Accurately diagnosing problems with your breath or gums is essential for effectively treating them.
Proper diagnosis involves identifying the types and amounts of bacteria present in the mouth. This enables dental professionals to determine if you are at risk for or have an oral infection. It also provides information that’s helpful in determining the best treatment if you do have an infection.
The History Of Using Mircobiology For Periodontal Treatment
The search for the etiology of periodontal disease started in the “Golden Era of medical bacteriology (1980 to 1920)”. During that period, the etiologic agents of many bacterial infections were isolated and characterized. Groups of investigators applied the microbiological techniques of medical science available at that time to study the oral microbiological environment. 23 – 25 After the initial enthusiasm in establishing the agents of periodontal disease to be infectious in nature, this concept was virtually ignored for the next four decades. From the mid-1920s to early 1960s a series of different factors and co-factors were considered to cause or to be related to the etiology of periodontal lesions. 26 Gottieb’s concept of passive eruption, 27 local irritation of the periodontium,28 and functional occlusal interferences 29 were mostly addressed and discussed as the causative factors of periodontal disease. Bacteria were thought to be merely superimposing as invaders in this process. 30 Today, periodontal disease is defined as the clinical manifestation of a variety of inflammatory conditions characterized by the progressive deepening of the gingival sulcus, resulting in the formation of a periodontal pocket. Concomitant, destruction of the supporting connective tissue and alveolar bone occurs. 10 With the introduction of the specific plaque hypothesis, 22 it is widely accepted that the colonization of the gingival sulcus by periodontal pathogens can be the initial triggering event contributing to the onset of periodontal tissue destruction. However, periodontal breakdown in a particular patient will occur is determined by complex interactions between host defense mechanism and the inflammation induced by the bacteria flora. These factors influence the equilibrium between bacterial aggression and host protection and determine disease progression.
There was a three year case study that followed an African American, 16-year-old female patient who had been diagnosed with aggressive localized severe periodontitis. In the initial data collection, microbiological culture and sensitivity testing were included. This confirmed the diagnosis and determined which antibiotic to prescribe for the patient when treatment was initiated. In this case, initial periodontal treatment of deep scaling and root planning was augmented from the beginning with one curse of Amoxicillin 500mg for 10days parallel with Metronidazole 250 mg for five days.
Her initial clinical appearance showed pathologic migration of her anterior teeth, flaring diastemas due to the progressive attachment loss. There was thick plaque (materia alba) on the buccal surfaces on her teeth, interproximal and at the gingival margin.
After the initial visit, the patient’s radiographs were showing moderate-severe localized vertical bone loss in the posterior, and horizontal severe bone loss in the anterior regions. After initial periodontal therapy was concluded the patient’s data was updated two years after initial visit. The periodontal status had improved and now has an increased caries risk. This indicated the presence of perio-protective gram positive and facultative micro-organisms21 in the oral cavity.
Two years after treatment further periodontal breakdown was not only arrested, but also bone matrix appeared to remineralized and in more coronal positon. The outstanding results are due to proper diagnosis and selection of treatment.