID-19 and gum disease, the same ACE2 receptor is attacked which creates an inflammatory cascade. This points towards a possible association between periodontitis and COVID-19, where several cytokine enzymes expressed in both diseases are regulated by this receptor.

ACE2 is a protein on the surface of many cell types. It is an enzyme that generates small proteins – by cutting up the larger protein angiotensinogen – that then go on to regulate functions in the cell. [source]

These enzymes contribute to the whole-body inflammation that creates worsening outcomes for COVID-19 patients with gum disease.

The Mouth/COVID Connection

The impact of a connection between periodontal treatment, IL-6 levels (an inflammatory molecule), respiratory conditions and COVID-19, can be powerful considering the high prevalence of periodontal disease in adults; the high transmission rate of SARS-CoV-2; the limited access to periodontal treatment during the pandemic and the shortage of health care resources related to hospitalized COVID-19 patients who require mechanical ventilation.  

The Mouth/Atherosclerosis Connection

Dr. Bale and Dr. Doneen state “high risk periodontal pathogens cause atherosclerosis”. The body’s reaction to them creates the triad of conditions that causes atherosclerosis. Dr. Bale says that his research shows that 50% of heart attacks are caused by these periodontal pathogens.

The Mouth/Alzheimer’s Connection

Dr Miklossy states “Alzheimer’s is a neurospirochetosis (caused by one of five oral spirochetes found with gum disease in neural/brain tissue) with 93.7% of Alzheimer’s patients having oral spirochetes in the brain tissues on autopsy.”

Spirochetes cause syphilis and Lyme disease, producing similar neurological conditions as Alzheimer’s. If these spirochetes could be killed, then Alzheimer’s could be prevented. The OraVital antibiotic rinse targets these bacteria.

How does gum disease affect overall health if you have COVID – 19, atherosclerosis and Alzheimer’s?  When gums bleed, bacteria gain entrance into your blood vessels and tissues. They look for sites to breed throughout the body by direct invasion, potentially 24/7/365. The pathogens also stimulate the immune system to produce inflammatory products that create inflammation and tissue damage, while allowing more pathogens to reproduce. Inflammation worsens the outcomes for Alzheimer’s, COVID and periodontal disease.

Educating Our Patients

To control periodontal disease, we need to educate our patients on how:to:

1. disturb and disrupt the gum biofilms effectively
2. create shallow pockets they can cleanse
3. test for these pathogens when indicated
4. prescribe an antibiotic particulate rinse to kill the pathogens under the gum, on the tongue, and in the throat/tonsillar areas.

Treating the gums alone does not and has not worked for over 100 years.

Individual Patient Responses Matter

To acquire gum disease you need gums, and the bacteria which create a reaction with the patient’s immune system dependent to the individual patient’s response to the bacteria. Take a look for the words gum and bacteria in the following recommendations which we give to patients to prevent gum disease.

To control gum disease caused by bacteria we recommend:

1. Brush your teeth. This is the wrong. One needs to brush the sulcus (gap between the gum and tooth) so the gum cleaning removes biofilm from the tooth and gum. If you brush your teeth you do not brush the gums where the infection is located. Brushing your teeth alone contributes to gum disease.
2. Floss your teeth. The tooth is inorganic and has its own biofilm. The gum is organic and has a different biofilm. Both must be disturbed for health. There is a gap between the tooth and gum wider than floss so the floss can not physically touch the gum and tooth at the same time. When you floss you push biofilm beneath the gum below where you can not remove it with floss. You can floss the tooth because it is convex. You can not floss the inside of a bowl which is the shape of the gum tissue surrounding/between the teeth. Floss is unable to physically remove gingival biofilms. Rather use Soft-Picks to push firmly against the gum AND tooth to remove the gum and tooth biofilm easily at the same time. On the third day swollen tissues shrink and tissues stop bleeding guaranteed.
3. Clean your teeth. Bacteria causes the infection. Cleaning teeth disturbs the biofilm. It does not remove it from the mouth NOR kill bacteria. In fact, it can cause gum disease to spread because infected scalers can seed infection in healthy tissues. So, cleaning your teeth delays the progress of the disease but does not prevent it. There is not one published study to show that cleaning teeth ALONE prevents gum disease.

