Diabetes and Periodontal Disease

How is diabetes, or prediabetes, related to periodontal (gum) diseases?

One of the main risk factors for the development of periodontal disease is diabetes.   We now know that individuals with type II diabetes are three times more likely to develop periodontal disease.   Conversely, results from the National Health and Nutrition Examination Survey (NHANES) and its follow-up studies suggest that non-diabetic adults with periodontal disease develop type 2 diabetes more often than those without periodontal disease.

In 2003 the American Diabetes Association stated that periodontal disease is often found in people with diabetes.  However, there are millions of individuals who are unaware that they may be “prediabetic” (they have elevated blood sugar levels), and that this may be a contributing factor in their periodontal disease.   While diabetes and pre-diabetes occur in people of all ages and races, some groups have a higher risk for developing the disease than others.   Diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.  This means they are also at increased risk for developing pre-diabetes.

What we now understand about diabetes and periodontal disease is that an elevation in inflammatory mediators in the gums is the cause for the close association between diabetes and increased incidence of periodontal diseases .  Bacteria thrive in the individual with elevated blood glucose, stimulating pro-inflammatory mediators, which leads to an overproduction of a bone destroying enzyme called collagenase.  It is well established that elevated levels of collagenase lead to the destruction of the periodontal ligament and bone supporting the teeth.

What you can do:

1) Get Tested

We highly recommend an HbA1c blood test for an accurate assessment of average glucose levels over time.  In our experience the simple fasting glucose test is not a good indicator of borderline or current diabetes.

Go to www.diabetes.org for more information

2) Learn More

A great comprehensive paper by water pik on diabetes

The two way connection

“Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.  Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.”  (American Academy of Periodontology)

Go to www.perio.org for more information abou the “mouth-body” connection, there are numerous articles on this topic.

3) Get definitive periodontal treatment

4)  Look into adjunctive medication which can help. How to help control chronic inflammation and destructive levels of collagenase enzymes created by elevated glucose levels and lack of good glycemic control.

Also Important to consider:

Prevention and proactive treatment of periodontal disease is fundamentally important in patients with diabetes because of the potential negative impact of untreated periodontitis on glycemic control and diabetic complications.  But as we have observed, one disease ‘feeds’ the other.  Addressing this two way connection is crucial to achieving periodontal health.  Host factors contributing to both periodontal disease and glycemic control must be defintively addressed if we are to expect success and remission of both diseases.

At PerioPeak Innovations we pinpoint and address all risk factors which may be contributing to your periodontal disease.  We pride ourselves in finding the cause - rather than just treating the effect.  Our mission is to provide comprehensive periodontal care,  empowering all of our clients for long term periodontal and overall health.

Find out how our advanced non-surgical approach for chronic periodontal disease can help to maintain optimal health.

Further important considerations with diabetes, periodontal disease, and cardiovascular disease:

Below is an exerpt from J. Periodontal 7/09 – The American Journal of Cardiology and Journal of Periodontology Editor’s Concensus:  Periodontitis and Artherosclerotic Cardiovascular Disease.

Metabolic Syndrome -

Metabolic syndrome is diagnosed when 3 of the following features are present: (1) increased waist circumference(men ‡40 in [‡102 cm], women ‡35 in [‡88 cm]), (2) increased serum triglyceride level (150 mg/dl [1.7 mmol/L]) and/or drug treatment for elevated triglycerides (most commonly fibrates and nicotinic acid), (3) decreased serum HDL cholesterol level (men <40 mg/dl [1.03mmol/L], women <50 mg/dl [1.3 mmol/L]) and/or drug treatment for decreased serum HDL cholesterol, (4) elevated blood pressure (‡130mmHg systolic and/or ‡85mmHg diastolic) or antihypertensive drug treatment of patients with histories of hypertension, and (5) elevated fasting glucose (blood glucose ‡100 mg/dl) and/or drug treatment for hyperglycemia.

Recommendation:

Patients with periodontitis meeting criteria for metabolic syndrome should be identified, and all risk factors for atherosclerotic CVD should be treated, beginning with lifestyle changes aimed at weight reduction. Metabolic syndrome is closely linked to insulin resistance and is a secondary target of lipid therapy because the risk factors for metabolic syndromeare highly concordant and, in aggregate, enhance the risk for atherosclerotic CVD at any serum level of LDL cholesterol.

Many patients with periodontitis meet criteria for the metabolic syndrome.  Because measures of systemic inflammation are a common feature of periodontitis and metabolic syndrome, it may be particularly important to identify patients who meet these criteria for CVD prevention strategies.  We highly recommend The Bale Doneen approach to early diagnosis, intervention, and prevention.

Find a provider near you www.baledoneenmethod.com

Signs and Symptoms of Gum Diseases

How do I know if I have some form of gum disease?

Gum disease, also known as periodontal disease, is a chronic inflammatory and infectious disease. Often there may not be signs or symptoms until the disease is well into the advanced stages unless you are routinely examined by a dentist.  Below is a list of all possible, more acute symptoms of moderate to advanced periodontal or gum disease.

