Advanced Gum Treatment (BOST)

Advanced Gum Treatment (BOST)

Oral health and dentistry have their place in the overall health of patients.
The Hale Clinic has established a dental service for treating periodontal gum disease, which represents the most direct connection between oral and general health.
Aggressive bacteria from the mouth can become localized in critical areas of the body - such as the coronary arteries - affecting the normal functioning of other bodily systems As a consequence general health can be affected.
Modern periodontal treatment starts by determining which bacteria are present in a periodontal gum infection, and how many. The Hale Clinic has chosen the BOST treatment, which corresponds most closely with the current state of dental scientific research.

What is B.O.S.T?
BOST; Non-surgical gum treatment: A safer, better, less invasive, less expensive, health conscious alternative to implants.
The Bone One Session Treatment (BOST), is an aerobic treatment that eliminates periodontal disease at its source: under the gums and in the bone supporting the teeth. Performed without surgery, the BOST treatment is fast, comfortable, and reliable.
A typical B.O.S.T full mouth treatment is performed in 4-5 hours during a one day period. Due to the length of the appointment, a specially designed treatment bed is used for added comfort, in favour of a traditional dental chair. After a single BOST treatment, the bone is able to heal and the pockets can fill with healthy tissue.
The basic ideas for BOST began over 20 years ago with Dr. William Hoisington of Seattle, Washington, USA. Years of research and continual improvement led to several publications in professional journals and articles in the popular press. Some 3000 cases treated with the technique by Dr. Hoisington and dentists he trained in several countries. These have provided a solid base of evidence of success measured by patient satisfaction, referral of their friends and the end, in most cases of tooth loss and further serious problems and expenses for replacements like implants.
Healthy Gums
Healthy gums do not bleed, are light pink, they are firm and fresh and resistant to movement. Healthy gingiva has a smooth appearance. The gums normally form a ʻditchʼ or ʻsulcusʼ that goes completely around the tooth; this is a shallow groove of 1-3 mm deep at the edge of the gum where the gum is not attached to the tooth.
In a healthy condition, the gums have a strong attachment to the root and underlying bone. The roots of all teeth are sturdily attached to the bone and the gums by many tiny, but very strong ligaments, which are called the periodontal ligaments. They allow minimal movements of the teeth in any direction.
In a healthy person there are many different microorganisms in the mouth. The bacteria are not destructive to our tissues, but live in harmony with us and actually help our digestive processes.
Gum Disease
Periodontal gum disease is an infection of the periodontal tissues, everything around the tooth: the gums, the ligaments, and the bone. This happens when the balance between the ‘good’ bacteria and the destructive bacteria is disturbed. Pockets of infection form between the teeth and gums, out of reach of normal dental hygiene. They accumulate and form plaque and tartar. Buried deep under the gums, aggressive bacteria produce chemicals that attack tissue and bone. They initiate an immune response and erode the connection between the gum and the roots of teeth. The aggressive bacteria involved are mostly ʻanaerobicʼ, meaning they live in low-oxygen environments away from air. The immune system tries to attack these bacteria but it isnʼt always able to fight back completely. As the gums, ligaments detach from the teeth and bone is lost the infection can spread and go deeper, creating more pockets and the condition worsens.
Symptoms of gum disease
Signs to look out for:
·    Bleeding while brushing, flossing, or eating hard food. There may not be any evidence of bleeding, even though gum disease is present. This is why the absence of bleeding gums does not mean there is no gum disease. Also bleeding may not be visible for smokers as the nicotine causes the blood vessels to contract.
·    Soft, puffy, swollen gums.
·    Sensitivity.
·    Receding gums / gingival recession, resulting in apparent lengthening of teeth. Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before. Heavy handed brushing or brushing with a hard toothbrush may also cause this.
·    Painful or tender gums.
·    Occasional gum swellings.
·    Loose teeth / moving teeth.
·    Pain when chewing.
·    Deep pockets between the teeth and the gums. Pockets are sites where the attachment between teeth and bone has gradually been destroyed.
·    Pus between your gums and teeth. Pus appears when you put pressure on the gums or teeth.
·    Toothache when the bacteria reach the nerve at the tip/apex of the root of the tooth.
·    Sores in your mouth.
·    Bad breath that is not related to food and does not go away.
·    Persistent metallic / bad taste in the mouth.
·    A change in the way your teeth fit together when you bite.
·    A change in the fit of partial dentures.
·    Lost teeth.
Periodontal disease is often silent, this means that symptoms may not appear until an advanced stage of the disease.

Bacterial DNA testing
Bacterial Deoxyribonucleic Acid testing.