Dental professionals do not routinely recommend bacterial testing for the pathogenic bacteria, nor recommend oral antibiotics because “they do not work for all gum diseases”. True and true. If you have bleeding and medical/dental risks, testing for the pathogens with BiofilmDNA is indicated. If a particulate antibiotic rinse is selected vs oral antibiotics to target the pathogens present, then one gets 3-4 times the minimum inhibitory concentration to penetrate all whole mouth biofilms unlike oral antibiotics. Rinses are superior to oral antibiotics. See article attached “Treatment of oral malodor and periodontal disease using an antibiotic rinse“.

The things we tell patients to do, do not work predictably. Now we know why 80% of our patients have Periodontal Disease. Change is needed especially in this COVID era. Using the OraVital system can control gum disease in four weeks in addition to the therapies we now recommend. The results are predictable and guaranteed. With the oral systemic link so important in the COVID-19 era, it is time for dental professionals to adopt new scientifically proven methods to restore our patients oral and systemic health.

What happens if you follow the OraVital System and have the recommended dental care? The gum disease for 90% of patients predictably goes away in four weeks. If you remove the bacteria and keep it away, the disease is controlled by the patient vs the procedures. Stomach ulcers are now controlled using the same principles. We can cure cancer and ear/bladder/chest infections. Not everyone is allergic to peanut butter. If you were, you do not leave peanut butter in the house ever! Dental care leaves the bacteria (peanut butter) in the mouth and then treat the symptoms.

Two Key Facts:

1. The same bacteria causes periodontal disease and breath odour/halitosis. They are spread by saliva and transferred by kissing, sharing food etc./ If you have bleeding gums do not kiss.
2. There is a 10% reduction in deaths from pneumonia in nursing homes if the gums are brushed 3 times a week—not a day. The periodontal pathogens contribute to the death from pneumonia. Gum disease is not a little infection or bleeding, but a life threatening/altering condition.

Oravital: a System to Predictably Treat Periodontal Disease and Halitosis

Review the medical history to discover medical conditions that are affected by periodontal pathogens. (CVD, HBP, stroke, diabetes, kidney disease, adverse pregnancy outcomes, cancers, RA arthritis etc). If they exist look for signs of periodontal disease closely.

• Look at family and personal medical, and dental history. Periodontal disease is spread by kissing/feeding infants and is passed usually through the mother. It can appear to be a genetic issue but is really a vertical transmission issue until saliva is exchange with strangers.
• Look for active periodontal disease not periodontal disease that has occurred. There should be no visible biofilm or disclosing on every hygiene visit. If there is, review biofilm control by putting the brush in the patient’s hand and together remove all biofilm.
• Use Soft-Picks to press firmly between the gum and tooth to do a Papillary Bleeding Score. The gums should never bleed or hurt. The Soft-Picks must exert pressure or switch to a larger tool. On the third day, the bleeding and soreness will stop guaranteed.
• Measure the space between the gum and tooth. It should be 3mm or less after care.
• Count the number of Bleeding On Probing points. It should be 10mm or less.

To transform the biofilm, you need to test for pathogens if there are indications of risk:

• Medical/dental concerns
• Bleeding
• pockets
• halitosis

BiofilmDNA checks for 6 periodontal pathogens, yeast, S mutans, and cavity causing bacteria. Then a recommended antibiotic/fungal is prescribed in addition to traditional care to kill the pathogens identified.

Kill the Pathogens Causing the Local and Systemic Effects

We use antibiotics for ear/bladder/chest infections, but not routinely for PD even though it causes permanent and life threatening/altering conditions. Oral abs are usually prescribed. They are diluted throughout the whole body, they cause systemic side effects, and deliver low saliva levels so the ab concentration is too low to attack mature, whole mouth biofilms. They do not work for mild to moderate PD for that reason.

Often the incorrect ab is used because the best one (Metronidazole) causes stomach issues if swallowed. Unfortunately, Amoxicillin is the second choice after Metronidazole, and it targets the Gm+ vs GM-ve bacteria. Ab particulate rinses deliver 3-4,000 times the concentration needed to kill planktonic bacteria (in saliva) and 3-4 times the minimum inhibitory concentration to penetrate whole mouth thick biofilms—not just biofilm under the gums.