1)  Halitosis (bad breath)

2)  Loose teeth, bite changes

3)  bleeding gums

4)  painful gums

5)  puffy, red gums

6)  pain when chewing

7)  pussy discharge from the gums

8)  gums pulling away from teeth (gum recession) and noticeably longer teeth.

9)  bad taste

10) noticeable gaps between teeth (“black triangle” appearance)

This picture is a good example of a patient in the advanced stages of periodontal disease.  Note the gum recession and “black triangles” between the teeth, as well as the puffy, bleeding gums. 

Find out how periodontal (gum) disease can be effectively treated with Regenerative Periodontal Endoscopy, or RPE.  

Some less obvious symptoms and signs of periodontal disease in the moderate to advanced stages may be chronic fatigue, swelling of the lymph nodes, or the inability to control blood sugar levels in individuals with diabetes.   Since periodontal disease is a chronic inflammatory disease, it takes a tremendous amount of energy for the body to “control it”.  The immune system is constantly being taxed in an effort to rid the body of infection.   The bacteria involved in periodontal diseases are pathogenic, meaning they are harmful to the body, causing infection.

While periodontal disease is characterized by a chronic infection leading to chronic inflammation in some, it is the actual inflammatory process (an upregulated or exaggerated inflammatory response) which leads to more advanced bone and tissue loss around the teeth.  The body is so efficient at ridding itself of this infection  -for survival purposes – that the infection/inflammation process will often continue if no professional treatment is pursued, until the affected tooth is extruded by the body (the tooth falls out).

New research is proving that the old model of “infection leading to chronic inflammation” may actually be the other way around in many individuals.  Chronic hyper-inflammatory response ( ”hyper-responder”) in many susceptible individuals may actually lead to a chronic infections.

These individuals are prone to inflammatory periodontal disease.  Traditional approaches will not generally stop the infection, especially long term.  Read more about genetic tendencies.

To determine if you have periodontal disease we highly recommend a professional examination, including full mouth x-rays and periodontal charting, by a gum specialist, or periodontist.  These professionals have many years of specialized training beyond dental school and are able to reach a more accurate diagnosis.   If you have been “maintaining” your chronic periodontal disease (infection) in a general dental practice with maintenance cleanings, and you have the moderate to advanced stages of gum disease, it is imperative to seek more specialized professional help.

Lack of proper diagnosis and definitive intervention of periodontal disease can lead to serious, even life threatening, and very expensive health problems as we now know.  But the millions of dollars spent “replacing teeth lost to periodontitis” is often overlooked.

Below is a picture of extractions from a single day in a periodontal specialty practice:

All of the individuals who lost these teeth had routine dental cleanings and maintenance in a general dental practice.  The cause of tooth loss is multi factorial, but nearly all of this is preventable with more advanced technology and intervention.

This blog is filled with detailed information as to what causes tooth loss and the limitations of main stream approaches to arresting or curing periodontal diseases.  We encourage you to explore all of this objective information.

See pictures and read about the limitations of traditional root planing

Read about genetics and periodontal disease

 

Maintaining Optimal Periodontal Health

How to Maintain Optimal Periodontal Health

Regenerative Periodontal Endoscopy - RPE, helps to repair the periodontal foundation and sets the stage for improved periodontal health by eliminating microscopic calculus (tartar) and bacteria deep below the gumline, removing infected tissue, and stimulating attachment repair with natural proteins.  How to maintain this level of health long term is the subject of this post.  We strive to empower periodontal sufferers through education.  There are several aspects to be considered, including excellent home care, regular professional cleanings, addressing bite problems, smoking cessation, considering anti-inflammatory medications when necessary, having good blood sugar control (nutrition), reducing stress, and promoting overall general health and wellness.

Home Care:

Excellent self care (home care) is of course very important if optimal periodontal health is to be maintained.  It has been our experience that once the chronic inflammation and destruction are addressed with RPE, maintaining excellent periodontal health becomes much easier.   We highly recommend the water pik and an Oral-B sonic toothbrush for general self cleansing.  We have found this combination of home care tools to be most beneficial for daily removal of biofilm more effectively.

Recently, an innovative product which claims to dissolve calculus (tarter) below the gumline has captured our attention.   This product, called Periogen by Global Tonic, is an easy to use powder dissolved in water.  Periogen is used with a water pik and/or an irrigator for deeper pockets.  While this may be a tremendous breakthrough, these claims have not been substantiated yet with studies.  However, it has been our experience that regular use of this product ”seems to” change the nature of the calculus, making it easier to remove during maintenance cleanings.   Again, this has not been proven with research and is merely anecdotal information. While Periogen may have benefit in loosening or dissolving some calculus between cleanings it may also be helpful in keeping areas clean and healthy which may be more challanging for any type of periodontal treatment to help repair, ie, advanced furcations (advanced bone loss between roots), which may be considered to have a poor prognosis long term.

