ANN ARBOR—The good news: more people than ever are
keeping their natural teeth into old age. The not-so-good
news: the longer people keep their teeth, the more likely
they are to develop periodontal (gum) problems.

But armed with the knowledge that most cases of
periodontal disease are actually treatable bacterial
infections, dental researchers and clinicians are changing
their ideas about how to deal with the problem, writes
Prof. Walter L. Loesche of the University of Michigan
School of Dentistry in the current issue of Critical
Reviews of Oral Biology and Medicine (Volume 10, issue 3).

The usual treatments for periodontal disease involve
removing plaque and tartar deposits below the gum line and
sometimes planing the tooth roots. Surgery also may be
necessary when deep pockets have developed between the
teeth and gums. But with new, antimicrobial approaches,
many teeth that previously would have been considered
“hopeless” can be saved from extraction, and as many as 75
percent to 80 percent of patients may be spared the
discomfort of periodontal surgery, says Loesche, who also
spoke on this topic at a dental symposium in Joinville,
Brazil, this month.

In his review article, Loesche notes that about 90
percent of periodontal disease cases are caused by the
overgrowth of anaerobic bacteria on the teeth. These
bacteria produce toxins that can damage the gums. For some
patients, the best approach may be to combine the
traditional scraping and planing with short-term use of
systemic antibiotics such as metronidazole or doxycycline,
which are effective against anaerobic bacteria.

Because these systemic drugs, taken orally in the form
of pills and tablets, travel throughout the body, they
should be used for no more than one or two weeks at a time,
to reduce the chance of side effects or the development of
antibiotic resistance. When only a few teeth are involved,
systemic antibiotics are not needed; clinicians can apply
antibiotic gels, chips or films directly to the pockets
between the teeth and gums.

As helpful as they may be, antibiotics are not a
“magic bullet” to be used on everyone with gum disease,
Loesche warns. They should be used only when a bacterial
infection has been diagnosed and the condition is serious
enough to need treatment.

Finding ways to deal directly with the bacteria that
cause periodontal disease has become increasingly important
as researchers have discovered links between periodontal
disease and cardiovascular diseases, says Loesche. Keeping
periodontal bacteria in check may be a simple way of
reducing one’s risk for heart disease and stroke.

The U-M School of Dentistry is one of the nation’s
leading dental schools engaged in oral health care
education, research, and patient care. General dental care
clinics and specialty clinics providing advanced treatment
enable the School to offer dental services and programs to
patients throughout southeast Michigan and the state.
Classroom and clinic instruction trains future dentists,
dental specialists, and dental hygienists for practice in
private offices, hospitals, academia, and public agencies.
Research seeks to discover and apply new knowledge that can
help patients worldwide.

More information is available on the Web at http://www.dent.umich.edu.