You can choose the best ab based on the pathogen testing, so you get improved results. They work throughout the whole mouth. They can treat strep throat, PANDAS, and tonsillitis too. Ab rinses are safer and work better. When the biofilm is normalized, we maintain it. Consider using probiotics and over the counter rinses to kill the gm negative biofilms with chlorine dioxide/ZN.

That is it! Inexpensive, easy and predictable.

Jim Hyland DDS BSc is a general dentist, educator, lecturer, author, and researcher who is President and CEO of OraVital Inc. He was the first dentist to use OraVital’s antibiotic rinses in 2008 and combined this with a new philosophy of biofilm control for his patients. For more information contact him at drjimhyland@oravital.com or 1+ 416-930-0310

The post COVID-19 Outcomes Are Worse If You Have Gum Disease appeared first on OraVital.

This highly preventable disease is posing a strain on our health care system and decreasing the length and quality of the lives of those we care about.

I am sure that you as well as I, have lost friends or family members in their 40’s and 50’s as a result of a heart attack or stroke.

Most oral health professionals (especially those who are aware of the Bale/Doneen Method) also now understand that people with gum disease are 50% more likely to suffer a heart attack or stroke.  This is yet another staggering statistic that we, as health care professionals have the ability to impact and reduce the potential for.

How do we accomplish this daunting task?

Focusing on these three points will make a difference:

• Become A Passionate Educator: Most of our patients/clients are unaware of the serious health risk gum disease poses, and how easily they can take control of, and improve their oral health. Help them understand through the use of analogies, that “pink in the sink” is a serious concern and requires our intervention.
• Determine Risk Factors:  Review medical and family history, note all dental risk factors, take regular blood pressure readings, and utilize microbiology to assess pathogenic biofilm.
• Go to work: Implement strategies and therapies that will reduce the pathogenic biofilm burden, modify risk factors, and address the host response.

Let’s look at our task a little more in depth using the analogy of a football game.  We, the dental health professionals are the home team.  The pathogenic biofilm is the away team.  And of course, we want to win!

• Know And Evaluate Your Opponents. You’ve heard the expression: “Keep your friends close, and your enemies closer.”  We want to know about the team we are playing so we can understand their strengths and weakness. What is the playing field like?  Who are the players and the biggest influencers? 

Using BiofilmDNA as part of our risk analysis will help us understand what we are dealing with before we assist our clients on their journey from disease to improved oral health and decreased systemic risk.  What high and moderate risk pathogens are present and what are their numbers?  Are Pg and Aa present at high levels increasing the potential for biofilm virulence and destruction?

• How can we knock down some of those big players as they barrel down the field making a run for a touchdown?

Understanding the pathogenic load and burden will help guide us to implement a more individualized treatment plan for our clients.  This is where our assessment, knowledge and education is critical in our development of an active periodontal therapy treatment that will decrease bleeding, inflammation, and begin shifting the biofilm to a healthier balance.  Then we can decide how aggressive we need to be in our strategy, what tools we will employ, and how we will educate our clients with respect to their role in their transition from disease to health.

Our Periodontal Therapy Strategy Must Include The Following:

• Reducing the pathogenic burden with adjuncts such as OraVital prescription antibiotic rinses and cream as well as laser technology and more specifically, laser bacterial reduction. Perhaps your toolbox includes other modalities such as Arestin, or Perio Protect trays.
• A focus on creating an environment where the patient can control their biofilm by performing LAPT/surgical curettage with lasers and/or pocket reduction surgery.
• Help our patients to adopt an improved home-care biofilm disturbance/disruption protocol that involves the use of disclosing, Soft-Picks® and other appropriate interdental cleaning tools. Without this component our treatments will not be successful.

