spirochetes

on 4/25/06 2:06 PM, Mike Rethman wrote:
Re: polymorphonuclear

leukocytes appear to play a key role in maintenance of periodontal health as they line the junctional epithelium and try to wall off the underlying tissues from the destructive pathogens."

Rethman: PMNs play this role (short term "wall-off" function) everywhere there is a break in the epithilium, skin, bowel, nose... anywhere. The periodontal sulcus is no exception. - Mike Rethman

From Paul Keyes,

As WBCs migrate through the periodontal tissues they release collagenase which breaks down collagen fibers. Over time this loosens teeth and leads to their exfoliation. This may be considered a defense mechanism in response to highly infected foreign bodies (tooth surfaces). After WBCs migrate into circumradicular spaces, they often face a battle they can not win: that produced by millions of organized spirochetes rippling together in organized metracronal activity. With a phase-contrast microscope it is not unusual to see spirochetes attacking WBCs. It is my opinion that WBCs in periodontal pockets are "impotent".

From: Lynne H. Slim
Sent: Friday, April 28, 2006 10:39 PM
Subject: Re: [periotherapist] Re: Spirochetes

Dr. Keyes, This information is supported by current research, too. I just finished reading a piece on spirochetes by Richard Ellen at the U of Toronto. Here's the scoop and what he and his colleagues have to say: "Treponemes (spirochetes) are at the forefront of established periodontal infections. Whether they contribute to the cause of the initial injury is a moot point. Once they emerge in the microflora, perhaps due to their nutritional requirements, treponemes probably join other omplexes to exacerbate and prolong injury to the epithelium. Treponemes have the capacity to induce abscesses; to contribute to necrotive ulcerative lesions and to trigger a wide range of degrading mechanisms of innate immunity pathways.

I don't know too much about the immune system but I do know that our human bodies keep pathogens at bay by destroying them and neutralizing their virulence factors. This defense mechanism is an ancient one and is referred
to as the innate immune system.

Richard Ellen, et al advocate suppression of oral spirochetes as one measurable goal of therapy and prevention of recurrent episodes of periodontitis.

I don't know about the rest of you folks, but this information makes perfect sense to me and that is why I spend so much time educating my patients in trying to teach my peridontitis patients how to prevent recurrent disease.

Lynne H. Slim RDH, BSDH, MSDH

Sent: Sunday, April 30, 2006 11:17 AM
Subject: Re: [periotherapist] Re: Spirochetes

Dear Sandy,

I am sure that you perform an oral examination before using the microscope so I am wondering, what other clinical signs do you observe with children that harbor spirochetes?

Steve Ury

In a message dated 4/30/2006 10:19:25 A.M. Eastern Daylight Time,

I couldn't agree more. This is why I rely so heavily on the microscope. We are seeing spirochetes in children, picked up from their parents. Stopping the infection early would save a lot of people a lot of grief. Sandy Sheffler

Sent: Monday, May 01, 2006 8:44 PM
Subject: Re: [periotherapist] Re: Spirochetes

From Paul Keyes,
I have found spirochetes in a 6 yr old boy whose mother was badly infected. He just happened to be with her when she came in for an examination. Can you get the teenagers you see to brush carefully with Mentadent and baking soda? If so, it should be very beneficial. BTW what do you advise them to do for their self-care?

Sandy Sheffler wrote:

Usually the children we test have parents who exhibit high bacterial counts. I am testing teenagers who have fair or worse homecare. We're starting younger and younger because we're finding bacteria. Sandy

Hi Dr. Keyes. I irrigate their mouth with Therasol. Sometimes my dentist prescribes a z-pack (with the consent of the pediatrician) and I try to get them on baking soda in some capacity, rubber tip, toothbrush etc. The Mothers tell me they have never brushed this much since seeing their bacteria. I tell the teenagers, be careful who you kiss. This is motivation in the best form. Sandy

Sent: Monday, May 01, 2006 11:05 PM
Subject: Re: [periotherapist] Re: Spirochetes

Dear Sandy,

Maybe you didn't understand my original question. Let me try a different slant.

You say, "Usually the children we test have parents who exhibit high bacterial counts." Is the 'testing' you speak of microscopic examination of sulcular samples? Do you perform a clinical examination on patients (young or old) before proceeding with a microscopic evaluation? Also, is the testing of children predicated on the parents bacterial assay?

Steve Ury

Usually the children we test have parents who exhibit high bacterial counts. I am testing teenagers who have fair or worse homecare. We're starting younger and younger because we're finding bacteria. Sandy

Yes, yes and yes. The practice where I work is mostly an adult practice. If the children are already patients, they are microscopically tested at their recare appt. if their parents are already perio pts or have high bacteria counts. Teenagers today have mouths like sewers!, I have found. I test all new pt. adults or children during their appt. Everyone has an exam. We are a very thorough office. Periodontal pockets are not the criteria I use to test bacteria. By the time there are pocket depths of 5mm or more, the disease has been there for a long time. Thanks for asking. SandySheffler RDH