ORAL HEALTH SYSTEMIC HEALTH CONNECTION & PERIODONTAL TREATMENT

Transcription

1 What s New in Medicine 2015: Internal Medicine-Infectious Diseases Continuing Medical Education Workshop ORAL HEALTH SYSTEMIC HEALTH CONNECTION & PERIODONTAL TREATMENT Bob Gottlieb,DDS September 11, 2015 Kennewick, Washington Disclosure: Dr. Gottlieb is an Investor in Onpharma Inc., and is a founding member and Investor in the PreViser Company.

2 About Me Bob Referral Based Private Periodontal Practice Dr.Cohen, Dr Bennett 40 years DDS- U of Illinois years Certificate in Perio- U of Washington 1977 Periodontal Therapy Lectures, SSC, PreViser

3 Questions Are dental diseases associated with systemic diseases? If so how are they associated? Is periodontal disease a medical condition with a dental solution?

4 Evidence Suggests A Relationship Between Systemic Diseases Including: Chronic Obstructive Pulmonary Disease (COPD) Pneumonia Chronic Kidney Disease Rheumatoid Arthritis Cognitive Impairment Diabetes, Obesity, Metabolic Syndrome Cancer Pre Term Low Birth Weight Babies Erectile Dysfunction Cardiovascular Disease

5 Oral Systemic FEMALES MALE MI TIA DIABETES ALZHEIMERS PTLBW MI TIA DIABETES ALZHEIMERS ERECTILE DYSFUNCTION

6 ORAL SYSTEMIC CONNECTION AAP Mission Statement Expert Lectures Literature/Studies Medical dental summit Ostler Textbook

7 Association Inflammatory Load Circulating Pro-inflammatory Cytokines Direct Bacterial Affects

8 Oral systemic Cardiovascular Diabetes Pregnancy

9 Cardiovascular AAP & AHA 2009 AHA 2012 Bale & Doneen AAP Position

10 Pre-Term Low Birth Weight Babies AAP Jeffcoat & OBGYN

11 PREGNANCY TREAT 2 ND TRIMESTER. NEW PTLBW: PRENATAL HEALTH 2 MONTH CLEANINGS

12 Diabetes AAP Mealey Diabetes Effect on Periodontal Disease Periodontal Disease Effect on Diabetes

13 Periodontal Disease Dental Diseases with Systemic Association Endodontic Lessons

14 Did You Know

15

16 Medical Condition:Dental Treatment Screening-Symptoms Red, Swollen, Tender Gums Bleeding while Brushing, Flossing or Eating (or spontaneous) Receding or Retracting Gums, Long Teeth Loose or Migrating/Separating Teeth Pus or Mouth Sores/Abscesses/Bumps Bad Breathe (Fetid Odor) Change in Bite/Change if Fit of Oral Appliances

17 Risk factors Factors Genetics, Smoking, Age, Stress, Medications, Systemic Diseases, Obesity, Teeth Grinding Risk Calculators/Systems Periodontal Risk Calculator My Dental Score Many paper forms

18 DIAGNOSIS VISUAL OLFACTORY TESTING CLINICAL-Periodontal Probing RADIOGRAPHIC Evaluation COMPUTER ANALYSIS MICROBIOLOGIC

19 ORAL DNA SALIVARY DIAGNOSTICS BACTERIAL ANALYSIS ANTIBIOTIC SPECIFICITY

20 GOAL No Bleeding upon Gentle Probing Shallow Healthy Pockets/Sulcus Healthy Bacteria

21 The effectiveness of subgingival scaling and root planing in calculus removal Rabbani, Ash, Caffesse POCKETS LESS THAN 3 MM WERE THE EASIEST SITES FOR EFFECTIVE SRP POCKETS BETWEEN 3 TO 5MM WERE MORE DIFFICULT TO REMOVE CALCULUS AND BIOFILM POCKETS DEEPER THAN 5MM WERE THE MOST DIFFICULT TOOTH TYPE DIDN T INFLUENCE THE RESULTS