It is important to note that using any irrigation product, or home care aid, will not definitively address the very serious nature of the periodontal disease process alone.  Periodontal disease is a multifactoral medical condition and requires a very comprehensive, multifaceted, and definitive professional treatment approach. 

For more information for any of these products check out these links:

www.oralb.com

www.waterpik.com

www.periogen.com

www.globaltonic.com

Host response modulation: 

For many individuals good home care along will not be enough to maintain optimal periodontal health.   Genetic tendancies will often dictate the progression of periodontal disease.  We now know that 1/3 of the population have a genetic tendancy to develop advanced periodontal disease through no fault of their own.  This can be described as an allergy, or “hyper-inflammatory” response to plaque bacteria.  In the literature these individuals are referred to as “hyper-responders”, with an immune system that actually up-regulates itself even in the presence of very little plaque bacteria.  A lot of research is being conducted in this area of periodontal pathogenesis and how to address it.  Periodontal specialists are now discovering the need for more proactive and aggressive treatment of these individuals including the use of “host modulated therapy”.  The most successful form of host modulated therapy is the addition of a medication called PerioStat, also known as SDD (sub-antimicrobial dose doxycycline 20mg), for the purpose of addressing the hyper-inflammatory mechanisms internally.   Few individuals may not be able to tolerate this medication either due to allergy or side effects, this is rare.  Others may not be able to get the prescription necessary to obtain this effective medication.  Unfortunately, few dental professionals are educated in it’s therapeutic use.

Recently at PerioPeak, a natural approach fora type of host modulated therapy has been discovered.  We feel this is a very exciting breakthrough to help chronic and destructive gum inflammation.  To learn more about this natural alternative go to www.periogain.com

Learn more about genetic periodontal disease and host modulated therapy

Nutrition and Supplementation:

One important host factor for healthy gums, which can be controlled by the individual, is diet and nutrition.  We have uncovered numerous research papers supporting this statement.  A diet high in antioxidants and natural anti-inflammatories, and low in refined carbohydrates, is a good start. 

We also highly recommend supplementation with these key vitamins for improved periodontal and overall health:  Vitamins B12,C, D, E, Magnesium, Calcium, Co-enzyme Q10, and Omega three fatty acids.  We recommend a comprehensive physical examination once a year with a physician or naturopath to determine nutritional needs, and to identify any health concerns which could be contributing to periodontal disease.

Stages of Periodontal Disease – Pictures and X-rays

 

Pictures and x-rays of periodontal disease and bone loss -

Stages of Periodontal Disease:

Early periodontal disease may be characterized by swelling and redness of the gums and early horizontal bone loss, but is usually not associated with loss of gum tissues, or gum recession.

gary retracted

Early horizontal bone loss around the teeth can be seen on the x-rays below.  Typical gum pocket depths would be 4-5mm.  Bleeding when measuring (probing) may be present.

x-ray 8.9

x-ray demonstrating early periodontal stage periodontal bone loss

Moderate Periodontal Disease: below

7D 6mm

6mm gum pocket on tooth #7

9D probing

5mm gum pocket tooth #9

The moderate stages of periodontitis are typically characterized by moderate loss of bone (see x-ray below) around the teeth – either vertical or horizontal.  Pockets can measure between 5-7mm, and there may also be associated tissue loss, or gum recession.

x-ray of moderate periodontitis for this patient below:

x-ray #9

note the loss of bone between the two front teeth (#9 and #10)

Advanced Periodontal Disease is characterized by more advanced bone loss around the teeth.  There is 50% bone loss or more.  Pockets typically measure 7-9mm or more, and there may or may not be tissue loss (recession of the gums) and mobility.

8mm gum pocket picture below:

25m 8mm

this is advanced periodontitis with severe inflammation and mobility – this patient is diabetic -note the profound difference in the tissue appearance from one half to the other.  This patient had already undergone Restorative Periodontal Endoscopy on half his mouth one week prior to taking this picture, the pink healthy tissue on one half is evident in this photo.

x-ray for this patient below:

8mm 25M x-ray

x-ray of advanced bone loss

There are many advanced case studies with pictures and x-rays throughout this web site to view.  We offer a procedure called Regenerative Periodontal Endoscopy (RPE) - a non-invasive and definitive affordable first phase treatment approach for all stages of periodontal disease.

All  stages of periodontitis – even the advanced stage - may not always be associated with pain, bleeding, or other obvious symptoms and signs.   See more pics. There may be no symptoms at all.  This is why a thorough examination and x-rays by a periodontist (gum disease specialist) or dentist is highly recommended.

 

The Cost of Periodontal Disease (Gum Disease) Treatments

The Cost of Periodontal Disease Treatments:

This post will help clarify and define the costs involved in available periodontal treatment options, including Regenerative Periodontal Endoscopy (RPE), Perioscopy, Osseous Periodontal Surgery, Extractions, Implants, traditional laser periodontal therapy, LANAP, and root planing combined with Arestin (antibiotics). Fees may vary depending on location and independent provider.

