Thinking Outside the (Caries) Box

Remember this patient? 

This patient went from having 4-7 mm pockets to the deepest being just a 4, with NO bleeding in 4 weeks! (see full story HERE) It turns out, there is a good number of practitioners who report:

“…big inflammation subsidence and pocket depth decrease while just rinsing (with the CTx4 Treatment Rinse), not irrigating.”

Many who see the soft tissue improvement are curious about why it is happening, as well as seek a specific periodontal protocol to implement with their patients.

Dr. Doug Thompson and his periodontal therapy team are one of the most well-known offices to use the CTx4 Treatment Rinse as an integral part of their periodontal treatment strategy. In a recent interview, he stated:

“Over the past several years my team has learned that controlling biofilm and biofilm diseases is the future of disease management for our patients. Caries and periodontal disease are caused and fueled by bacteria that flourish due to our personalized environmental and genetic susceptibilities. Bacteria load control is going to be a mainstay of winning this battle. Thank you CariFree for providing a disinfectant with claims of biofilm penetration and providing a nonselective kill approach for effective biofilm management. My patients, my practice, and my team are all healthier using CariFree as part of our disease management protocols.”
We sat down with Dr. Thompson and gained valuable insight into his groundbreaking four-part protocol for “total mouth disinfection” where Dr. Thompson and his team work to “stabilize the infection and reduce the risk for further bone breakdown.”

Dr. Thompson is a leader in using the latest developments in dental science to provide whole-body wellness. Dr. Thompson and his team provide their patients with care on the cutting edge of dental science, while building a strong foundation of trust and mutual respect.

In addition to caring for patients, Dr. Thompson conducts seminars to educate dental professionals on the latest advancements in periodontitis (gum disease), risk-assessment treatment planning, dental photography, and, insights from his experience working with physicians to study the incredible impact of oral health on total body wellness.

Committed to providing his patients with knowledgeable, compassionate, access to the latest advancements in dentistry, Dr. Thompson works with his patients to provide each with the individualized personal care for which he is well-known. In addition to building and improving his professional relationships, Dr. Thompson maintains a strong family commitment and is dedicated to his community.

NEW!

We sat down with Dr. Thompson at the 2019 Oregon Dental Convention.

We had the great privilege to sit down and discuss a groundbreaking Personalized Periodontal Medicine approach that is taken at Integrative Oral Medicine with Dr. Doug Thompson DDS and Veronica Wambach, RDH.

Q: Dr. Thompson, why did you decide to start using the CTx4 Treatment Rinse in your Personalized Periodontal Medicine protocol?  What is it doing for you?

A: Dr. Kutsch introduced the product to the dental market for the application of controlling cariogenic bacteria in biofilm. When I think about another disease I have to control in the practice, I think of periodontal disease and that is also a biofilm disease.  Knowing that CariFree [CTx4 Treatment Rinse] was non-selective in its approach in its killing power, because it is sodium hypochlorite, I thought that it should be quite effective.  I started to experiment on my patient base since CariFree is an FDA approved product, I could use it in the mouth safely, and it was pre-mixed and pre-measured.  These features made it easy and safe for me to incorporate in the practice.  We started to use it as an adjunct to scaling and root planing and we found that patients were doing very well.  In summary, they were doing better using the sodium hypochlorite rinse than they were using the old chlorhexidine rinse.

Q: Veronica, can you walk us through your thought process when choosing patients to take through the protocol?

In our practice, we have established what we consider clear criteria for active periodontal disease. Whenever we see 4 or more sites of bleeding the periodontal therapist is concerned about the disease and the inflammation. Identification of bleeding gums is the signal to begin the process of talking to the patient about periodontal disease. Depending on the classification of the disease and the extent of the inflammation the conversation may go into asking the patient what their home care includes or move right into bacteria testing. We always try to find out what negative impact gum disease may have for them. Some people are very concerned about not having it and others seem to have very little concern and need to be educated about what it means and why it is a disability.  We work mostly with those that want to avoid the complications of having the disease.