22 Therapy Personal Oral Hygiene Therapy To Eliminate Bleeding/Deep Pockets Continual Periodic Professional Cleanings- Maintenance Therapy- Life Time Treatment

23 Therapy Clean Roots Shallow Pockets Healthy Bacteria

24 Therapy To Eliminate Bleeding/Pockets Root Cleaning- Periodontal Debridement Hand Instruments & Ultrasonic Cleaners Pocket Reduction Surgery Flap Debridement Osseous Surgery Laser

25 Bacterial Reduction Antibiotics Empirical- Slots Oral DNA Local Chemotherapuetic Therapy-Tetracyclines Laser Shallow Pockets

26 Periodontal Program Fundamentals EXAMINATION HEALTHY ORAL HYGIENE PROGRAM PERIODONTAL DEBRIDEMENT OCCLUSAL THERAPY THERAPY EVALUATION DISEASED MORE THERAPY / REFERRAL SPT D-SPT

27 Educate/Inform GLOVE Pictures Model MOUTH

28 SPT-SUPPORTIVE PERIODONTAL HEALTHY PATIENTS THERAPY KEEP HEALTHY

29 D-SPT DISEASED SUPPORTIVE PERIODONTAL THERAPY DEFINITION: DISEASED PATIENTS OBJECTIVE: GET HEALTHY CHANGE THE PROGRAM

30 WHAT IS NEW:IPANW Treatment ENHANCED LANAP

31 PERIOSCOPY

32 The Dental Endoscope A miniaturized fiberoptic camera attached to a tiny probe less than one millimeter in diameter and then placed below the gum line The images are immediately displayed on a chair side monitor and magnified from 24 to 48 times Allows clinicians to diagnose and treat below the gumline

33 Base 2 foot pedals

34 The MCU

35 Fiberoptic And Sterile Sheath

36 Right and left Explorers are used to visualize all areas of the teeth

37 Explorer Tip

38 The shield retracts soft tissue from the camera lens, creating a visual access space to the root surface

39 What Magnification Looks Like

40 2 Handed Perioscopy: View And Instrument Simultaneously

41 Technique In Action

42 In Conclusion: If you can see it, you can treat it My Motto: When in doubt, scope it out!

43 :The new gold standard in modern periodontal therapy

44 Debridement RDH Heals the periodontium by shrinkage from the top down

45 LANAP Laser Surgery DDS Heals by Repair and Regeneration Great for the esthetic zone

46 A Prospective 9-Month Human Clinical Evaluation of LANAP Therapy by Nevins, et all showed: Human proof of periodontal regeneration with new cementum, periodontal ligament, and alveolar bone adjacent to previously diseased root surfaces

47 OTHER RESEARCH YUKNA-INITIAL STUDY NEVINS-REATTACHMENT TILTH-LONG TERM RESULTS

48 PerioLase MVP-7 6 watt FR (Free Running) digital pulsed Nd:YAG laser designed especially for the LANAP protocol

49

50 LANAP PerioLase MVP-7 is the first and only FDA Cleared laser with an outcome claim of cementum mediated new attachment to the root surface in the absence of long junctional epithelium. It s all about the patient!

51

52

53 Trifurcation and DB Root Denuded of Bone Company Confidential 2010 Institute for Advanced Laser Dentistry Courtesy of Robert Gregg, DDS

54 Osseous Fill of Furcation No Membrane or Bone Graft Company Confidential 2010 Institute for Advanced Laser Dentistry

55 9 Year Post Op X-ray

56 WHY LANAP AND LAPIP WORK WOUND HEALING 101 REMOVE INFECTED TISSUE AND NOT HEALTHY TISSUE KILL BACTERIA, REMOVE PATHOGENS CREATE A CLOT KEEP IT THERE