Below is an example of a treatment plan to replace one front tooth with an implant after the extraction of one tooth.   This is a good example of just how important it is to save natural teeth, rather than undergoing extractions.

  • Simple Extraction                             $150
  • Tomographic series                          $262
  • Implant Placement                          $1900
  • Provisional temp. crown                   $250
  • Abutment placement                        $500
  • Porcelain Crown                               $1000

Total Fees for one implant =         $4062  (this fee does not include bone grafting or sinus lift)

These fees are fairly typical of what many individuals face to replace one tooth.

In contrast, the cost to save one to eight teeth in a quadrant with Restorative Periodontal Endoscopy is only $750 – $1200, depending on the severity of bone loss the number of teeth treated.   View an actual case comparing cost of treating one tooth with Regenerative Periodontal Endoscopy (RPE) instead.

How much do full mouth extractions followed by implants cost? Many of our clients were facing full mouth extractions and were given a $30K - 80K treatment plan by their dentist and periodontist.  This option is certainly definitive and comprehensive, but may not be a good option for everyone.  The devastating implications of full mouth extractions can have an enormous negative impact on a person’s life and self esteem.  While the cost alone is staggering, the enormous time involved with the many follow up appointments, as well as the predictable discomfort, make this a very difficult decision if other viable, less invasive options may be available.  Below is one such example.

Before Regenerative Periodontal Endoscopy (RPE):  5-15mm pockets (advanced periodontal disease)

After RPE – health restored – gen 2-4mm, no extractions or implants necessary.  Read this patients testimonial.

What are the fees for Osseous Periodontal Surgery with or without extractions?

We have treated clients from all over the world faced with 4 quadrants (full mouth) of osseous periodontal surgery.  Fees for this procedure vary depending on how many extractions one needs, as well as bone grafts or regenerative materials are used during the surgery.  Osseous surgery fees can range from $900 – $2200 per quadrant (there are 4 quadrants in the mouth), depending on the number of teeth treated.  This may or may not involve extractions.

If teeth need to be extracted there are additional fees for replacing lost teeth, either with implants, a bridge, or partial dentures.   Fees can add up quickly, easily taking the total for one quadrant (section) to over $5000.

The patient below was facing full mouth osseous surgery:

Before RPE – generized 5-9mm pockets

6 weeks after RPE – health restored - pockets reattached (closed) -  no need for osseous surgery

This patient was facing a $12,000 surgical treatment plan.  By having RPE instead her fees were less than a third of that total.

How much is root planing or “deep cleanings” with local delivery antibiotics such as Arestin?

This non-definitive traditional approach leaves much to be desired in results with advanced cases.   Osseous or flap surgery usually follows this non-definitive approach due to the inability of the clinician to see and remove all the disease causing deposits and plaque on the roots in deep pockets.   Learn the objective truth about the limitations of root planing. Fees for traditional root planing can range from $230 per quadrant to $375 per quadrant (there are usually 4 quadrants). Add to this the fees for Arestin (an antibiotic) placed under the gums during this non-definitive treatment.  Arestin is charged out at $35-$110 per site (one tooth may have several sites), if a patient has multiple deep pockets in one quadrant the fees can add up quickly.  The research is unremarkable, demonstrating a reduction in pocket depths of less than 1mm.   Due to the ineffectiveness of this approach it may be repeated every few months, annually, or every three years.

What is the cost of multiple rounds of traditional laser periodontal therapy?

Typical fees for traditional non-definitive laser periodontal therapy range from $250 – $400 per session (there are usually 6-8 sessions in all). There is very little research demonstrating clinical benefit for this more traditional treatment approach – tartar typically remains in deep periodontal pockets as the literature demonstrates.  Laser periodontal therapy is performed blindly under the gums in an attempt to arrest the disease by “killing bacteria”.  Since tartar in deep pockets and decay may go undetected for months or years,  any benefit of killing bacteria with the laser may be short term.    

What are the fees for LANAP?

After reviewing fees for many offices providing lanap around the country we have determined fees to have a wide range, depending on the severity and the individual clinician offering lanap.  Fees for full mouth lanap treatment range between $4000 to $15,000. The consultation for treatment may cost up to $450.  Lanap is not intended for the treatment of single teeth according to the trained clinicians providing it, therefore only full mouth treatment is performed.

What are the fees for Perioscopy?

Fees for Perioscopy have generally not changed much over the past decade.  Fees can vary somewhat if the office providing perioscopy charges by “time” rather than by quadrant.   In our experience a quadrant fee can be anywhere from $350 to $900.   If antibiotics are used adjunctively, such as Arestin or Atridox, additional fees would apply, as well as examination fees; and for many offices traditional root planing fees are charged prior to the actual perioscopy treatment.

