Instant Cures and Magic Bullets
It's human nature to look for a quick and easy solution to any health problem, and treating periodontal disease is no exception. Almost monthly there is another claim of curing gum disease with a new drug, mouthwash, or pill. Unfortunately, these "cures" don't work, and by the time the patient discovers that, much more periodontal destruction has occurred. Patients can't even trust most medical "studies", which seem to show fantastic results. Often the company selling the new product sponsors these studies, and that same company is paying the dentists who are touting the results. Anecdotal results, or short-term studies, are simply not a sound basis upon which to base treatment. Most serious researchers believe there must be at least two "blind" human studies of 6 months or longer to warrant attention, and longer-term studies to dictate therapy. And beware of claims that periodontists don't want to use a product because it would do away with the need for surgery, and thereby reduce their income. Any ethical dentist looks for the best health solution for his or her patients, regardless of profit margin, and if you don't feel that confidence with your dentist, you need to change.
The following treatments often generate claims of cures that are either highly exaggerated or just plain false.
Mouthwashes - The gold standard for mouthwashes is chlorhexidene, commonly sold as the prescription mouthwash Peridex. It is extremely effective in reducing plaque, and we prescribe it frequently after active therapy. It is safe, but will stain teeth over time, which is of concern to most patients. (The stain is removed by tooth polishing unless it stains a leaking filling).Certainly we would rarely discourage its use by a patient. However, no mouthwash is able to penetrate to the bottom of a pocket, and even when an irrigator is used, a pocket will still contain plaque that produces more disease.
Mouthwashes are good adjuncts to therapy, particularly when flossing and brushing are limited, but they do not cure periodontal disease. Other mouthwashes that are useful include PerioMed, a stannous flouride mouthwash, and Listerine, a well-studied rinse that helps reduce plaque.
Vitamins and Supplements - For years, researchers have studied the effects of diet on periodontal disease. While there are numerous studies that indicate one supplement or another reduces or cures gum problems, none have been reproducible by objective researchers. Our current thinking is that those with normal, healthy diets do not improve their periodontal health with supplements.
Antibiotics - While it seems logical that taking antibiotics would be helpful in treating an infection, with periodontal disease the problems tend to return as soon as the antibiotic is no longer taken. Also, good scaling and root planing seem just as effective as antibiotics without the risks of side effects or the formation of resistant strains. In general, antibiotics are used only for specific cases (see Antibiotics).
Low Dose Antibiotics - It has been known for many years that the antibiotic doxycycline not only kills bacteria, but also reduces collagenase, an enzyme that causes breakdown of periodontal tissues. It was found that in low doses, when the antibiotic effect is no longer available, collagenase reduction still occurs. Because of the low dose, it is thought that the problems with side effects and bacterial resistance are greatly reduced, and the drug can be used on a long-term basis. This attempt to increase patient resistance is the first step of what promises to be an important approach to maintaining periodontal health. Unfortunately the research on this specific product (Periostat) is extremely limited, and the results non-conclusive. In the only human study the difference between the control and the product was less than 1 mm change in pocket depth, which is not clinically significant. We use Periostat with certain cases that are resistant to conventional care, but it is not recommended at this time for the typical case.
Local Delivery Products - In the last decade there has been an attempt to place antibiotics (Actisite and Atridox)or antimicrobials (PerioChip) directly into the pocket. With newer techniques it is possible to have the product time-release over several days, which helps kill the bacteria in the pocket. These products seem to help in certain cases, although the most recent research indicates that over a 5 year period, no difference is seen with or without the product use. We currently use these local delivery antimicrobials in the maintenance (recall) phase of treatment, when specific areas don't seem to be doing well. They are not used in the original treatment phase.