Changing approaches to treating gum disease

ANN ARBOR---The good news: more people than ever are keeping their natural teeth into old age. The not-so-good news: the longer people keep their teeth, the more likely they are to develop periodontal (gum) problems.

But armed with the knowledge that most cases of periodontal disease are actually treatable bacterial infections, dental researchers and clinicians are changing their ideas about how to deal with the problem, writes Prof. Walter L. Loesche of the University of Michigan School of Dentistry in the current issue of Critical Reviews of Oral Biology and Medicine (Volume 10, issue 3).

The usual treatments for periodontal disease involve removing plaque and tartar deposits below the gum line and sometimes planing the tooth roots. Surgery also may be necessary when deep pockets have developed between the teeth and gums. But with new, antimicrobial approaches, many teeth that previously would have been considered "hopeless" can be saved from extraction, and as many as 75 percent to 80 percent of patients may be spared the discomfort of periodontal surgery, says Loesche, who also spoke on this topic at a dental symposium in Joinville, Brazil, this month.

In his review article, Loesche notes that about 90 percent of periodontal disease cases are caused by the overgrowth of anaerobic bacteria on the teeth. These bacteria produce toxins that can damage the gums. For some patients, the best approach may be to combine the traditional scraping and planing with short-term use of systemic antibiotics such as metronidazole or doxycycline, which are effective against anaerobic bacteria.

Because these systemic drugs, taken orally in the form of pills and tablets, travel throughout the body, they should be used for no more than one or two weeks at a time, to reduce the chance of side effects or the development of antibiotic resistance. When only a few teeth are involved, systemic antibiotics are not needed; clinicians can apply antibio

Contact: Nancy Ross-Flanigan
University of Michigan

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