Interview with KDWN Host Truman Hawkins and Dr. Ronald Levandoski

The most prevalent problem is periodontitis or gum disease. In fact, the surgeon general has estimated that over 60 million adults have some form of gum disease. It is the leading cause of tooth loss in adults.

There is a growing body of evidence that suggests inflammation associated with gum disease can have serious negative impacts on other serious medical conditions, such as diabetes and heart disease. It has been shown that it is more difficult to control diabetes when a patient has uncontrolled gum disease. Many doctors are beginning to suspect that a patient with chronic inflammation such as that found in gum disease are at much greater risk for heart attack or stroke.

There are actually two major components of this disease. There is a bacterial component and an inflammatory component. Bacteria initiate the inflammatory process, and it's the body's own inflammatory reaction that causes most of the problem.

In an attempt to fight the bacterial infection, the body destroys the tissue that normally surrounds and supports the teeth. When enough tissue is destroyed, the tooth is lost because there is not enough bone or gum tissue to hold the tooth in the jaw.

There are some telltale signs that can alert a person that they may have a problem. Gums that bleed when you brush or floss your teeth, or sometimes a pink residue will show on your toothbrush. If the gums look red or swollen, that usually indicates a gum problem. Bad breath is also a common complaint of people with this disease. As the disease gets worse, a person may notice a bad taste in their mouth, or they may notice that their teeth have shifted or come together differently than they used to.

Actually, gum disease is usually painless until it's too late to do something about it. Fortunately, a thorough dental exam can detect even the earliest stages of the disease, when there is still opportunity to avoid pain and tooth loss. A proper exam involves evaluating the overall health of the gums, several precise measurements around the teeth, dental radiographs to evaluate the bone around the teeth and an assessment of all possible factors the patient may have that would affect the course of the disease.

There are several key factors that can influence how gum disease progresses and how our treatment will proceed. Bacteria are just one consideration. Some people have a genetic predisposition to developing gum disease. Other people may have a systemic condition such as diabetes which puts them at higher risk for gum disease. Some people may have a nutritioinal deficiency which can affect this disease. Even stress has been shown to play a role. We try to take all these factors into consideration as we develop to control gum disease.

We have a number of therapies available to us today that were not available even just a few years ago. Because of this, our treatments are more effective and less difficult than they used to be. We try to reduce bacterial plaque and calculus or tartar, and now we can directly target the patient's own inflammatory response. We are able to individualize treatment using these newer therapies for each patient. The outcomes for our patients are more predictable because we can take into consideration their unique situation and risk factors.

Well, for instance, we now have medications such as atridox. Atridox is an antimicrobial gel that we can place directly on the site of the infection. It kills the bacteria that surround the teeth. This has been shown to be very effective in many cases, especially in areas that the patient has difficulty keeping clean on their own.

Another breakthrough therapy is called periostat. This is perhaps the most innovative therapy for treating gum disease in the past 30 years.

Periostat has been around for over 5 years now. Thousands of dentists and periodontists have prescribed Periostat to over a million patients. They prescribe Periostat because Periostat has a unique way of fighting the effects of gum disease.

You remember we talked about the inflammatory component of the disease? Periostat is available by prescription, and its the only therapy that addresses the destructive inflammatory component of gum disease. When someone has gum disease, their body produces tissue destroying enzymes in an attempt to fight off the chronic infection. Unfortunately, these enzymes are what are destroying the support around the teeth. Periostat is a small pill that is taken twice a day. Periostat suppresses those tissue-destroying enzymes while the body heals. When combined with the appropriate antimicrobial therapies, Periostat provides us with a better means of managing periodontal disease.

That is something that we need to clear up. The bacteria found in gum disease are not capable of destroying tissue or causing tooth loss. The bacteria elicit the host response, and the patient's own enzymes actually destroy the tissue and cause the patient to lose their teeth. Periostat works by reducing the activity of those destructive enzymes.

Unfortunately, that is easier said than done. We have not yet developed a way to permanently sterilize the mouth. The bacteria always come back regardless of what we do. Besides that, there are those 'risk factors' we talked about earlier. For instance if a person is a smoker, they are 5 to 7 times more likely to develop advanced gum disease than a non-smoker, regardless of how good their oral hygeine is.

We all know what a challenge that can be. But that is one reason why Periostat is so important. Research has shown that even in patients who smoke, Periostat can improve the clinical outcomes. It is also beneficial to patients with other risk factors such as diabetes and genetic predisposition to gum disease. These conditions all contribute to the destructive nature of periodontal disease, and until Periostat was introduced, there was little we could do to counter their influence on the disease.