While reducing the bacterial burden is critical to our success and will ultimately reduce localized bleeding and inflammation, we must also consider chronic systemic inflammation. Could we gain greater ground by also addressing the host response with Subantimicrobial-Dose Doxycycline?  (Periostat®)

Finally, we must help our patients to modify as many risk factors as possible which includes their ability to maintain optimal self care on a daily basis.  Have we also placed them on the most appropriate hygiene recare interval?  Can we add any additional home care strategies such as xylitol products and/or oral probiotics to help further tip the balance towards health?  Only when we address all of these points we will be well on our way to making a difference in our patients oral and overall health.

Lorraine Gambacourt, RDH graduated from George Brown College in 1985. In addition to currently practicing dental hygiene two days a week at a General Practice in Brantford, she has also been a Clinical Coach with OraVital® Inc. since 2010. Lorraine enjoys writing and blogging and sharing her knowledge with her colleagues.  Her article, “A Healthy Mouth—A Healthier Heart” was published in Oral Hygiene in February 2018.

In June 2019, Lorraine, along with her friend and past dental co-worker Val, organized an event bringing Drs. Bradley Bale and Amy Doneen to Canada for the first time to address a group of 200 dental and medical professionals of “The Critical Role of Oral Health in Heart Attack and Stroke Prevention.” Lorraine has also been a presenter for rdhu’s ‘Dental Hygiene Quarterly’ (now rdhq) and is one of rdhu‘s Soft-Tissue Diode Laser Trainers.

She is passionate about implementing protocols and strategies that promote oral health, reduce oral-systemic risk, and inspire medical/dental collaboration.

The post Battle of the Pathogenic Biofilm appeared first on OraVital.

One problem is that most people don’t listen with the intent to listen but with the intent to reply. Consider the following questions with an open mind vs defending what we do because we have always done something a certain way:

In dental school I was taught to never etch dentine, that amalgam was the best filling material and that stomach ulcers were caused by too much acid produced by type A personalities. These truths are now considered to be false.

Perhaps it is time to re-evaluate our presumptions about periodontal disease, how it is caused, treated and prevented. A new paradigm is needed. Some thoughts and observations to consider:

• Last week I saw pink in the toilet bowl at 11pm. By 3 pm the next day, I had an appointment with my physician to find out why. If a patient sees blood on their tooth brush or we dental clinicians see pink in the sink when they spit during a cleaning, why isn’t everyone as concerned as I was when I saw blood in my stools?

Have we taught our patients to minimize bleeding by saying come back in 6 months and we will clean your teeth again?  If my physician said to me come back in 6 months when I saw the blood in the toilet, I would look for a new physician immediately.

• Untreated gum infections don’t heal on their own. They last 24 hours a day, 365 days a year for decades. The infection has a surface wound area dependent on the degree of infection that allows bacteria, viruses and blood products direct access to the bloodstream.
• For example, a single bleeding point has a surface area of 4 sq. mm, 50 have the surface area of a finger nail and severe gum disease 5 to 6 sq. inches!!

This open ulcer that does not hurt, swell, raise our temperature nor have an appearance we can use to diagnose infection, easily allows oral-systemic complications because the bacteria don’t stay in the gums, but travels throughout the body via its arterial highways, causing secondary systemic effects we all know about. They pose a constant risk to our patients’ health.

• Gum disease first and foremost, is an infection. Are we treating it as an infection or a tooth cleaning issue? Does cleaning the teeth kill bacteria or prevent gum disease predictably? If not, why not?

For example, we all have an acid etch procedure that we know as a formula/recipe to follow. When we do the same steps we always get the same results with a good bond and no sensitivity.  So, what is the gum disease formula equal to our acid etch formula? Why does every dental office have their own way to treat gum disease?

• Do we spread the infection when we use scalers in infected sites and put them in healthy areas? Would you allow a physician to use instruments from an infected site in another healthy area of your body if you were having 2 surgeries? Then why do we do it in dentistry?
• Do patients know they get gum disease from saliva transfer and that they put those closest to them at risk for life threatening infections if they have gum disease? Do you think it would motivate them to adopt better home care if they knew this?
• Speaking of home care, we should emphasize brushing the gums and cleaning between the teeth with a SoftPick® or StimuDent® to clean the teeth and gums at the same time – a method patients will use 85% of the time, vs flossing which they will do 8% of the time!
• When a patient flosses, the floss cleans the tooth BUT it is impossible for it to push against the gum’s biofilm at the same time as the tooth is engaged, so the biofilm remains less disturbed than when using a SoftPick® or StimuDent®.

