Optimizing Periodontal Treatment for Patients with Systemic Diseases: Individualized Treatment Processes and Instructions

2023-06-26 03:57:34

Photo: © Birgit Thiele-Scheipers

To support and accompany periodontal diseases, possibly in connection with general diseases such as diabetes mellitus, high blood pressure, rheumatological diseases, cardiovascular diseases as well as nicotine abuse or burning mucous membranes, our patients need individual treatment processes and instructions following a precise, up-to-date anamnesis, diagnostics and therapy.

As specialists, we can choose from a wide range of options for supporting and accompanying products that, if possible, do not cause any additional side effects and negative side effects for the patient, such as burning of the mucous membranes, discoloration of the tongue and teeth or impairment of the intestinal flora caused by antibiotics. Dental sprays (e.g. ParoMitQ10 Spray, Zantomed) help us with this through mild, highly effective application and compatibility through the support of the body’s own mitochondria.

Daily medical history

When we look at the daily medical history of our patients, we often find that they suffer from multiple systemic diseases and ignore common warning signs of inflammation. A list of the medications shows that we have to carry out an accurate diagnosis of the oral cavity, taking into account the side effects of the medication, in order to be able to diagnose side effects such as dry mouth, reddened or swollen gingiva or burning mucous membranes. The patient-specific diagnosis is the basis for planning the therapy and all necessary subsequent treatment steps. The daily medical history should include: always provide information regarding new illnesses, self-detected changes in the oral cavity such as burning tongue, reddened gingiva, etc., medications, general diseases and oral hygiene items already used, so that we can pick up the patient with therapy options and instructions where his individual needs are.

periodontitis

Periodontitis is an inflammatory disease that has a negative impact on our general health that should not be underestimated. If general diseases such as coronary heart disease, rheumatological diseases or systemic diseases are already present, both general health and the effect of the medication on the general disease can be negatively influenced. If the patient smokes, his risk of developing periodontitis increases sixfold. Patients often ignore accompanying symptoms and are often amazed by our findings at the extent to which they have already assumed. Education regarding the connection between oral and general health should always have a high priority for us as specialists in our everyday work with patients.

Diabetes

Systemic diseases such as diabetes are often underestimated in their impact on oral and general disease. With a good adjustment of the HbA1c value, both the quality of life and the interaction between general and oral health are significantly less endangered. Once the periodontitis has been recognized and treated systematically, the medication can be easily adjusted for a diabetic. A poor HbA1c value improves and the inflammation of the periodontal tissue has a better healing process. Recurrences can be avoided with a stable value of approx. 6 to 6.5. It is important that the patient has his value adjusted by the family doctor or diabetologist in order to achieve and maintain the greatest possible success in active periodontal therapy and also in supportive periodontal therapy. The number of unreported diabetics is very high. In the case of inflammation that cannot be treated or can only be treated poorly, a blood sugar test should be carried out in the practice if diabetes is suspected. If the possibility of testing is not available in the practice, the patient is asked to have this checked by the family doctor. A side effect of taking medication in diabetic patients is often dry mouth. The effects are caries risk, halitosis, inflammation in the mucous membrane area, dry mouth, redness and burning of the mucous membranes.

high blood pressure

Gingival hyperplasia is a common side effect in hypertensive patients. Oral hygiene at home can often only be carried out insufficiently, since the patient is often overwhelmed with the situation in the mouth. In addition, dry mouth, burning and reddening of the mucous membranes are often found as side effects of the medication. These symptoms greatly affect the patient’s quality of life.

Galerie

Fig. 1: Initial situation of the patient at the initial diagnosis. © Birgit Thiele-Scheipers Fig. 2: Situation at the appointment for anti-infective therapy (AIT). © Birgit Thiele-Scheipers Fig. 3: Application of the dental spray (ParoMit Q10, Zantomed) during AIT. © Birgit Thiele-Scheipers Fig. 4: Patient situation three months following therapy with consolidated soft tissue. © Birgit Thiele-Scheipers

patient case

The 70-year-old patient (smoker) had not been to a dental practice for several years. The anamnesis revealed that the patient suffers from high blood pressure, is diabetic (HbA1c value 7.5) and has high cholesterol levels. He has also been suffering from changes in the gingiva for some time. Stress and malnutrition were added to the aggravating diagnosis of smoking. The patient’s findings using the screening program (ParoStatus.de) made it clear that he was suffering from acute periodontitis. The parameters collected, such as the bleeding, plaque and probing index, showed this in the evaluation. Oral hygiene revealed deficits in the choice of home oral hygiene aids. As a first step before the systematic periodontal treatment, a PZR appointment was arranged for the patient. After cleaning and polishing, a dental spray (ParoMit Q10) was used in this session and given to the patient to take home for further treatment.

Use of dental spray

In the case of periodontitis, the immune system must be strengthened. Our immune system needs energy to deal with inflammation and accelerate its healing process. Simply cleaning and removing plaque, tartar and concrements may not bring regarding the desired healing process quickly enough. We need an additional approach that locally supports the supply of micronutrients to the host’s own cells and can thus strengthen the body’s own defences. Kaneko Q10 is an endogenous enzyme that ensures and supports the circulation and supply of important micronutrients in the cell. A dental spray (ParoMitQ10) offers the possibility of directly supporting this process locally in order to optimize the body’s own resistance. The patient distributes approx. five to eight spray strokes in the upper and lower jaw and then swallows the liquid so that it can continue to have an effect in the body. Diabetes medication and cholesterol-lowering drugs significantly reduce the body’s own production of Q10, which is already reduced from middle age, so that we have to pay attention to optimization in this patient group in particular. Q10 was previously also produced by the body, but only up to around the age of 40 to 45. The recommendation here is to take around 150 mg of Q10 prophylactically from the age of 40, so that there is always systemic support for cell renewal and an increase in vitality. Liquid Q10 doses without alcohol are preferable to powders or capsules, as they reach the cells much more efficiently.

The patient was individually instructed in his means of the systematically carried out periodontal treatment in oral hygiene and additionally asked to continue using ParoMitQ10. The patient’s adherence improved from appointment to appointment, as he was able to observe very well how the condition in the mouth was changing positively and how the medication intake was also improving. The HbA1c value might be adjusted well with the improvement in the inflammation values ​​and is now 6.4. Since the patient has been a smoker for many years, this risk factor must also be repeatedly communicated to the patient. The change in behavior caused the patient to regain an enormous amount of quality of life. This is a wonderful side effect and reward for the patient and for us as the practitioner.

Advantages

Can immediately and significantly reduce pain, inflammation and bleeding Ideal for use in PZR, UPT, AIT or following oral surgery Can make a significant contribution to tooth preservation Coenzyme Q10 supports and strengthens the immune system in the fight once morest inflammation Acts directly locally, making teeth, gums and jawbones stable and can be kept healthy. May extend the life of dental restorations in the mouth. Suitable for vegans and vegetarians

Conclusion

Due to demographic change, our patients are getting older. With age, the risk of general diseases increases, which can negatively affect both general and oral health. We have to see the patient individually with their own needs and abilities in order to show them the best possible support and support in diagnosis, instruction and the course of therapy. Dental sprays such as ParoMit Q10 can be used by patients following professional tooth cleaning, active periodontal treatments (AIT) and supportive periodontal therapy (UPT) without side effects such as burning or discoloration of the teeth and tongue in oral hygiene at home. With dental sprays, we achieve a high level of patient acceptance in the application. With support in AIT, UPT and domestic oral hygiene, we achieve great treatment and therapy success.

This post is in PJ Prophylaxe Journal 03/2023 appeared.

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