That is true. They have only discovered the genetic link in gum disease within the last decade or so. What they found was rather shocking. According to the research, approximately 30% of people carry a gene that makes them more susceptible to developing gum disease. In fact, it has been estimated that if you have gum disease and a close relative like a brother or sister or parent had the disease, there is better than two chances in three that you carry the gene. See? Its not your fault.

I would say so. Remember, that genes, just like bacteria, are just one of many factors that need to be considered. Periostat interferes with the destructive inflammation of gum disease, regardless of what may be driving it.

The research that eventually brought Periostat to market began well over 20 years ago. Since then, dozens of peer-reviewed studies have been published which prompted the American Academy of Periodontology last year to state and I QUOTE: "it is logical to consider therapies that modulate the host response in addition to antimicrobial therapies in the management of chronic periodontitis. " As of today, Periostat is the only host response modulating therapy approved for treatment of gum disease.

Yes, Periostat is the only systemic medication approved by the FDA for the long term treatment of gum disease. Not only that, but Periostat has received ADA seal of acceptance. This means that Periostat has been shown to be effective in the treatment of gum disease when combined with regular professional care.

The first patient I would consider for Periostat is one who has a history of periodontal treatment and still has signs of active disease. It is obvious that whatever was done in the past was not effective in the long term. Periostat gives us another opportunity effectively manage this disease in the long term.

That depends on several variables, including the current severity of the disease, the various risk factors to be considered, and the liklihood of the disease getting worse in the future. Most patients start off taking Periostat for at least three months and longer if needed.

Studies have shown that patients can safely take Periostat for as long as 18 months. Even beyond that, there is no reason to believe that a patient would experiene problems.

Periostat starts working almost immediately, and it continues to work for as long as the patient takes it as directed. What takes a long time is the healing process. The tissue that we are trying to heal is called collagen, or connective tissue. Connective tissue can take a very long time to properly heal. Ask anyone who has ever torn some cartiledge or ripped a tendon. Anywhere from three months to a year or more. We need to suppress the collagen-destroying enzymes for as long as that healing process is continuing. Esentially, Periostat conserves collagen between dental visits.

The first thing they should do is see the dentist. Only with a complete gum exam can you make a proper diagnosis and help the patient develop an effective strategy for managing the disease.

Unfortunately, gum disease is most often not curable. Like other chronic conditions such as diabetes and high blood pressure, we have to manage gum disease until we find a cure. Periostat is just a tool we use to help patients manage their gum disease.

They can always come and see Dr. Ron. My staff and I are ready, willing, and able to provide the best possible dental care. We treat our patients with all the gentleness and consideration we would want for ourselves.

I do prescribe Periostat for a lot of my patients, but only after I have done a thorough examination, developed a solid treatment plan, and answered all the patient's questions. I believe that the best dentistry is based on mutual trust, respect, and teamwork. Periostat is simply a part of the overall strategy, and I only prescribe it when I believe it will benefit a specific patient.

Oh yes, I've personally seen patients who's gum disease seemed to completely stabilize once they completed our office treatment and started on Periostat twice a day. I'll grant you individual results can vary, but overall, those on Periostat seem to do much better than those who don't take their Periostat as directed. I've also seen some results that were completely unexpected. One patient in particular comes to mind. In addition to gum disease, she also suffered from TMJ syndrome. She had tremendous pain and inflammation in her jaw joints right in front of her ears. She could hardly open her mouth because of the pain. After a few weeks of Periostat, her pain was completely gone and she could open her mouth normally. Now, I don't have any scientific research to back this up, but my intuition tells me that it was probably the anti-inflammatory properties of the Periostat that gave her that relief.

The first place they should go is their dentist's office. They should be able to get good advice regarding Periostat from the dentist. If they don't have a dentist, they can call my office at 310-5970. We'll be happy to set up an appointment to discuss their dental health and all their treatment options.

Another good source of information is on the internet at www.periostat.com. There is a good deal of helpful information on that site including a test listeners can take to see if they have gum disease.

The important thing I want people to know is that we have come a very long way in our understanding of periodontal disease and we have developed new strategies and technologies to treat the disease. There is hope even for those folks who may have given up and resigned themselves to losing their teeth to gum disease. My staff and I are ready to discuss all available options with anyone listening. Losing your teeth to gum disease does not have to be part of your life.