Bug Hunt May Turn up Keys to Periodontal Disease

Mostly good bugs, they abound on our teeth and gums to help the digestive process and help fend off less-kindly bugs that can produce periodontal and systemic disease.

Investigation during the past 20 years has identified hundreds of oral microbes. Now, researchers at Stanford University Medical Center have joined in the search for more elusive microbes in an effort to close in on an eventual cure for periodontal disease.

"Our data suggest that a significant proportion of the resident human bacterial flora remain poorly characterized, even within this well-studied and familiar microbial environment," says David Relman, MD, assistant professor of medicine and of microbiology and immunology at the Stanford Medical Center.

Relman, along with lead author Ian Kroes, MD, and Paul W. Lepp, PhD, published their study in the Dec. 7 issue of the Proceedings of the National Academy of Sciences.

The Stanford study looked at one 39-year-old male, studying his dental plaque sample in two ways, using the traditional culture method and the newer molecular technique. Researchers prepared DNA directly from the plaque and studied each genetic sequence that had a bacterial signature. When the results were compared, they found that the DNA-based molecular technique found 31 never-before-seen bacteria, and the culture method found six more new microbes.

Lepp says that the study sought to establish a baseline of the normal oral bacteria flora.

"We need to characterize a lot more information before we can determine if what we found produces any diseases," he said. "But to better characterize those bacteriological communities, we’ve taken what amounts to a first step to find out what is there to start with."

The next step, according to Lepp, is to investigate oral disease cases to better determine the prevalence of the bacteria in a larger-scale study. The Stanford research team is collaborating with Gary C. Armitage, DDS, MS, chair of periodontology at the UCSF School of Dentistry. He is clinically characterizing the periodontal disease in patients and collecting samples. Relman’s team then applies the molecular technique to describe the sample’s microbial diversity.

"If you don’t know what’s causing the infection, you can’t target a therapy," Armitage says. "So it’s a hunt for potential pathogens. These specific targets will allow specific therapies to be targeted against them."

Similar work is also under way on the East Coast. Floyd Dewhirst, DDS, PhD, head of the Department of Molecular Genetics at Boston's Forsyth Institute, the nation’s oldest nonprofit dental research organization, is studying organisms that may be involved in periodontal disease. Dewhirst's study includes a larger number of patients than Relman’s.

"What Dr. Relman’s and my groups agree on is: Of the easy-to-cultivate bugs we’ve already picked up, there are maybe a dozen bad guys responsible for periodontal disease," says Dewhirst, a 1973 graduate of the UCSF School of Dentistry.

Dewhirst, Relman, and Armitage assume that about 50 percent of total oral bacterial flora are unknown, so it is likely that the yet-undiscovered group will include more pathogens.

"Once we make associations through clinical studies by looking at the bugs with DNA probes, we can begin to identify these other difficult or impossible-to-cultivate bugs and develop therapies to eliminate them," Dewhirst says.

An example of how molecular research can result in improved periodontal health can be found in relationship to a particularly bad pathogen, Porphyromonas gingivalis. Dewhirst says the bug is principally responsible for periodontal disease. In collaboration with the Institute for Genomic Research in Rockville, MD, Dewhirst’s group is determining its entire genome, a step toward developing a specifically targeted therapy to kill it.

"We’ve determined all 2.4 million bases of its DNA, and we’re now in the process of identifying and writing up the 2,000 genes in the organism, describing each," he says. "Later this year, we hope to have the manuscript ready describing this organism."

Dewhirst says that a good analogy for what is now happening in periodontal research can be found in the changing view of stomach ulcer treatment.

"For many years, people thought ulcers were from stress and poor diet," Dewhirst says. "When the bacteriological link was finally discovered, patients could be cured with antibiotics, so it completely changed how ulcers are treated. Periodontal disease is now treated by scaling, root planing, surgery, and supplemental antibiotics. As we understand more about the organisms that are involved in the disease, hopefully we can come up with some very specific therapies to eliminate the particularly virulent ones."

According to Dewhirst, periodontal research is headed in a direction characterized by his and Relman’s studies, and research yet to come.

"We’re looking at what organisms are present; and, given that, we’re finding the best ways to eliminate the bad ones."

