Bacteria
Date: September 19, 2019
Interested in more information?
The new model of Periodontal Disease?
Polymicrobial Synergy and Dysbiosis (PSD)
“This refers to the entire colony of multiple different bacteria (polymicrobial) working together (synergy) to initiate periodontal disease (dysbiosis) rather then by a few select bacteria known as ‘periodontal pathogens’.” Kathryn Gilliam; A paradigm shift that will change clinical practice.
RED COMPLEX BACTERIA:
Aggressive, transmittable, tissue invasive,
Must be treated with Laser, Antibiotics, Ozone Therapy (or another adjunctive therapy),
SRP alone does not kill the bacteria that has invaded the tissue,
ALL of the salivary tests will identify these pathogens.
Porphyromonas gingivalis
Key concerns:
Amplifies the pathogenicity of other bacteria, impairs host immunity.
It is ideal to identify/eradicate this pathogen at the earliest signs of gingivitis (or earlier)
Oral signs/symptoms:
Periodontal Disease (PD)
Systemic Signs and Symptoms:
CAUSAL: CVD and possibly Alzheimers.
ASSOCIATED WITH: RA, infertility, aspiration pneumonia, cancer, dementia, Low birth weight, diabetes, macular degeneration
Tannerella
forsythia
Key concerns:
Initiates connective tissue destruction and alveolar bone resorption
Oral signs/symptoms:
Aggressive and Chronic Periodontal Disease (PD), Gingivitis
Systemic Signs and Symptoms:
Increased risk of MI, increase in total cholesterol, atherosclerosis
Treponema
denticola
Key concerns:
Tissue invasive spirochete
Oral signs/symptoms:
Periodontal Disease (PD)
Systemic Signs and Symptoms:
CVD, Alzheimer’s disease, low birth weight
ORANGE COMPLEX BACTERIA:
ALL of the salivary tests will identify these pathogens.
Prevotella intermedia
Key concerns:
Virulence properties similar to Pg
Oral signs/symptoms:
Acute necrotizing ulcerative gingivitis, dental abscesses, pregnancy gingivitis, Periodontal Disease (PD)
Systemic Signs and Symptoms:
CVD, Increased risk of MI, bacterial vaginosis, nasopharyngeal infection, intra-abdominal infection
Peptostreptococcus micros
Key concerns:
Oral signs/symptoms:
Periodontal Disease (PD)
Systemic Signs and Symptoms:
Gastrointestinal infections, genitourinary infections
Fusobacterium nucleatum/
periodonticum
Key concerns:
Increases blood vessel permeability; increased abundance in smokers
Oral signs/symptoms:
Periodontal Disease (PD) and endodontic infections
Systemic Signs and Symptoms:
Ulcerative colitis, colorectal cancer, appendicitis, inflammatory bowel disease, atherosclerosis, cerebral aneurysm, Rheumatoid arthritis, Alzheimer’s disease, preterm birth, preeclampsia, neonatal sepsis, lemierre’s syndrome, respiratory tract infection, mastoiditis, chronic otitis, sinusitis, tonsillitis
ORANGE ASSOCIATED COMPLEX:
Campylorbacter rectus
Key concerns:
Oral signs/symptoms:
Periodontal Disease (PD)
Systemic Signs and Symptoms:
CVD, Low birth weight, pre term birth
Eubacterium nodatum
Key concerns:
Colonizes more in smokers than in non-smokers; colonizes on inanimate objects such as orthodontic appliances and implants
Oral signs/symptoms:
Periodontal Disease (PD) and peri-implantitis
Systemic Signs and Symptoms:
Infections and Pelvic inflammatory disease
GREEN COMPLEX:
Eikenella corrodens
Key concerns:
Oral signs/symptoms:
Periodontal Disease (PD)
Systemic Signs and Symptoms:
Osteomyelitis, meningitis, endocarditis, neonatal sepsis
Capnocytophaga species
Key concerns:
Oral signs/symptoms:
Periodontal Disease (PD) and root caries
Systemic Signs and Symptoms:
Bacteremia, endocarditis, pericardial abscess, coronary heart disease, lung infections, bone infections, peripartum infections or preterm birth, low birth weight, neonatal sepsis
Aa COMPLEX:
Must be treated with Laser, Antibiotics, Ozone therapy, or another adjunctive method.
