By Carol Wells and Dr. Eric Zaremski
Published: July 29, 2021
Written by Carol Wells, RDH
This paper originally appeared in the January 2019 issue of the Scientific Archives of Dental Sciences(Volume 2, Issue 1).
A visit with a Biological Dental Hygienist is a little different from your usual hygiene visit...- International Academy of Biological Dentistry and Medicine
Published October 14th, 2017
Written by: Carol Wells, R.D.H
Written By Carol Wells RDH Published Nov. 2014
We learned all about the basics, plaque, and calculus. I was taught that it is the bacteria in your mouth that was responsible for the cavities that you got and the type of gum disease that you got. We were taught that if we – the dental hygienist, removed the plaque and calculus that it would slow down the decay rate and the disease process. Our job was to motivate the client so that they would be able to brush and floss their teeth properly. If I, the dental hygienist removed all the calculus, made the root “glass like - smooth” and was able to motivate the client to remove the soft deposit properly – this would stop the gum disease process. We did not talk about the types of bacteria that were able to survive in the gums. We certainly did not talk about what the bacteria would do to the rest of the body. I know we had to take classes in Biology and Histology & Nutrition. A question was asked once by a student “ Why do we have to learn about the body and its functions? After all, we are working in the persons mouth – right?”. The answer was “because we are working with the whole person, not just the mouth.” But it really ended there. We learned about how the whole body functions, the heart, the liver, the kidneys, and blood.
My first job as a dental hygienist was in a general dentist office, Dr. John Boersma in Hamilton Ontario. I was the first dental hygienist to work in the office so this was new for all of us. It was a very interesting time – changing the office protocols to include a dental hygienist. Dr. John Boersma had been to Pankey Institute, a now famous independent postgraduate dental school in U.S.A. Dr. L.D. Pankey was a dentist in Coral Gables in 1926. He was determined to practice dentistry without pulling another tooth. Dr. Boersma and I decided that we also wanted to practice dentistry in a proactive way – not a reactive way. So we, as an office started out on the quest to learn about Preventive Dentistry. One of the ladies in the office became the Office Facilitator. Her role was to help clients understand the role that plaque & calculus played in their mouth and how to change their homecare routines to help them become healthier. Even at that time we did not include how this disease process would affect the rest of the body. During the course of 10 years we came to understand how the mouth did affect the whole body and began to include conversation at each appointment. We did not call it the Oral Systemic Connection.
Now we have a lot of dental and medical professionals questioning the role that the bacteria plays in your mouth. Inflammation plays a role in all kinds of illnesses that have plagued our communities for many years. Now we are talking about the Oral Systemic Connection.
Research shows us that Periodontal disease is related to different types of disease related bacteria that is able to survive in the oral cavity.
Disease related bacteria in the oral cavity creates infection of the gums. Infected gums create inflammation, in the mouth and in the body. Most illnesses in our body start with inflammation, from one source or another.
This makes gum disease/ periodontal disease bi-directional.
An easy way to think about inflammation is to remember the last time you had a sliver.
1) “ Inflammation is characterized by several familiar signs, redness, swelling, heat and pain. To understand inflammation is to understand how and why these signs develop. These signs represent a response that is programmed into your tissue. This response is one of your body's principal defense reactions, designed to anticipate, intercept and destroy invading micro-organisms. Inflammation is best appreciated by understanding your body's functioning at the level of cells and tissues. Subsequent processes of tissue repair (healing) involve cell growth and division, cell movement and differentiation, and manufacture of extracellular material. “
Lets use the example of getting a sliver. Everybody gets slivers, if the sliver remains in your finger for too long there is an inflammation response. At first you may or may not notice that a foreign bodies embedded in the skin. Usually the site becomes red and you will feel the pain associated with the sliver. If the sliver remains there too long, you will see more swelling and eventually you will see a blister forming with pus inside. This can become very painful. You know at that point that the sliver needs to be removed.
The inflammation process to periodontal disease is very similar to that of the sliver. We know that Periodontal Disease is associated with disease related bacteria. When disease related bacteria is present in the mouth you can see red, swollen, bleeding gums but there is one difference from the sliver. There is no pain. Gum disease is not painful until it is too late and your teeth become loose. WHY IS THAT? That is because the bacteria is outside of the gum tissue, between the tooth and the gum space. The body goes through the same type of physiological responds with slivers, as it does with periodontal disease, minus the signal of pain. The body cannot get rid of the disease related bacteria that is inside of the periodontal pocket. This sets up the inflammation response.
What happens in the mouth affects the rest of the body.
Now the stage has been set for the Oral Systemic Connection.
PERIODONTAL DISEASE IS AN ULCERATED WOUND THAT CAN NOT BE SEEN
Most Dentist/ Dental Hygienists do not pay attention to the body. Most Medical Doctors do not pay attention to the mouth.
The medical and the dental communities need to start to work together.
It is time for a paradigm shift
SIUC / School of Medicine / Anatomy / David King http://www.siumed.edu/~dking2/intro/inflam.htm Last updated: 1 January 2013 / dgk
Oral biofilms, oral and periodontal infections, and systemic disease. Am J Dent. 2013 Oct;26(5):249-54.Maddi A, Scannapieco FA
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