What are the fees for Regenerative Periodontal Endoscopy – RPE?

Regenerative Periodontal Endoscopy – RPE can prevent steep costs by eliminating or reducing the need for extractions, traditional flap surgery, osseous surgery,  repetitive treatment with perioscopy, traditional root planing, or laser periodontal surgery.

Fees for RPE can range from $750 per quadrant to $1200 per quadrant (there are 4 quadrants if all teeth are present).  Full mouth RPE treatment can range from $3000 to $4800, depending on the severity of disease and the number of teeth treated.  There are no fees for the examination or digital records.  RPE is performed in one appointment and local anesthetic is used for comfort.  One tooth can be treated with this modality (rather than requiring full mouth treatment as with LANAP), fees for one tooth can be $750-$900, depending on the severity.  No traditional root planing is recommended before RPE.

Watch a short video to see how this pioneering treatment works.

We offer complimentary periodontal consultations .  Contact us for more information.

Alzheimer’s and Periodontal Disease

Gum Disease Now Linked to Dementia: 

In addition to the overwhelming evidence to support the theory that periodontal disease contibutes to cancer, heart disease, stroke, diabetes, and pre-mature births, there are now studies to support a link between periodontal disease and dementia. All countries are experiencing an increase in the number of people over the age of 65 with Alzheimers.  Alzheimer’s disease is the leading cause of dementia in the US population.

A study of dementia led by University of South California researchers revealed that missing teeth and chronic inflammation of the mouth at an early age quadruples the risk of developing Alzheimer’s disease. The study, which was presented at the first Alzheimer’s Association International Conference on Prevention of Dementia, looked at the records of over a hundred pairs of identical twins.  Each pair consisted of one twin who had developed dementia, and one who had not. Acting on the principle that identical twins share the same genetic blueprint, the study looked into external factors that could have led to the mental demise of the demented twin.

Dementia is an umbrella term that includes Alzheimer’s disease, and once correctly diagnosed in the twins examined, researchers looked into several potentially modifiable risk factors that could have brought it on.  Among these were: periodontal disease before age 35, the experience of a stroke before the onset of dementia, physical exercise between ages 25-50 and years of education.

Titled Potentially Modifiable Risk Factors From Dementia: Evidence from Identical Twins, the study found that a stroke could increase the risk of dementia six-fold in later years, while periodontal disease in early years quadruples that risk.

Lead author Margaret Gatz said the link between periodontal disease and Alzheimer’s does not mean that extra flossing will defend against dementia, adding that catchphrases like “Brush your teeth: Prevent Alzheimer’s disease,” are excessively naive.  Periodontal disease should instead be seen as an indication of exposure to inflammation, which in turn can proceed to harm brain tissue and cause dementia, Gatz said.

Learn more about our advanced gum disease treatment to end chronic periodontal inflammation

For more information about Alzheimer’s:

http://www.hsibaltimore.com/ealerts/ea200709/ea20070918a.html

http://www.eurekalert.org/pub_releases/2005-06/uosc-adl061605.php

https://www.nyu.edu/dental/news/index.html?news=127

Other health risks associated with periodontal disease

Definitive treatment for periodontal disease involves a multi-faceted approach to control chronic inflammation.  Putting periodontal disease into remission and ending the chronic inflammation associated with it is not achieved by merely removing tartar, the repetative use of antibiotics (either locally or systemically), or cutting out pockets with a laser or traditional periodontal surgery.  Chronic hyper-inflammation is a host response problem and may require the addition of safe and effective anti-inflammatory medications.

Regenerative Periodontal Endoscopy: Before and after pictures and x-rays

How Regenerative Periodontal Endoscopy Works:

Regenerative Periodontal Endoscopy, or RPE, is an advanced non surgical endoscope procedure pioneered and offered by PerioPeak Innovations.  The skilled use of a periodontal endoscope, micro-ultrasonic piezo technology, and regenerative proteins can eliminate the need for aggressive surgery.   When used properly, endoscope technology allows for pinpoint precision and the complete removal of gum infection and tartar in deep pockets without surgery.   Emdogain, a natural regenerative protein,  is then placed in all deep gum pockets to stimulate the body’s own regenerative stem cells, reduce inflammation, inhibit growth of bacteria, aid in the reattachment of the gums, and promote bone fill.  Enzyme inhibitors are used to promote more rapid healing and stability of the gums.

To understand more about the research and science behind this advanced protocol click here.

Watch this procedure on You Tube.

More cases:   Perioscopy Case Studies, Before and After pictures,    Advanced Cases.

____________________________________________________________________________________________

RPE is completed in one appointment with local anesthetic, there is no need for repetitive visits as with other periodontal treatment modalitites.  There is no pain and no down time following RPE, making it very convenient for our many clients traveling in from out of state.  Our clients do not need to alter their diet and they do not experience root sensitivity following RPE.  Remarkable clinical results are achieved without surgery, including closure of deep gum pockets and bone fill.   RPE is a definitive and affordable treatment option which can reduce or eliminate the need for periodontal surgery and extractions.  View our long list of testimonials and request references.