For many patients, we try to give them a chance to see if they can get positive results by changing their home care first. We can measure the effects of just using a power brush and water pick when we bring them back for an evaluation.  If the situation at the re-probe or re-evaluation does not change then we let the patient know that there is something more that we can do for them in the form of professional disinfection.

We encourage and recommend a saliva or a molecular diagnostic test so we can determine what bacteria is causing the infection. After we get the test results back, the patient comes back for a consultation and then we make recommendations on how to stabilize the disease. Our treatment recommendations usually involve what we refer to as a Total Mouth Disinfection Protocol.  It is within this protocol that the CariFree treatment rinse is introduced. We feel that our protocol, together with all the home care adjuncts that are recommended is what gets the patient to stability.

We have seen awesome results when the patient elects treatment and has gone through total mouth disinfection including scaling and root planning.  After the scaling and root planning, all the sites are irrigated with CariFree and Arestin is placed if needed. The patients go home with 4 boxes of the CariFree Treatment Rinse, which will last 2 months. They are instructed to use it twice a day. We get them back in for a 2-month reevaluation and, if they are stable, we will put them on a maintenance rinse, which is a different bleach-based rinse.  Initially, the taste was an issue for some patients – but by the end of our program we have more patients that are sad that they aren’t going to be using it anymore- they just really felt the positive difference by using the CariFree Treatment Rinse.

During the full mouth disinfection, we feel we need to attack the bacteria on four fronts.

1. In the crevice or the sulcus between the tooth and gum using mechanical disruption.
2. In the crevice or the sulcus between the tooth and gum using chemical disruption with the CariFree irrigant. We use a 23 gauge cannula to irrigate around all the teeth. We also use Arestin in pockets 5mm or greater.
3. On the cheeks, tongue, and roof of the mouth by putting them on CariFree Treatment Rinse [for 2 months] to control the periodontic pathogens there. It helps alter the biofilm on the tops of the teeth and create an environment that is less favorable for periodontal pathogens to thrive.  Their failure to thrive is due to both the pH shift and through a direct kill approach which alters their population. We have them rinse for 2 months with the 4 boxes of CariFree after the scaling and root planning and we find it’s a big help with the bacterial management protocol.
4. Also, based on our salivary diagnostic, or molecular diagnostics testing, we might add an antibiotic as an adjunct to scaling and root planing which increases the effectiveness of our treatment.

We really created a comprehensive protocol and CariFree is a significant part of that for the in-office treatment portion of disease control and for the follow-up home care in the bacterial management going forward.

Once they reach stability we work hard at reinforcing the bacterial management approach and let them know we cannot “fix” their disease and they have to manage it by working hard at home. Another way we help with this is to irrigate with CariFree Treatment Rinse at ongoing Periodontal Maintenance visits.  We do this whether the patient is active or not, they get irrigated with CariFree Treatment Rinse.

To summarize, Integrative Oral Medicine Protocol:

For patients who present with active periodontal disease, a salivary or molecular diagnostic test is recommended to qualify and quantify the bacterial load initiating the infection. Once this is determined and the patient is consulted and hopefully consents to total mouth disinfection, the following protocol is executed to stabilize the infection and reduce the risk for further bone breakdown and negative effects from oral inflammation.

During treatment the bacterial load is attacked on four fronts:

1. Mechanically through scaling and root planing with ultrasonic and hand instrumentation.
2. Locally, with the insertion of Arestin into pockets 5mm or greater and irrigation of all pockets with CariFree Treatment Rinse.
3. Systemically with the antibiotic regimen recommended by the lab as a result of the salivary or molecular diagnostic test.
4. Orally with CariFree Treatment Rinse

For further information about the Personalized Periodontal Medicine approach that is used at Integrative Oral Medicine or to learn about seminars and workshops taught by Dr. Doug Thompson, please email him at drdoug@ioralmed.com or visit impactdentalsolutions.com for past seminar and workshop information.