Live Long(er), and Prosper

By the close of 2001, humankind will realize numerous scientific and medical phenomena that will revolutionize the delivery of health care in the next five years. As a result, the human lifespan will lengthen and the quality of life will improve.

Those predictions were part of the discussion at the Seventh International Congress on Anti-Aging Medicine and Biomedical Technologies, hosted by the American Academy of Anti-Aging Medicine in Chicago in December.

According to academy President Ronald M. Klatz, MD, DO, the next two years hold enormous promise for the realization of boundless youth and vitality. Among his predictions:

* Fleets of miniature robotic warriors will fend off disease on a cellular level, collect information to diagnose cellular functions, and deliver site- and time-specific medications to target tissues.

* Baldness will be beaten. With laboratory-based hair cloning already a success in human test subjects, genetic therapies that will eliminate male pattern baldness are soon to become widely available to the general public.

* Alzheimer’s disease will be halted. Genetic therapies, including manipulation of the predisposing Apolipoprotein-E factor, will become available to battle this disease.

* Age-related vision loss will be counteracted by implanted biochips that will stimulate tissue growth to slow or reverse macular degeneration as well as stimulate the visual center of the brain to create artificial or enhanced sight.

* Spinal cord injury will be reversed. Based on new research from the University of California, it is anticipated that implantable biochips and nerve growth factors that stimulate repair and regrowth of nerve tissue will be a reality.

Fees for Service

Dental Economics has released the results of its latest dental fee survey. Following is a list of sample fees drawn from the 1999 report. For the full results, see the December 1999 issue of Dental Economics.

National Median of Select Dental Fees

Code Procedure Median Fee

00150 Comprehensive exam $35.34

00210 X-rays (complete) 71.92

01110 Adult prophylaxis 49.63

02140 One-surface amalgam 63.25

03330 Molar root canal 550.33

Crafting an Image Is Another Key To Practice Success

By Dell Richards

Many professionals think that as long as their work is good, their image doesn't matter.

But it does, and creating, presenting, and maintaining a positive image can go a long way toward ensuring a positive perception of a professional enterprise -- including a dental practice.

Image is not a concern reserved for a select few. Increased media savvy makes skillful presentation of one's practice a key ingredient in competing successfully. And, although they are corporate giants, companies such as Coca-Cola and IBM offer time-honored lessons about how to build an image -- lessons that comfortably apply to small businesses such as dental practices.

Coca Cola is a modern-day icon not just because of design and longevity, but because the whole package -- from the theme of the advertising to the color of the logo and the shape of the original bottle -- works together to present one image.

It will benefit dentists to objectively assess their offices, stationery, logos, dress and mannerisms to determine what they convey to prospective patients. The message being received might be surprising.

Here are a few ways to think about image:

Be color-wise. Colors have an enormous impact on people’s responses. When it comes to color, no one can beat IBM.

IBM has used a particular blue for so long that it has become known as "IBM blue." The color is widely used by other entities because the rich blue projects authority, trustworthiness, and dependability -- attributes IBM wants associated with its products.

Coca-Cola’s fire-engine red is a polar opposite. It creates a sense of excitement, energy, and activity -- all in line with Coke's desired product image.

Colors convey specific characteristics, and care should be exercised when choosing colors with which to associate an enterprise. Cool colors such as dark green and blue tend to be more classical and traditional, and they present few negative connotations. Warmer colors such as red, orange, and yellow have positive associations such as liveliness, but they also can be associated with anger, loudness, even jaundice, and should be used sparingly.

Pure primary tones should be avoided. Instead, more muted tones with gray added to enhance subtlety are more effective.

Be sophisticated. Because of its superb design, the Coca-Cola logo is practically timeless, reflecting excellent use of graphic art. As with Coke, dentists should find a good logo and image and stick with them, not change them every few years.

A design conveying simple elegance usually is more expensive than one featuring down-home appeal. Dentists should be mindful of that when searching for a designer. Graphic -- or interior -- design is an important investment, and a professional should not skimp in these areas.

Similarly, written materials should be top quality. High grades of paper should be used for brochures, stationery, and other hard-copy consumer communications.

Watch out for clutter. A brown box full of brochures stored on an open shelf or a pile of papers on a desk can be forgotten and become part of the furniture.

