MID wrt Periodontology
As students, we had to carry out a quota of simple gingivectomies. I can still remember the blood!
I never carried one out in general practice. I used a Cavimed for a few years, and now the evidence shows that, except in a few cases, Chlorhexidine mainly generates an income for us by staining the teeth, but only when used correctly and not at the time toothpaste is used.
Following the Legionnela scare, I used a percentage of hypochlorous acid from our Sterilox machine, which may have had some positive effect in oxygenating the pocket. Around that time I asked a Professor in Perio if we could use dilute hypochlorite in the Cavimed ultrasonic scaler. The answer was no, as no one knew a safe dose, and as it was so cheap, no one would fund a trial. They have now. But still, there hasn't been a Cockrane review. There is a ten-year-old review for Endodontics , and there are now a few on hypochlorite rinses and a recent Cochrane review that concludes it's not too effective in plaque reduction, similar to chlorhexidene but without the potential staining, a similar poor taste, and a lot cheaper.
I also invested in a Healozone machine and wondered if ozone could safely be applied in the pocket. There was a device to clean the root canal with ozone, but I never managed to use it, although gas has many advantages over liquid.
I never carried one out in general practice. I used a Cavimed for a few years, and now the evidence shows that, except in a few cases, Chlorhexidine mainly generates an income for us by staining the teeth, but only when used correctly and not at the time toothpaste is used.
Following the Legionnela scare, I used a percentage of hypochlorous acid from our Sterilox machine, which may have had some positive effect in oxygenating the pocket. Around that time I asked a Professor in Perio if we could use dilute hypochlorite in the Cavimed ultrasonic scaler. The answer was no, as no one knew a safe dose, and as it was so cheap, no one would fund a trial. They have now. But still, there hasn't been a Cockrane review. There is a ten-year-old review for Endodontics , and there are now a few on hypochlorite rinses and a recent Cochrane review that concludes it's not too effective in plaque reduction, similar to chlorhexidene but without the potential staining, a similar poor taste, and a lot cheaper.
I also invested in a Healozone machine and wondered if ozone could safely be applied in the pocket. There was a device to clean the root canal with ozone, but I never managed to use it, although gas has many advantages over liquid.
A few years ago, I attended a Perio update course run by Philip Ower. I cannot praise the course highly enough as it gave some insight into how to provide a reasonable service in general practice regarding perio. I was given, with their permission, a link to a video on Pocket cleaning, which I sent to a woman of 75 who viewed it on her iPad, and the result was the tooth we both anticipated her losing became stable. The notes are after this video summary on Ian Dunn's excellent perio update of November 2022.
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This is a video I created a couple of years ago, but it remains highly relevant, as there have been very few changes in the understanding and treatment of periodontal disease. The most important aspect is the cooperation of the patient and their need to take ownership of their health.
Most of my videos are freely available on YouTube. I upload them on Vimeo, and if you need editing assistance, you can visit Denflix.co.uk. There, you will likely find the video, along with the accompanying text and instructions on how to modify them. |
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I sent my patients their BPE on a template, which included an Oral Cancer Nudge and where you could market your advice. If run through the practice software, it gives a record of your periodontal advice and possibly support for periodontal litigation.
These are the notes that started my interest in delivering preventive video advice to my patients |
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Years ago, I consulted with a professor about using hypochlorous acid in my ultrasonic scaler and inquired about the safe concentration. I believed that oxygenating pockets might be a better alternative than just using water. I also considered whether my ozone machine could be used similarly to bleaching trays, but I realized that achieving a proper seal would be a challenge.
When I asked about the safe concentration for hypochlorite, the professor admitted he didn't know. He explained that research on this topic wasn't funded by pharmaceutical companies. While chlorhexidine has its applications, it primarily benefits shareholders rather than the public. Nonetheless, it remains available by prescription, as does Duraphat, despite the existence of better and cheaper alternatives. |
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I created this video based on resources from the American Mobile and Teledentistry Alliance. I'm extremely grateful for their permission to share this content. Please check the teledentistry section to view the original materials, as well as the complete two-day lecture content that we can all benefit from.
Regarding research, I found only one study on the use of Silver Diamine Fluoride (SDF) for gingivitis. It may also help with periodontitis when applied with a super interspace brush. |
