By Dr. Ken Southward D.D.S.

Abstract: Physician’s commonly utilize tests to determine the specific, causative agents involved in an infectious process and then prescribe treatment accordingly. Dentists have more commonly focused on reducing all bacteria rather than identifying and treating the pathogenic ones. There is a growing awareness in dentistry of the potential of the medical model to identify and treat specific oral pathogens. This approach will have significant benefits for many medical patients.

Oral Bacterial Intervention (OBI) explained
Our Oral Bacterial Intervention (OBI) program is our new approach to dental health. Modern technology now permits the identification of the specific oral bacteria that cause dental decay, periodontal disease and the breath problems that accompany oral infection in some people. We can now identify when to intervene and have the tools to eliminate the pathogenic oral bacteria.
This is not to diminish the importance of traditional dental efforts focused on treating the result of bacterial damage with a goal to reduce both normal and pathogenic bacteria. We regard traditional efforts as secondary prevention because there are already measureable symptoms. Our OBI program to identify and treat the specific bacterial cause is a primary prevention program that can be used prior to symptoms appearing or to arrest the breakdown process if it is already underway.

Medical Implications
There are many areas where medical and dental concerns for the patien/client overlap. Our OBI or primary prevention program can have a significant impact for a number of medical patients. The patient would still continue their relationship with their regular dentist for secondary prevention and restorative care. Here are a few common concerns.
Halitosis – Bad breath is the smell of oral infection. It can occur prior to clinical symptoms of breakdown such as in young children with breath problems. On the other hand, it may be a sign of significant damage which has not yet been treated as in adults with periodontal disease. Halitosis numbs the patient’s ability to taste and smell, so they may not realize they have a breath problem. A doctor’s opinion/referral for a consult/treatment may be most appreciated. Other patients, however, already suspect foul breath and are using high alcohol mouthwashes like Listerine (26.9% alcohol) and sugary breath mints to try to mask halitosis rather than treating its cause. Our prescription level antibiotic rinses are necessary to eliminate the gram negative, anaerobic bacteria most responsible for bad breath.
Recurrent throat infections and tonsillitis – An imbalance of oral bacteria constantly seed the throat with pathogenic bacteria. Prescribing antibiotics for a throat infection is secondary prevention to minimize the risks of more serious consequences. Diagnosing the pathogens and minimizing them prior to an acute tonsillitis is primary prevention.
Peptic Ulcers – Heliobactor pylori, the gram negative, micro-aerophilic bacteria implicated with peptic ulcers, is similar to the gram negative, anaerobic periodontal pathogens. Both stimulate an excessive inflammatory response and create damage either in the GI tract or the mouth. 15.7% of patients with periodontal disease have H. pylori in their mouth and 6.7% of people with bad breath have H.pylori identified in their oral flora. Our metronidazole based rinse is effective in eliminating these gram negative pathogens that serve as a reservoir for future infection.
Diabetes – Many of the complications of diabetes such as retinopathy and neuropathy are due to the effect of chronic inflammation on the body. Periodontal disease is one of these inflammatory complications for diabetics. Controlling the bacterial cause of periodontal disease lowers the inflammatory load on the body and could help minimize other diabetic complications.
Xerostomia – Seniors are especially susceptible to dry mouth due to the effects of many medications. This results in an increase in dental caries, especially on the root of the tooth. Much can be done through our primary prevention program to help these vulnerable, dry mouth patients and to minimize their risk. This could save them significant amounts of money and enhance their quality of life with their natural teeth.
Pregnancy – Like diabetes and periodontal disease, gestational diabetes and pregnancy gingivitis are two conditions of pregnancy that may someday be linked. Unlike many systemic drugs, our antibiotic rinses are mild enough to be used during the second and third trimesters to help control gingivitis and decrease inflammation.
There is published evidence linking periodontal disease to low birth weight babies so primary prevention plays a significant role to minimize this happening. Secondary prevention by the dentist or dental hygienist may reduce oral bacteria for one or two days in a nine month period. Primary prevention with our OBI program is done on a daily basis by the pregnant mother at home.
Early Childhood Caries (ECC) – There is an increase in early childhood dental caries, especially in Niagara. This is due in large part to the discontinuation of community water fluoridation. There is also increased recognition that the oral bacterial flora is mostly passed from mother to child, making dental caries a transmissible infectious disease. Primary prevention with our OBI program identifies and balances the mother’s biofilm so that she does not transmit pathogenic bacteria to her child. When transmission has already occurred, the children at risk can be identified and techniques are available using rinses and varnishes to re-balance the flora and minimize dental caries. We recommend children’s first dental appointment be at age one for primary prevention services rather than waiting till age three for secondary prevention.
Cardiovascular disease – Much attention is focused on the inflammatory component of cardiovascular disease as measured by c-reactive protein levels. Periodontal therapy to decrease oral inflammation has been shown to decrease c-reactive protein levels in the blood. Periodontal and cardiovascular risks are linked through inflammation. Our OBI program identifies and controls the offending pathogens in a cost effective and comfortable manner. For medical patients with normal cholesterol but high c-reactive protein levels, this could be life saving information.

Summary
Primary prevention with our Oral Bacterial Intervention program identifies the bacterial causes of periodontal disease, dental caries and halitosis. Specific, targeted therapies to control bacteria are recommended when necessary and progress is monitored. OBI supports the secondary prevention efforts of a patient’s regular dentist so they are encouraged to maintain this relationship. It also supports the efforts of the physician to enhance their patient’s health and manage risks. Primary prevention empowers each person to do things for themselves before more costly and uncomfortable restorative treatments are necessary.