Before and after pictures and x-rays of actual RPE:

before RPE  10-12mm pockets  #2, #3           6 mo’s after RPE – bone fill, no pockets

before RPE  - 8mm  bony defect           10 months after RPE – bone regenerated

very advanced bone loss 12mm      10 months after RPE- nice  bone fill



Above – Before RPE - 12mm pocket -  advanced bone loss – this patient was advised by his periodontist he needed to have this tooth extracted and an implant placed.  He chose RPE as a less invasive, more affordable option- see result below.


3  months after RPE – normal healthy tissue 3mm- bone fill well underway, no mobility, and no need for an extraction and implant.  This tooth was treated in 2006 and is still healthy.  This patient saved thousands of dollars in treatment costs by avoiding an extraction, bone graft,  impant, and crown.

Before RPE – 10mm pocket (x-ray below)             after RPE – 1-2mm (x-ray below)

(This patient is a heavy smoker)

Before RPE - very advanced bone loss        6 mo’s after RPE – remarkable bone fill

Before RPE-  10mm pocket (x-ray above)                        After RPE – 1mm (x-ray above)

___________________________________________________________________________________________

Before RPE  - advanced bone loss                    4 months after – complete bone fill

___________________________________________________________________________________________

Before RPE 13mm (advanced furcation)       6 months after RPE – 2mm – healthy

Before RPE – 13mm advanced furcation          6 months after RPE – 2mm

Before RPE – 11mm  (advanced mobility)       6 months after RPE – 2mm -solid

see before and after x-rays below

Before RPE  - 19 considered “hopeless”                Bone fill 6 months after RPE (pics above)

Before RPE advanced bone loss          6 months after RPE – nice bone fill – see the photos for this tooth below

Before RPE – 10mm                                                 6 months after RPE – 2mm

before RPE and root canal therapy (8-11mm)       6 months after (1-3mm) – health restored

pics are for x-rays above – before – 10mm                          6 months after RPE – 2mm

Before RPE – advanced bone loss #4                      6 months after RPE – nice bone fill

Before RPE – 9mm furcation                                  6 months after RPE – 2mm – healthy

Before RPE – 7mm                                                       6 months after RPE – 2mm -healthy


Before – 10mm pockets tooth#10         15 mo’s after RPE – 3mm- no mobility

The patient above was told she needed to have this tooth extracted and an implant and crown placed.  She was also treatment planned for full mouth osseous periodontal surgery for multiple infections and deep pockets.   Instead, she chose the option of RPE.  She was able to avoid spending $12,000 for the full mouth surgery and the added expense of having an implant placed.  Her total cost for full mouth RPE treatment was only $3000.


Before 10mm                                                                         after 3mm

The above result has been maintained since 2006.


Before -  7mm pocket                            3 months after RPE- bone filled in

The patient above was facing the loss of her entire bridge due to advanced periodontal bone loss, 3 months after RPE she no longer had to worry.  Health restored to the gums with nice bone fill on the x-ray.

(above) before – 10mm pockets                                (above) 3 months after RPE – 3-4mm

the patient above was able to avoid extraction of the molar tooth, thus saving the bridge.  She was able to avoid having an implant placed, followed by a new bridge for this area.

before RPE – extraction of 18 imminent          1 year after RPE – her dentist sent us this x-ray with nice bone fill

Nelly LL before best x-ray Nelly LL after best x-ray

Before RPE – 10mm (19 & 20)                               1 yr after RPE – bone filled in -health restored

The case study below demonstrates well the speed at which healing occurs with RPE.

(above) Before – 8mm                                     2 weeks after RPE – 3mm – x-rays below

Before x-ray #28 mesial                                             8 weeks after RPE – rapid bone fill is evident

Before – painful abscess 7mm                                  2 weeks after – 1mm – health restored


Before – 7mm pockets – tongue stud damage      Bone fill 6 weeks later

tongue stud damage                                                  6 months after RPE – health restored

Before RPE – 10mm                                                   6 months after RPE – 1mm

Before RPE – 11mm with heavy bleeding and a periodontal abscess clearly seen – 6 months after RPE 2mm very tight healthy tissue – see bone fill on x-rays below.

Before RPE – class II mobility                     6 months after RPE – nice bone fill

Before 11mm pockets                                          bone fill at 6 months

Before – 10mm pocket 19 mesial                                        6 months after, nice bone fill, 4mm.

