The standard of care for the treatment of dental caries, gingivitis and periodontal disease includes: 1) removal of bacteria (i.e., that source of inflammation), by mechanical, and if necessary, chemical and/or antibiotic/antimicrobial agents; 2) providing and training patients to maintain optimal oral hygiene; 3) dietary evaluation and nutritional counseling and/or supplementation; 4) maintenance of host defenses (through building a strong immune system); and 5) the use of the best available oral health care products, along with other nutritional products and supplements. This is the most effective way of preventing oral diseases and their related systemic diseases.

Home Care

The first step in prevention and treatment is to mechanically remove bacterial plaque upon waking, after meals and before bedtime. This may be accomplished with toothbrushes (manual and electric), toothpastes (dentrifice), floss, inter-dental brushes, and the use of water irrigation devices. Make sure that all of the surfaces of the teeth are cleaned, and also place the brush, pointing it at a 45% angle, where the teeth meet the gums to stimulate the gum tissue and enhance plaque removal. Tongue brushing or use a tongue scraper is beneficial in removing plaque and foodstuffs that may be present. At bedtime, reduced salivary flow can lead to increased plaque formation overnight. So, keep only water on your night stand if you tend to get thirsty.

Choosing a Treatment

In principle, all patients should have regular dental checkups, at least twice a year. However, pain usually leads one to seek dental care and treatment. Thus, earlier problems that arise may not be treated in a timely manner. Also, dental treatment and care varies widely with genetic makeup, race, ethnicity, gender, and socioeconomic status and education level. Significant periodontal research has provided evidence that chronic periodontitis is treatable. However, once periodontal tissue is lost, complete restoration of these tissues are limited, and are dependent upon the specific circumstances. The majority of periodontal treatments are aimed at arresting the progression of the disease in an attempt to prevent tooth loss. It has also been shown that the majority of individuals that have sought periodontal treatment significantly reduced their risk of tooth loss.

  • In-Office Dental Treatments

Dental caries can be prevented by good oral hygiene and regular professional care, and can be effectively treated by adequate brushing and flossing of the teeth and by the use of mouth care products. Mouth rinses, gels, and toothpastes, when used in conjunction with toothbrushing and flossing, are probably adequate to deliver the needed preventive measures. If the carious lesion reaches the underlying dentin layer of the tooth the dentist should treat it. The dentist will place a filling (amalgam or composite) to restore proper functioning of the tooth. More severe and extensive dental caries may require root canal therapy and/or a crown to be placed. If the decay is so severe that the tooth cannot be restored properly, surgical extraction may be the only course of treatment. Even if a tooth is extracted, the dentist can place an implant or bridge to restore proper functioning and/or esthetics to the mouth.

Individuals at risk for dental caries, gingivitis and periodontitis, should seek a professional comprehensive dental evaluation, complete with a medical history for existing systemic diseases or conditions, prescribed medications, and other risk factors for systemic diseases. The dental professional should seek consultations from other health care providers concerning systemic health conditions, oral (especially periodontal) conditions, and proposed treatment, which should be documented by the dentist in your file.

  • Treatment Outcomes

As previously mentioned, periodontitis may adversely affect glycemic control in individuals with diabetes, possibly leading to an increased risk of cardiovascular complications associated with diabetes. Periodontal treatment has been shown to improve glycemic control. Grossi and Genco re-examined studies that addressed the effect of periodontal treatment on metabolic control of diabetes mellitus which included type 2 patients. Periodontal treatment was divided into two groups, mechanical treatment only, and with systemic antibiotic therapy as an adjunct to mechanical treatment. The results show that the effect of periodontal treatment on diabetic metabolic control was dependent on the mode of therapy. When mechanical periodontal treatment alone is provided, regardless of the severity of periodontal disease or degree of diabetes control, the treatment outcome was strict improvement in periodontal status or a local effect. On the contrary, when systemic antibiotics were included with mechanical therapy, an improvement in diabetes control, measured as a reduction in glycated hemoglobin or reduction in insulin requirements, was achieved. Therefore, it was proposed that control of the chronic gram-negative periodontal infection should be part of the standard treatment of the diabetic patient.

Women with periodontitis may have an increased risk for preterm-LBW deliveries. Early intervention studies of patients at risk for periodontitis and adverse pregnancy outcomes such as LBW infants are presently ongoing in several cities. Early data indicate that periodontal therapy administered to pregnant mothers with periodontitis can reduce the incidence of preterm low birth weight deliveries. Thus, pregnancy has far-reaching systemic effects extending beyond the reproductive system.

As previously discussed, individuals with periodontitis may have a significantly increased risk of coronary heart disease, as well as related events, such as angina pectoris and myocardial infarction. Periodontal pathogens may play a role in atherogenic and thrombo-embolic events in coronary arteries, and comparable developments may arise in other arteries which may lead to a risk of cerebral ischemia and non-hemorrhagic stroke. Early intervention studies of patients at risk for periodontitis and its effects on CVDs are presently ongoing in several cities.

Bacteremias may occur in individuals with a healthy periodontium, however can be more exaggerated in individuals with periodontitis. Treatment considerations for individuals at risk for or with existing cardiovascular diseases include: 1) diagnosis of the individual’s periodontal condition; 2) consultation with individual’s physician advising of adverse periodontal findings and planned treatment, following the American Heart Association guidelines for individuals at risk for infective endocarditis; 3) concern of diagnosis and CVD status, treatment and medications, as well as other periodontitis risk factors that may influence CVDs. Individuals with bacteremias and CVDs should learn more about the potential impact of periodontal infections.

Periodontal therapy may be required to re-establish and/or maintain good periodontal and dental health.

Current conventional and pharmaceutical choices for oral diseases and their associated systemic diseases are, in some cases, inadequate. The eventual objective, obliteration of dental infections, is impossible for most individuals. More reasonable goals should be set that may include additional treatment options. Considerations are the reduction of oral bacteria, their end-products, and the resultant inflammation, along with similar reductions of all of these in the circulation. A decrease in inflammation could reduce the incidence and severity of the oral diseases and their associated systemic diseases. This view could help to increase the individual’s overall general health.