For as long as I have been a dentist, I’ve been telling, educating, stressing, and even nagging my patients to please come in for their periodontal therapy (often referred to as a “cleaning”) more frequently. Many patients don’t want to come in that frequently or rely on their limited insurance coverage that really “covers” nothing, or simply “have better things to do” than to come in every (whatever number of) months I recommend.
But year after year, those patients who we see at the frequency I recommend look the same year after year when I examine their mouth and x-rays, whereas those that I don’t see as often deteriorate and some, faster than even I would have predicted. But it’s really hard to sell the future when you can’t see it and even more so when our patients think we are just nagging at them appointment after appointment. Their insurance tells them they don’t need it (cause apparently insurance coverage knows what’s best of you.… hmmm). They can’t see the bone loss, or feel it…. Until it’s so very too late and by then they are older and “wiser” but may not be able to fork out the thousands of dollars required for implants and bone grafts because there is not enough bone to support their teeth or dentures. But hindsight is 20-20, right?
So when I came across this study, I thought to myself, let’s go again. I know my patients are sick of me telling them to come in so frequently, and the ones that do will actually love this study since it supports and affirms their recurring visits. For those that don’t come as often as I would like, maybe just maybe this will help clarify why I am such a nag :)
A postdoctoral fellow at the University of Michigan published this study in the journal of Cell Host and Microbe. I know, you are probably thinking: is this what she reads on her time off? And well, hmmm, yep, sometimes. So here is the gist of this study. The study found that the bacterium that causes gum disease, called NI1060, also triggers a normally protective protein in the mouth, called Nod1, and turns it into an attacker of bone. So under normal circumstances, the Nod1 is our protector, a fighter of harmful bacterium in your body. “Nod1 is a part of our protective mechanisms against bacterial infection. It helps us to fight infection by recruiting neutrophils, blood cells that act as bacterial killer,” Inohara from this study says. “It also removes harmful bacteria during infection. However, in the case of periodontitis, accumulation of NI1060 stimulates Nod1 to trigger neutrophils and osteoclasts, which are cells that destroy bone in the oral cavity.” So it turns our protector into our attacker and goes to destroy more of our bone!
This study helps and reaffirms what it is we have been doing and keep doing with our patients. Understanding gum disease at the molecular level helps us develop personalized therapy of our patients. It also helps us recognize at-risk patients and treat them preventively rather than watch year after year as their bone disappears in front of our eyes. So next time you say no to me when I ask you to come in more frequently, I am going to make you read the entire study before you can leave LOL.