Disorganization spells lack of attention to detail. While new patients may not be conscious of the disarray, a messy office will have a negative impact on their impression of the dentist.

Non-essential material should be removed; and, in the waiting room, magazines relevant to health and dentistry should be featured. For children, fun material with dental themes are available.

Nothing should get in the way of the sophisticated image a dentist wants to present.

Be consistent. Coca-Cola’s advertising may change year to year, but the theme -- good times, basically -- does not. That consistency creates the feeling of certainty and stability, a necessary quality for any product or service. Everything that is associated with a practice should send one message.

The design, colors, and material of the logo, stationery, brochures, advertising, office decor, and uniforms should closely relate and project a consistent image. Conscious management of creation and maintenance of an image helps ensure that patients are receiving the messages that the sender intends.

Dell Richards is the owner of Dell Richards Publicity in Sacramento, Calif.

Protection Gets in Your Face

Full-face shields are significantly better than half shields at protecting against dental and facial injuries in hockey players. Despite speculation to the contrary, they do not increase the risk of concussions, neck injuries, or other injuries, according to an article in the Dec. 22/29 issue of the Journal of the American Medical Association.

A team from the University of Calgary in Alberta studied risks for head or neck injuries when full-face and half-face shields are used by intercollegiate hockey players. A half shield is a clear plastic visor that is attached to a helmet and extends to the tip of a player’s nose. A full-face shield extends to the bottom of a player’s chin and covers the entire face.

The research team, led by Brian W. Benson, MSc, and Willem H. Meeuwisse, MD, PhD, conducted the study during the 1997-1998 Canadian Inter-University Athletics Union hockey season. The study subjects were 642 male hockey players (mean age 22 years) from 22 teams. Athletes from 11 teams wore full-face shields, and athletes from 11 teams wore half-face shields during play. From the first practice of the season, team therapists used standardized weekly exposure sheets to record the level of individual participation (full, partial, or none) and the type of face shield worn for every practice and game throughout the season. If a player sustained an injury that met the reportable injury definition, team therapists, physicians, or both were required to complete an injury report form.

"Although we found a significant difference in rates of head and facial injuries between the two groups, there was no significant difference in risk of sustaining a concussion, neck, or other injury for athletes wearing half shields compared with those wearing full-face shields," the authors write. The finding that seven of the 11 athletes who suffered dental injuries in the half-shield group were wearing mouth guards at the time of injury suggests that use of such protective equipment in combination with half shields is not enough to offer protection from those injuries.

The authors recommend that sports governing bodies at the intercollegiate level of competition should seriously consider mandating full facial protective equipment for all participants under their jurisdiction.

"Ice hockey associations from Canada and the United States have introduced head and neck risk management strategies, the most significant being the mandatory use of full facial protection for athletes across many different age groups and levels of play," the authors write.

Honors

Teran Gall, DDS, CDA’s director of Special Projects, has been elected to the Board of Directors of the American Society for Geriatric Dentistry. He will be inducted as a fellow in that organization later this spring.

Steven E. Schonfeld, DDS, PhD, chair of CDA's Council on Education and Professional Relations, has been appointed to the Professional and Technical Advisory Committee of the Joint Commission on Accreditation of Healthcare Organizations.

Dudley Glick, DDS, will be inducted this month into the Hall of Fame of the University of Southern California School of Dentistry. He is the director of endodontics in the general practice residency program at Cedars-Sinai Medical Center in Los Angeles.

Web Watch: Fluoridation

With fluoridation in the news, patients may be asking their dentists for information to help them separate fact from fiction. The following Web sites explain the benefits of water fluoridation.

http://www.ada.org/public/topics/fluoride/fluoride.html

The ADA’s main index of fluoride information.

http://www.www.nidr.nih.gov/fluoride.htm

The story of fluoridation from the National Institute of Dental and Craniofacial Research.

http://www.cdc.gov/nccdphp/oh/flintro.htm

The surgeon general’s statement on community water fluoridation and other general fluoride information.

http://fluoride.oralhealth.org

The Web site for the National Center for Fluoridation Policy and Research.

A listing here does not constitute endorsement by the California Dental Association. As is the case with all web sites, content is subject to frequent change.