23D before 10mm 23 after 3months

Before RPE - 10mm                             3 months after – 3mm (see x-rays below)

23 before 23 after 6 wks

Before RPE                                       6 weeks after - good bone fill occuring

23 before lingual 23 after lingual

before RPE – 10mm                                               3 months after RPE – 2mm

30D before 30D after

Before RPE – 10mm                                                                3 mo’s after RPE – 3mm

30 DL before 30DL after

Before RPE – 12mm                                                    3 mo’s after RPE – 4mm (see x-rays below)

da30big 30 3 mo after x-ray

Before RPE (is tooth fractured?)                   3 mo’s after, slight bone fill – no fracture detected

Before RPE - 10mm                                      6 months after – nice bone fill occuring – 3mm


Before RPE – 10mm             7 months after RPE – no mobility – 3mm

The above tooth was treatment planned for extraction by the periodontist.  #31 presented with a 10mm distal defect, a 10mm furcation on the buccal, and mobility.  Only 7 months after RPE, all periodontal probings are normal, there is no mobility, and the tissue is tight and healthy.

The RPE protocol is very specifically designed to arrest the chronic inflammation associated with periodontal disease, allowing long term healing and restoration of the gums to occur.  RPE goes beyond the short term results seen with traditional non surgical treatment strategies – including the overuse of oral or locally applied antibiotics, and/or traditional laser periodontal therapy. View more case pictures.

One third of the population has a genetic tendency to develop periodontal disease, one half of those individuals will develop advanced periodontal disease, resulting in tooth loss.  RPE can effectively interrupt and reverse this grim outcome for millions of individuals.

While no formal research yet exists on this innovative approach, there is impressive research on each technology studied independently, demonstrating efficacy in the treatment of periodontal disease.  Pairing these technologies properly promotes “synergy” – the phenomenon in which the combined action of two or more things is greater than the sum of their effects individually.  Because periodontal disease is multi-factoral, it can typically be more effectively treated using a synergistic approach.

Contact us for a complimentary consultation

For more information about sub-antimicrobial dose doxycyline 20mg go to host modulated therapy.

For more information about  regenerative proteins (Emdogain) go to http://periopeak.com/blog/category/bone-regeneration/

Advanced Periodontal Disease Pictures – Successful Treatment Without Surgery – Implant Alternative

Pictures of Advanced Gum Disease Treatment  – pictures taken by PerioPeak Innovations

 
Above:  Before non surgical Regenerative Periodontal Endoscopy (RPE) -bleeding and infected 15mm pocket tooth #6.  This patient was advised by three different periodontists that due to the advanced nature of his periodontal disease he needed all of his teeth extracted. 

 
Above:  3 months after RPE – 4mm – very healthy tissue – no bleeding.  This patient has remained stable and healthy for many years.   See more pics below, or  Learn more about this unique protocol.

 

 
Above:  Before RPE - 9mm infected advanced periodontal pocket- tooth #8 is very loose

 
Above:  After RPE – 2mm, healthy, no bleeding, no mobility.

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Before RPE – severe inflammation – 7mm pocket tooth #26.  This patient was also told she needed full mouth extractions due to the advanced periodontal disease on all the teeth. (she had generalized 5-12mm pockets).

 
After Regenerative Periodontal Endoscopy -RPE:   minimal inflammation – pink, healthy tissue - 3mm measurements – health restored to all her gum tissues.  No longer a need for full mouth extractions.

 
Before – 10mm – this patient was treament planned for extractions by her periodontist.

 
3 weeks after RPE – 3mm tight, healthy tissue – no need for extractions.

 
Before – 7mm – severe inflammation

 
3 weeks after RPE – 2mm – very healthy tissue

 
Before – 11mm pockets #24 and #25

 
After RPE – 2mm – healthy

Read how Regenerative Periondontal Endoscopy works

or watch our You Tube Video 

Comparison Pictures of Periodontal Surgery vs. RPE Below:   

 

Left: This patient underwent periodontal surgery (osseous surgery) for her advanced periodontal disease (she had 5-9mm pockets generalized) – this picture is 6 months after undergoing periodontal surgery.

Above: This patient had 5-9mm pockets generalized but instead of having the periodontal surgery recommended by her periodontist, she had non-surgical RPE.  This picture is 6 months after RPE.  No tissue and bone is removed as in the periodontal surgery picture.  A superior cosmetic outcome is the result – with no gaps between the teeth and no recession of the gums.

RPE is a conservative treatment approach which does not cause the disfigurement often associated with aggressive periodontal surgery.  The two cases presented above had identical pocket depths.  One patient underwent traditional osseous periodontal surgery, the other chose RPE.  The difference in results is obvious.  Unfortunately for many patients who have undergone periodontal surgery, the gum and bone is removed (cut out) to reduce periodontal pockets –  in doing so the roots are exposed causing disfigurement of the gums (black triangles and recession).  

 Periodontal surgery picture below (warning – this photo may be disturbing):

 Below:  Regenerative Periodontal Endoscopy Procedure – RPE.