Aggregatibacter actinomycetem-
comitans
Key concerns:
Oral signs/symptoms:
Periodontal Disease (PD) and Juvenile PD
Systemic Signs and Symptoms:
Aspiration pneumonia, infective endocarditis, bacterial vaginosis, rheumatoid arthritis, low birth weight
MISCELLANEOUS :
Streptococcus mutans
Notes:
OraVital® salivary test will identify, as well as a number of chair side tests (see “cavities” page)
Oral signs/symptoms:
Caries, biofilm initiator
Systemic Signs and Symptoms:
CVD, prosthetic joint infections
Candid albicans
Notes:
OraVital® Salivary test will identify
Oral signs/symptoms:
Childhood decay, peri-implantitis, soft tissue infections, angular chilitis
Systemic Signs and Symptoms:
Yeast Infections
Interleukin 6 (Il-6) Gene
Notes:
OralDNA® will identify. Clove essential oil may reduce inflammation associated with Il-6
Oral signs/symptoms:
Greater risk of PD
Systemic Signs and Symptoms:
Greater risk of heart disease, cancer and arthritis
Key concepts:
Associated: There appears to be some relationship between the oral/systemic systems, but a cause and effect relationship has not been proven.
Causal: PD causes disease (ex. Cardiovascular disease)
Bidirectional: PD causes the disease and the disease causes PD (ex. Diabetes type 2 and Rheumatoid arthritis)
Laser Therapy: the Laser is able to penetrate the soft tissue (to kill the microbes) as well as degranulate the diseased epithelium (when the tip is initiated). Check with your state’s Practice Act to determine if this is within your scope of practice. Use code D4999 (unspecified perio) with a narrative.
Ozone Therapy: Use code D4999 (unspecified perio) with a narrative.
A closer look at the most common Salivary Tests available…
OralDNA®:
In addition to pathogens, OralDNA® offers a test to detect the IL-6 gene. They pair their findings with treatment recommendations (including systemic antibiotics). The materials are free for the office to obtain, and you only pay when you submit a sample. This is a swish/spit test. Cost to the office is around $99-149 (depending on the test), plus S/H.
OraVital®:
In addition to perio pathogens, OraVital® will also screen for Candida albicans and Strep mutans. This system uses paper points. The findings are paired with treatment recommendations that include proprietary rinses.
Hain Diagnostics:
Identifies the periodontal pathogens and pairs findings with a treatment recommendation that generally includes systemic antibiotics. This is a paper point test.
FidaLab:
Quantatative test that screens for 29 periodontal pathogens, and provides a risk assessment. It is a swish and spit test and can be paired with their HPV screening.
We recommend that you do a Lunch & Learn or webinar with each of the companies, to determine which one(s) you want to use.
Print off the “Oral Bacteria” PDF under Patient Education, for a great resource that will help your patient understand the necessity of salivary testing!
Ms. Gilliam’s Perspective…
We all have different views on rinses and antibiotics, Kathryn has extensive training in Oral/systemics and the oral micro biome, and therefore a perspective worth sharing. Here are her thoughts on certain “hot topics”
Systemic Antibiotics: “Avoid systemic antibiotics if possible, because of their negative effect on the gut micro biome. There are other options available. I prefer to prescribe compounded topical antibiotic and antimicrobial rinses, such as those recommended by the OraVital® System.”
“My favorite Rinses are the Chlorine Dioxide rinses (CloSYS®, Oxyfresh® and OraCare™). Chlorine dioxide is a strong oxidizer and it effectively kills pathogenic microorganisms such as fungi, bacteria and viruses. It also prevents and removes biofilm. When my patients use these oral rinses, I see a reduction in inflammation as evidenced by a decrease in or complete elimination of bleeding.”
Remember, when you educate your patient, use code D1330.