Physicians bring the patient back if a patient is diagnosed with a medical condition to see if the therapy is working. If there is significant bleeding, we as dental clinicians should do the same.

The post Are Dental Clinicians Contributing to The Gum Disease Epidemic? appeared first on OraVital.

• I want to create a sense of urgency for this patient to get optimal treatment underway.
• I want them to accept my recommendation for a BiofilmDNA test to screen for high risk periodontal pathogens.

How often do we assume the client will want an estimate sent to their Insurance company to see what is covered, and assume they will base their decision on coverage? This delays necessary treatment mandatory for their health.

One of the cardinal rules to apply to life in general, and especially our interaction with our clients is to “never make assumptions”.

Recently a client returned to our office after a 5-year absence. There had been many family stresses which led him to putting his own oral and overall health on the back burner. He mentioned that he was aware he needed to start looking after himself better in general which included losing some weight and looking after his oral health. I had already established some credibility and rapport with this patient in the past, and after re-acquainting and building further trust, I began my assessment:

His previous periodontal charting indicated over 30 bleeding points. (This is equivilant to a wound the size of a silver dollar) This allowed me a segue for discussion about the oral-systemic link and the benefits of BiofilmDNA testing to assess his risk further.

The client was taking medication for high blood pressure, and further medical history questioning indicated that his mother had diabetes, and there was heart disease in his family.

After completing one quarter of his perio charting, I noted that bleeding had increased, with two areas that were spontaneous. I stopped and said the following:

“I am concerned about the infection you have, and that the bleeding has increased. When there is bleeding, it is like there is an open door allowing harmful bacteria into your bloodstream. We need to close the door and kill the bugs causing this infection. A DNA test will help us understand if you have the high-risk bacteria that increase your risk of heart disease and diabetes. You have two options. The DNA test costs $xxx. We can either send an estimate to your Insurance company if you need to know what is covered first, or I can go ahead and do this test for you now, which will help us to understand the best course of treatment for you.”

Without hesitation he said, “If that’s all it is, go ahead because it is important.”

As we wrapped up his appointment, I suggested that the next time he sees his physician, it would be ideal to have her test for diabetes and inflammatory markers. I also offered to send a letter with our report of periodontal findings along with the DNA test, which he thought was a great idea.

The lesson here is two-fold:

• Don’t make assumptions that can delay treatment. Be direct. Share with compassion. Ask the question, and let the client respond.
• There is a need for medical/dental collaboration, and as a profession we need to start a movement in this area.

Lorraine Gambacourt, RDH has over 32 years experience as a practicing dental hygienist in a very proactive practice using the OraVital System. She has also worked with OraVital since 2010, educating and supporting dental teams in the implementation of the OraVital System. Lorraine is a strong advocate for medical/dental collaboration in the support of oral and overall wellness.

The post Don’t Delay Necessary Dental Treatments By Making Assumptions appeared first on OraVital.

Are You Keeping Oral-Systemic Secrets?

In my humble layperson’s opinion (IMHLPO), one of the responsibilities of dental professionals is to inform their patients of the many oral-systemic health links, and to reinforce the fact that the health of their mouths often determines their overall health.

Although more and more of this information is being distributed via medical and dental journals. the consumer media and the internet, dental professionals have the unique ability to deliver this information one-on-one, tailor it based on an individual patient’s medical history, and provide expert and immediate answers to your patients’ questions.

As a respected and trusted health care provider, you are also in a position of influence that can help empower your patients to take charge of their health and re-chart its course towards a longer “health span” with more activity and productivity during their golden years, instead of merely waiting longer and in ill health for the Grim Reaper to come.

Unfortunately, if you are not proactively imparting the latest evidence that the mouth can “make or break” one’s health, you are keeping oral-systemic secrets. Speaking of secrets, if not addressed, periodontal disease and soft plaque may be secretly and silently affecting other parts of your patients’ bodies.