The miniature fiber optic used in this picture enables our highly skilled clinicians to clean all root surfaces without the need for flap/osseous periodontal surgery.  There is no need for bone and tissue removal as in osseous periodontal surgery.  Instead, all infected gum tissue in deep pockets is gently removed with micro-ultrasonics,  regenerative proteins are then placed on the roots to stimulate adult stem cells – promoting closure of periodontal pockets.  Healing is accelerated due to the conservative nature of the procedure and the addition of host modulated therapy.  Since there is no trauma to the tissue, the disfigurement and recession often associated with traditional periodontal surgery does not occur with RPE.

Pancreatic Cancer and Periodontal Disease

Pancreatic Cancer linked to Gum Disease?

Scientists have recently discovered what appears to be a definitive link between pancreatic cancer and periodontal (gum) disease. Pancreatic cancer is the fourth leading cause of cancer deaths in the U.S. because it is so difficult to treat. More than 300,000 Americans are expected to die from it this year.

The study found that men with periodontal disease have a 63% greater risk of developing deadly pancreatic cancer. The research studied 51,000 professional non-smoking males from 1986 to 2002. It may be that the chronic inflammation from periodontal disease is setting off an inflammatory response which is detrimental to overall health, or that the bacteria associated with periodontal diseases are the culprit. More research is needed to determine the actual action periodontal disease has in creating a higher risk of cancer.

At PerioPeak Innovations we are committed to addressing chronic periodontal disease and the inflammation associated with it proactively and definitively.  By using a synergistic approach, involving advanced miniature fiberoptic technology and host modulated therapy, the periodontal inflammation can very effectively be put into a remissive state for the long term…lowering the overall health risks associated with all stages of periodontitis, or gum disease.

Below are recent articles about the link between periodontal disease and pancreatic cancer:

http://abcnews.go.com/GMA/OnCall/story?id=2813658&CMP=OTC-RSSFeeds0312

http://www.medicalnewstoday.com/medicalnews.php?newsid=60977&nfid=rssfeeds

http://www.healthcentral.com/newsdetail/408/601047.html

How does Perioscopy Work?

How does Perioscopy, or periodontal endoscopy, technology work?

Periodontal endoscope technology, or Perioscopy, is an important part of the PerioPeak protocol, RPE – Regenerative Periodontal Endoscopy.  It is a crucial component to achieving excellent overall results for many reasons.  Periodontal endoscopy is a non-invasive way to view and clean root surfaces microscopically in all depths of pockets, without performing surgery, using micro-ultrasonic technology simultaneously.

Important: We prefer the term “periodontal endoscopy” rather than the commercial trademark term “perioscopy”, which over the years has become a term associated with “removing calculus only”.  We view this narrowly focused use of the periodontal endsocope as antiquated use of the technology.

The dental endoscope, or periodontal endoscope, is a fiber optic is less than 1mm in diameter, it incorporates powerful illumination with 48X magnification.  It is essentially employing the use of a miniature microscope under the gums. The image is viewed live on a high resolution flat panel color monitor. It takes a great deal of  experience to perform periodontal endoscopy procedures (diagnosis and periodontal treatment) with proficiency.  PerioPeak Innovations has provided this treatment successfully for over a decade on hundreds of clients with advanced periodontal disease.

Below are four still endoscopic pictures viewing the area between the root and gums (deep gum pocket) during a periodontal endsocopy procedure.  Click on images to enlarge

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SCI 3:  Subgingival Calculus Index 3 is calculus that extends beyond the plane of the root, it can be felt and possibly seen in x-rays (radiographic calculus).

click on image to enlarge

SCI 2:  Subgingival Calculus Index 2 is calculus which cannot be felt with instruments (explorers) beneath the gum line…also known as burnished calculus (tartar).  This tartar left behind following traditional root planing because it is very smooth and can fill in the tooth depressions, furcations, and flutings in the roots.

Burnished tartar is typically left on the roots following traditional root planing. Burnished calculus cannot be seen or felt with traditional techniques beyond a depth of 4mm.   30-50% of the root may have residual calculus; infection and inflammation may persist.

click on image to enlarge

SCI 1:  Subgingival Calculus Index 1 is microscopic calculus which cannot be seen or felt, even with direct vision, as in surgery.  Commonly referred to as “glitter”, SCI 1 is found in all depths of pockets and even on exposed recessed root surfaces – inflammation may persist.

The presence of microscopic calculus can be identified and removed by experienced individuals using a periodontal endoscope. Surgical microscopes and loupes (magnified glasses) do not reveal this truth because they do not incorporate 48X magnification with tremendous illumination.  In addition, a surgical microscope cannot be placed beneath the gums.

Note: Only a scanning electron microscope on extracted teeth will reveal this detail.

click on image to enlarge

SCIO:  Sub-gingival Calculus Index Zero is what we refer to as “microscopically clean”.

The limitations of current traditional techniques, such as root planing, was unknown until the innovation of the periodontal endoscope. Using lasers beneath the gum blindly, root planing tactilely in deep pockets, or performing periodontal surgery without an endoscope, may allow toxic calculus to remain embedded in the roots, hence, periodontal inflammation and infection may continue.