SOME BACTERIA ENTER DIRECTLY INTO THE BLOODSTREAM, (THROUGH A BLEEDING POCKET) REACHING EVERY PART OF OUR BODY
EXAMPLES OF BACTERIA THAT ENTER OUR BLOODSTREAM DIRECTLY:
- Porphyromonas gingivalis
- Fusobacterium nucleatum
- Tanerella forsythia
- Treponema denticola
- Prevotella intermedia
- Aggregatibacter actinomycetemcomitans
BACTERIA MAY CAUSE
- CAUSAL FOR CARDIOVASCULAR DISEASE (Stroke, heart attack, etc)
- Preterm birth
- Adverse Pregnancy Outcomes (preterm birth, pre-eclampsia, etc)
- Diabetes type 2
- Chronic obstructive pulmonary disease
- Osteoporosis
- Kidney Disease
- Rheumatoid Arthritis
- Increased rates of Cancer and more aggressive forms (Prostate, kidney, Colon, esophageal, etc)
- Prostatitis
- Brain Abscess
- Inflammatory Bowel disease
Remember from Statistics, Association does not mean Causation (research is ongoing).
ORAL BACTERIA TRIGGERS INFLAMMATION
EXAMPLES OF BACTERIA THAT TRIGGER THE INFLAMMATORY PROCESS
- Porphyromonas gingivalis
- Fusobacterium nucleatum
- Tanerella forsythia
- Treponema denticola
- Aggregatibacter actinomycetemcomitan
* Red Complex bacteria
There is a lot of overlap between the bacteria that trigger inflammation and the bacteria that enter our bloodstream directly.
CHRONIC INFLAMMATION MAY CAUSE
- Cardiovascular disease
- Type 2 Diabetes
- Rheumatoid Arthritis
- Alzheimers
- Autoimmune Diseases
- Pulmonary Diseases
The link between CVD/Diabetes with Periodontal Disease is so strong, that in some cases medical insurance will pay for Perio therapy in the dental office (though you need to know how to bill). See the Coding page for more info.
ORAL BACTERIA IS SWALLOWED
EXAMPLES OF BACTERIA MAY TRIGGER DISEASE IN OTHER PARTS OF THE GI TRACT
- Klebsiella pneumoniae
- Klebsiella aeromobils
BACTERIA THAT IS SWALLOWED MAY CAUSE
- Crohn’s Disease (in susceptible individuals)
BACTERIA ENTERS THROUGH CAVITIES
EXAMPLES OF BACTERIA THAT MAY CAUSE AN INFECTION THROUGH THE TOOTH
- Streptococcus mutans
- Prevotella nigrescens
BACTERIA THAT ENTERS OUR BODY THROUGH OUR TEETH, MAY CAUSE
- Painful, localized infection at the root of the tooth
- An infection that spreads and may become life-threatening (every so often the news reports a child that had died from such an infection)
- S mutans is Causative of Heart Attack and maybe stroke!
BACTERIA ENTERS THROUGH OUR RESPIRATORY SYSTEM
EXAMPLES OF ORAL BACTERIA THAT MAY CAUSE AN INFECTION IN OUR RESPIRATORY SYSTEM
- Aggregatibacter actinomycetemcomitans
- Streptococcus sobrinus
- Porphyromonas gingivalis
BACTERIA THAT ENTERS OUR BODY THROUGH OUR RESPIRATORY SYSTEM MAY CAUSE
- Recurring Pneumonia (especially common in the elderly, or immunocompromised or on ventilators).
PROBIOTICS FOR THE ORAL CAVITY
PROBIOTICS MAY MINIMIZE THE BAD BACTERIA
- Streptococcus salivarius (Strains DSM 14675, BLIS K12, BLIS M18, DSM13084)
- Lactobacillus acidophilus may help, depending on the strain (this is more research based and not commercially marketed yet)
Probiotics available specific to oral health:
EvoraPro
Zymogen (currently reformulating)
PlaqueHD
And many more…
The specific strain of probiotics matters!
Read this study (“Streptococcus salivarius MS-oral-D6 promotes gingival re-epithelialization in vitro through a secreted serine protease“) to see how different strains of the same bacteria had different results in gingival re-epithelialization. The more reputable brand of probiotics will inform you what stain of bacteria their product contains.
Interested in more information?
Check out the American Academy of Oral Systemic Health, www.AAOSH.org.
“Beat the Heart Attack Gene” Bradley Bale, MD, and Amy Doneen,ARNP, or visit their website www.baledoneen.com.
“The Dental Diet” Dr Steven Lin, or visit his website at www.stevenlin.com
“Tailored Treatment: Evaluation of Salivary Diagnostics” Rebecca Comstedt, article in RDH Mag (10/18)
Tools for the office?
Salivary testing. See the Patient Education page for a printable PDF that compares the two most common tests available.