This may not be your intent. In fact, you may be one of the countless dental professionals who are well-intentioned, but overwhelmed by this “bridging the oral-systemic gap” thing.

Therefore, allow me to provide some tips that will help you become a more effective and proactive oral-systemic health link evangelist and help you turn back the tide of declining health in the United States one patient at a time!

Become an Oral-Systemic Information Aggregator

There’s a ton of oral-systemic health information out there and some of it is published first in your dental and hygiene trade publications. Therefore, you as a dental professional often have a “home court advantage” over the mainstream media.

Unlike a stock broker, you can and should share this insider information with your patients. You can easily keep on top of the latest oral-systemic news by reading the following information sources:

• Dental and hygiene magazines and association publications, web sites, newsletters and social media accounts
• Social media accounts of dentist and hygienist thought leaders who weigh in regularly about oral-systemic health links
• Set up Google News Alerts for terms such as “periodontal disease,” “mouth-body connection” and “oral-systemic health links.”

Become an Oral-Systemic Information Distributor

Once you’ve been monitoring and archiving this plethora of oral-systemic health information, you will need to share it. Luckily, the channels of information distribution are numerous (mostly free) and collectively, can make a strong impact on your patients and surrounding community.

• Like and share social media posts pertaining to oral-systemic links
• Always incorporate an oral-systemic story or two in your practice newsletter
• Have some print versions of your newsletter in your waiting room
• When using digital media such as social media, e-newsletters and your web site, link to the source article so the reader can get full details. In print media, provide the URL or web address
• Speaking of URLs, use an embedded “click here” link or a URL shortener such as www.Bit.ly to avoid posting long URLs that look like www.oralsystemicblahblahblahyadadaydayda.com
• If you can, set up an RSS newsfeed on your web site or blog that searches for and posts oral-systemic news items
• Share information as it relates to your patients while they are sitting the chair. Use it to help them understand the importance of recommended periodontal treatment, why they need to follow their home care regimen and the impact oral health has on their personal medical condition such as cardiovascular health, arthritis, diabetes, etc.
• Quote facts and references that are specific to each patient’s medical history in recall letters and collaborative care letters to their physicians.
• Clip articles, slip them into in plastic protective sleeves, and put them in a loose-leaf binder in your waiting room. Use labeled tabs to organize alphabetically by systemic disease state such as arthritis, Alzheimer’s disease, cardiovascular, diabetes, low birth weight, etc. Keep this binder updated.
• Make a few copies of this binder so patients can sign them out and read at home – this can reinforce the importance of your recommended home care regimen.

Avoid Plagiarism and Games of Hot Potato

When reposting or quoting an oral-systemic factoid or article, always give credit where credit is due, and prominently mention the source of your oral-systemic information. For example:

According to the Mayo Clinic, “Oral health is a window to your overall health and can be linked to cardiovascular disease, osteoporosis, diabetes, Alzheimer’s disease and other conditions.” The Mayo Clinic also states, “Contact your dentist as soon as an oral health problem arises.” Click here for the complete article. Remember, our dental team is specially-trained to answer any questions you may have regarding your oral health and how it may cause or complicate medical conditions.

By sharing information in this way, you not only avoid plagiarism, you are leveraging the credibility of one of the most highly-regarded medical institutions in the world. Also, by “wrapping” this reference within an introduction and a close, you are making it more conversational and relevant to your practice and your patients.

This post only scratches the surface of how to educate your patients about the importance of oral-systemic health links, but I think you get the idea. The ball is in your court…or should I say your operatory chair?

About Our Guest Blogger: 

Michael Ventriello is the owner of Ventriello Communications LLC, and has been specializing in strategic dental industry public relations, marketing communications and business development for more than a decade. During this time, he has worked with several companies in the periodontal disease and oral-systemic categories including OraVital^® Inc., the American Academy of Periodontology, OralDNA^® Labs, Arestin^®, 3rd Era Dentistry and others. Michael is a frequent contributor of articles and commentary to dental industry trade journals and is also a member of the American Academy of Oral Systemic Health.  Read his article “Do Dentists Need to Doctor Up on the Oral-Systemic Link” on DrBicuspid.com. Contact him at Michael@Ventriello.com.

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