April 04, 2020

Battling gum disease

We are writing in response to the article titled, “Hygienist brushes up on microscopy,” by Ruth-Ellen Cohen (BDN, Nov. 3).

First, we heartily endorse the message reportedly being delivered to the public by Mary Lynne Murray-Ryder; namely, that gum disease appears to be a risk factor for more serious systemic diseases and that oral health is important to overall health and well-being. The link between oral and systemic health is important and is currently being clarified by research.

We have lingering concerns after reading this article. The public may have been led to believe that the microscope, temperature and sulfur probes advocated by Murray-Ryder may be utilized alone or in combination to diagnose gum disease, determine disease activity and alert the patient to the potential for certain autoimmune diseases. We do not believe that existing information supports this view.

Currently, there is no substitute for a thorough medical and dental history, clinical and x-ray examination in determining the presence, nature and severity of gum disease. While the microscope and the devices mentioned may be useful for patient education and motivation, they have not demonstrated superiority in improving patient compliance with oral hygiene recommendations. In addition, these devices have not shown added value over other available techniques as aids in diagnosing disease and determining disease activity. Most bacteria strongly associated with aggressive forms of gum disease, when viewed under the microscope, mimic bacteria found in healthy mouths. In other words, this device may fail to identify active gum disease.

Your readers may have concluded, as well, that dental hygienists and dentists not using the technology advocated by Murray-Ryder are providing services well behind the state-of-the-art, or even worse, are uncaring about the dental health and welfare of their patients. This is most emphatically not the case.

We agree that darting, motile bacteria taken from a person’s mouth and displayed on a television screen present a potent visual image – potentially scary, in fact. Murray-Ryder hopes her audience will say, “Those were bugs moving around my mouth and I don’t want them there.”

While we appreciate her enthusiasm in “vigorously promoting her cause,” we have concerns that public viewing of bacteria on a TV monitor without follow-up counseling, may lead to irreversible gum injury in susceptible individuals. One of us has seen four instances this past year in which conscientious patients have become over zealous and destructive in their oral hygiene practices after learning that gum disease is caused by bacterial infection. We feel this may be due, in part, to increased media emphasis on the causes of gingivitis. While we believe delivery of this message is important, we caution that follow-up by appropriately trained dental professionals is necessary when potentially fear-provoking methods are employed.

In summary, we endorse efforts to increase public awareness that healthy gums are linked to overall health and well-being. We believe there are many appropriate means to deliver this message. New technologies for identification of specific bacteria known to cause gum disease offer great promise in both diagnosis and treatment. Prudent dental professionals, however, often wait to see convincing evidence that new technologies offer added value over those currently in use before committing to purchases that may lead to an increase in the cost of dental services to the public.

Lisa A. Dufour, RDH, MS, is a professor of dental hygiene at the University of New England in Portland. Laura A. Reidy, DMD, has a periodontics practice in Bangor. Andrew L. Allen, DMD, has a periodontics practice in Brunswick.

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