57 HOW LANAP AND LAPIP WORK: KEY REQUIREMENTS FOR REGENERATION SELECTIVITY BACTERIAL KILL CLOSE THE SYSTEM

58 SELECTIVITY REMOVE THE DISEASED TISSUE FROM THE HEALTHY TISSUE

59 BACTERIAL KILL KILL BACTERIA AND REMOVE THE PATHOGENS

60 FR Pulsed Nd-YAG can Penetrate radially 6mm into tissue = Effect At Depth Company Confidential 2008 Institute for Advanced Laser Dentistry

61 The Seal s The Deal Close the System Create a Clot KEEP IT There

62 Changing the nature of Blood is like Egg. Poaching an Company Confidential 2001 Millennium Dental Technologies, Inc. All rights reserved.

63 Company Confidential 2001 Millennium Dental Technologies, Inc. All rights reserved.

64 LANAP = New Attachment: Cementum Ligament - Bone

65 Deep reaches into the tissue vs. surface effect only Intense controlled, short, powerful bursts of energy Selective for perio pathogens & diseased tissue Guided missile destroys disease and spares the health LANAP in Summary Durable hemostasis is deep and extensive vs. superficial burnt blood. Results are stable User Friendly - Adjustable presets, safe, proven, verifiable & designed specifically to support the LANAP protocol for all periodontal case types

66 ABX OHI ENHANCED LANAP OUR PROTOCOL PERIOSCOPY/LANAP ½ MOUTH AT A TIME X 2 WITH OCCLUSAL ADJUSTMENT LANAP SPT 9 MONTHS CASE REEVALUATION/COMPREHENSIVE CARE

67 Male age 70 No social habits Medical History: Arthritis, high cholesterol, GERD Medications: Motrin (OTC) as needed for arthritis, Simvastatin daily for cholesterol, Omeprazole for GERD as needed Dental History: FM osseous surgery 25 years previously Chief Complaint: Has had periodontal disease his entire adult life

68 Periodontal Clinical Findings Moderate to advanced periodontitis Infection/inflammation Deep pockets Root accretions Acute/chronic apical periodontitis (endodontic lesions) Occlusal Traumatism Malocclusion Parafunctional Habits

69 UR Pre Tx Pockets 4-9mm Class ll furcation involvement in both molars Possible Endo abscess #3

70 LR Pre Tx Pockets: 4-8mm #30-31 Class l furcations both molars

71 #26 and 27 Pre Tx Pockets 5-8mm. Severe bone loss #26, 8mm DF, 5mm straight facial, +2 mobility

72 UL Pre Tx Pockets 4-7mm Possible periapical abscess #15

73 #18 pre Tx Pockets 4-12mm, Class lll buccal and lingual furcations, Possible endodontic abscess #18

74 OUR PRESENT DAY GOLD STANDARD E-LANAP PERIOSCOPY LANAP

75 13 months Post Tx

76 Post Tx UR/LR LL Deepest Pocket 4mm

77 Post Tx UL/LL Deepest Pocket UL 4mm LL 6mm

78 #27M now 2mm (reduced from 6mm) #26 DF, now 2mm from 8mm

79 #26 F now probes 2mm, #26 and 27 have slight mobility

80 18 buccal PD 2mm (reduced from 9mm) Radiographic bone fill in #18

81 Case Conclusion A full set of X-rays taken 13 months Post Tx: Bone fill in the deepest pockets with pocket reductions of up to 7mm #3 referred for endodontic evaluation # s 15 and 18 show no signs of endodontic involvement #15 tests vital

82 Case Study #1 Type 2 Diabetic Patient Not responding to conventional therapy. I should consider the patients oral condition? True or False?

83 Case Study #2 My patient is high risk for PTLBW birth. I can reduce the risk by evaluating and treating her periodontal condition? True or false?

84 Case Study #3 My patient has a history of a MI. Part of my therapuetic regimen to prevent another MI includes periodontal evaluation and necessary treatment. True or False?

85 Commitments Creation of medical-dental teams to manage oral-systemic diseases. Create structure for communication, referral and interdisciplinary case management.

86