The complexities of P gingivalis: How to optimize the periodontal outcome

The CDC estimates that 71% of adults age 65 and older have periodontal disease, and nearly half of patients age 30 and older experience symptoms of periodontal disease.1 These are the latest statistics for literature published in 2018.

Periodontal disease is multifactorial, and the complexities brought about by the ongoing COVID-19 pandemic—such as social isolation, increased mouth breathing, increased oxidative stress, and more—further increase patients’ periodontal risks.

When treating patients with periodontal disease, we need to think holistically about the root causes of the disease. Patients may be battling any of the red complex bacteria that can increase the risk of periodontal disease and tooth decay. Several innovations allow us to optimize treatment outcomes both chairside and at home.

the truth is about Porphyromonas gingivalis

Porphyromonas gingivalis It is also known as a “critical” pathogen due to its destructive nature and high virulence factors even at low concentrations.2 “To date, periodontal pathogens have been associated or linked to 16 systemic diseases, including cardiovascular disease, diabetes, respiratory disease, chronic obstructive pulmonary disease, rheumatoid arthritis, gastrointestinal disease, and Alzheimer's disease , osteoporosis, kidney disease, premature birth, premature birth weight, and cancer.3 Therefore, the preventive gear we use in chairside and patient home care programs must be evidence-based and designed to target the types and levels of bacteria present.

Periodontal Chairside Program

The best way to treat periodontal disease is to understand the levels and types of bacteria we are treating. Just like blood work, once we understand how a patient is doing, we can determine a comprehensive treatment plan to help eliminate the root causes of the periodontal disease process. Our hygiene regimen should include methods that target complex bacteria, such as subgingival irrigation with povidone-iodine products, low-level bacteria reduction treatments with lasers, and subgingival decontamination with subgingival powders such as erythritol.4-6

Additionally, patients must be screened for airway dysfunction, such as mouth breathing and sleep apnea, as these may increase bacterial resistance.7

Home care advice

Motivational interviewing conducted in the chair is very effective for preventive oral hygiene efforts. Once we determine exactly what patients would use at home, we can help determine the reasons behind our recommendations. Patient-specific recommendations based on the individual disease process are critical to the long-term success of periodontal treatment.3 Dental professionals must be committed to keeping pace with emerging science.

You might be right too. The first step to address the root causes of ecological imbalance

Another factor recommended for home care of periodontal patients is pH balance. Clinical studies have shown that patients with red complex bacteria have an acidic resting pH in their mouths.8 Clinicians should choose products that contain ingredients that help promote remineralization, such as calcium, phosphates, xylitol, fluoride, hydroxyapatite, and CPP-ACP. Using products like probiotics to repopulate beneficial bacteria after a SCRP session is a simple way to promote symbiosis.

Integrating “care” into patient care

It is often said that people don’t care how much you know unless they know how much you care. I find this is true for patients as well. Building rapport with patients is key to improving patient compliance. Historically, dentistry has been centered on a fear-based model. If you don't brush and floss, you'll get gum disease!” This may be true, but oral health is more than just brushing and flossing.This is how we train biofilms to function for We are in the mouth instead of trying to eliminate all the bacteria. In some cases, brushing and flossing are enough for patients. People with dysbiosis need more support. These patients had minimal biofilm, almost no calculus, and meticulous home care at the time of exposure, but their periodontal probing levels were 5-7 mm. Perhaps these patients' oral pathogens have become resistant to the products they are using, or perhaps systemic disease is increasing the severity of periodontal disease. Social habits such as smoking can also cause patients to be in a state of dysbiosis. Patient cooperation and trust along with chairside testing to determine red complex levels and types are critical in disease management to more accurately assess the underlying cause of a patient's periodontal disease.

You might be right too. It's all about biofilms

One of the most rewarding parts of my career has been changing patients’ mindsets about their preventive care. Many patients believe that because their parents had periodontal disease, they will automatically have periodontal disease as well. As preventive oral health specialists, we can provide our patients with the knowledge and tools they need to reduce the risk factors they manage during the multifactorial process of periodontal disease. There is no greater feeling than when a patient achieves oral health under our care. Let’s work together to stop the progression of periodontal disease and gain a complete understanding of the root causes.

Editor’s note: This article appeared in the October 2023 print edition RDH Magazine. Dental hygienists in North America are eligible for a free print subscription. Register here.

refer to

  1. Gum disease. Centers for Disease Control and Prevention. Comment date: November 18, 2020.
  2. Olson I, Lambrys JD, Hadji Shengalis G. Porphyromonas gingivalis Disrupt host symbiosis homeostasis by altering complement function. Journal of Oral Microbiology. 2017;9(1):1340085. Number: 10.1080/20002297.2017.1340085
  3. Warner T. Defining periodontal disease in terms of its causative agents. American Academy of Oral Systemic Health. January 3, 2018.
  4. Moritz A, Schoop U, Goharkhay K, et al. Treatment of periodontal pockets with diode laser. Laser Surgery Medicine. 1998;22(5):302-311. doi:10.1002/(sici)1096-9101(1998)22:5
  5. Sindhura H, Harsha RH, Shilpa RH. Efficacy of subgingival irrigation with 10% povidone-iodine as an adjunct to scaling and root planing: a clinical and microbiological study. indian dental journal. 2017;28(5):514-518. doi:10.4103/ijdr.IJDR_497_15
  6. Abdulbaqi HR, Shaikh MS, Abdulkareem AA, Zafar MS, Gul SS, Sha AM. Efficacy of erythritol powder air polishing in aggressive and supportive periodontal treatment: a systematic review and meta-analysis. international dental journal. 2022;20(1):62-74. doi:10.1111/idh.12539
  7. Surtel A, Klepacz R, Wysokinska-Miszczuk J. Paul Merkul Lekarski. 2015;39(234):405-407. polishing.
  8. Baliga S, Muglikar S, Kale R. Journal of Indian Society of Periodontology. 2013;17(4):461-465. Number: 10.4103/0972-124X.118317

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