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Progress Notes

Dr. Jeffrey Rossmann

Media Resources/Steven Doll

Statistics trigger discussion surrounding periodontal disease, comprehensive mouth exams

In these Q-and-A sessions, we take a closer look at pressing topics within the dental profession and what they mean to Texas A&M Health Science Center Baylor College of Dentistry.
From TAMHSC-BCD initiatives to hot-button questions, we consult the college’s own subject matter experts to get their input.

This issue includes the perspectives of Dr. Jeffrey Rossmann, chair of the Department of Periodontics, on some eye-opening findings from the Centers for Disease Control and Prevention published in late August.

The findings, based on data from the 2009-2010 National Health and Nutritional Examination Survey, revealed that more than 47 percent of adult Americans age 30 and older have periodontal disease.

Why the staggering numbers?

The answer may surprise you.

For the first time, survey data was collected based on comprehensive periodontal exams, in which every tooth was visually examined below the gum line, save for third molars. In comparison, in years past, just partial mouth periodontal evaluations were performed. Since periodontal disease is not distributed evenly in the mouth, its presence may have been missed, causing epidemiologists to underestimate the prevalence of the disease in the United States by as much as 50 percent.

It’s a subject that takes on relevance for general dentists and the public alike.

"Very few general dentists right now are doing a comprehensive periodontal evaluation, and that’s what we’re hoping to change,” Rossmann says of the American Academy of Periodontology’s efforts in the wake of the findings.

“Our biggest issue has been identifying the patient early so that we can treat the damage and help prevent future damage, but you’ve got to probe the mouth to make the correct diagnosis. This has been an issue for us for a long time.”

BDRO: When you consider your roles here at TAMHSC-BCD, with the American Board of Periodontology and at your private practice, what is your take on these newly reported statistics on periodontal disease? Do you think the number of American adults with periodontal disease — currently numbered at nearly 65 million — appears to be rising or falling?

Rossmann: According to the academy, the rate hasn’t changed. It is just the first time we have accurately identified it. I relate it to diabetes. For years diabetes was defined a certain way. When that definition was expanded to include people who were considered prediabetic, it raised the question, ‘Do all these people now have diabetes or did they always have it?’

We didn’t change the parameters. We just did a more comprehensive evaluation.

BDRO: The statistics just get more staggering with age. According to the study, 70 percent of adults ages 65 and older have this chronic inflammatory disease that can be so detrimental to the gum tissue and bone supporting the teeth. As more of the population is living longer, what emerging non-surgical options and products are available to the millions of Americans who want to be proactive in mitigating the effects of the disease in its early stages?

Rossmann: Products are now coming out that are looking more at anti-inflammatory components and not just antibacterial ones. There are a slew of products trying to make the market that deal much more with antioxidants and anti-inflammatory medications.

We can’t stop the inflammatory response. That’s part of the human body’s response to trauma, including bacterial assault. What we’re trying to do is minimize the destructive side, and that’s still in research mode.

Everyone wants a quick fix to a disease, but some of these are pretty tenacious diseases. Periodontitis stems from what lies on the root surface and requires a thorough cleaning at the site of the disease. There’s no real substitute for doing that.

What we need is something that works at the interface between the tooth and the gum tissues, and that’s below the surface or inside the pocket of the gum, but no one product has hit the market that is the cure for what we’re looking for.

BDRO: On the research front within the field of periodontics, what are some projects geared toward early intervention?

Rossmann: One of the things that we’re doing here at Baylor College of Dentistry, which right now is still at the basic science level, is looking at antioxidant products. Dr. Kathy Svoboda — Regents Professor and graduate program director in biomedical sciences — has been the spearhead of this. She has been working with one of the companies that has a commercially marketed product to determine whether it has efficacy.

Another thing that is of interest to me is the two scientists in biomedical sciences who are trained in translational research. One of their many talents is to put together a local delivery of a substance that can be delivered in a microsphere or a scaffold to the location of infection. Now you’re not putting it on the surface, you’re putting it in the diseased pocket, in a delivery system that allows you to place it where the disease is instead of trying to systemically bring it to where the disease is through a pill, mouthrinse or gel. That’s something that’s been looked at in several universities.