Modern periodontal treatment starts by determining which bacteria are present in a periodontal gum infection and how many. Using the bacterial DNA test, we are able to identify exactly which bacteria are causing the periodontal infection. In the majority of cases, the DNA test will reveal that the type of bacteria that are present in the gums can be eliminated without the use of antibiotics. In these cases, it is preferable to avoid antibiotics in order to prevent a drop in the immune system.

However, some species of bacteria cannot be brought under control using the treatment alone, as some bacteria are very resilient. Actinobacillus actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) are aggressive species of bacteria that fall into this category. If the test shows that these bacteria are present, then appropriate antibiotics are usually added to the treatment in order to produce complete healing.

The bacterial DNA test is done, by putting a paper point under the gum tissue for about 15 seconds. It is safe, quick and a painless procedure. Bacteria thrive in the plaque (biofilm) that covers the tooth roots down at the level of attachment. Once the bacteria are collected on the paper point, the test gets send off to a laboratory where the bacteria will be identified by comparing their DNA with DNA profiles held in the labʼs reference database. It is very interesting for dentists as it gives you a list of the main periodontal anaerobic pathogens present (causing the infection), which helps with the formulation of the treatment plan. Compared to culturing the bacteria, bacterial DNA-testing offers much greater accuracy as well as reduced cost. It tells you exactly whatʼs there.

Why is a DNA test necessary?
The bacterial DNA test provides a scientifically accurate way of knowing which bacteria are causing the infection. Without the test, there is only one chance out of ten of choosing the right antibiotic combination to fight the bacteria under the gums. When invasive bacteria are inside the tissue, on the roots and the bone, the BOST treatment can’t reach them and antibiotics are needed to clear them out. Without the focus given by the test, we are more likely producing resistant strains than good treatment results. Most patients find that it is very reassuring to know whether or not they have aggressive strains of bacteria in their gums. If the Aa and Pg are not present, patients feel relieved immediately. Patients who test positive for the aggressive strains of bacteria, on the other hand, gain a better understanding of why they have had such a difficult time with periodontal problems in the past. They can feel hopeful for the future because they know that they will receive properly targeted antibiotics in addition to effective local treatment.

Who should take the bacterial DNA test?
·    People who have symptoms of gum disease: Bleeding gums, swelling, receding gums, painful or tender gum. Loose teeth, moving teeth, pain when chewing, pockets, pus, toothache, sores in your mouth, bad breath, persistent metallic / bad taste in the mouth, bite change, lost teeth, etc.
·    Prior to orthodontic treatment: With braces, force will be put on the bone and oral hygiene will be more difficult. Aerobic hygiene is also important to help prevent common post-orthodontic problems like gum recession as well as gingivitis during treatment.
·    As part of fertility program. Periodontal disease has been linked to infertility, low birth weight and premature birth. Before entering the reproductive years a bacterial DNA test is a great tool to help with prevention and/or treatment. If any aggressive bacteria are present, treatment and aerobic oral hygiene is recommended. It is vital not to pass aggressive bacteria on to the newborn baby.
·    Before implants. The test tells you what bacteria are there. Which is great because it is essential that the mouth is correctly prepared before the implants. When implants are placed without knowing what kind of bacteria are in the mouth, peri-implantitis (gum infection around the implants) can occur. This infection around implants is notoriously difficult to get rid of.
·    For patients who have (a family history of)
* Heart disease/stroke
* Diabetes
* Arthritis
* Recurrent respiratory infections (sinus/lung)
* Digestive problems
* Alzheimerʼs disease
* Mouth ulcers.
Periodontal bacteria are linked to these disorders.

Mainstream Treatment
Problems with conventional treatment

Traditional treatments involve potentially harmful disinfectants and even surgery. With conventional treatment there is firstly a non-surgical stage, which is executed in sessions (i.e. closed field curettage). After this there is often a second stage, which is surgical and involves cutting the gum, ʻflappingʼ it (opening up the gum, peeling it from the teeth and bone), root scaling, osteoplasty (remodelling / cutting the bone), removal of excessive wound healing tissue (granulation tissue), soft tissue grafts, bone grafts etc. The gums get stitched back around the teeth, which makes it sore to clean after. Post-operative pain and discomfort is a major drawback. Also it is virtually impossible to do the surgical stage in one go. Therefore re- infection from the untreated side happens. Only a few people have the courage to endure four sessions of treatment and the subsequent weeks in pain. On top of all this, the gums, which are usually already receded to begin with, recede even more as a result of the surgery. As the gums recede, obviously the pockets get shallower, but the aesthetics are impaired. The extra exposure of the root can also give extra sensitivity.
Instead of supporting the bodyʼs natural healing processes, surgery removes infected tissue and bone, leaving one with much lower, more receded, gums.
The problem with the mainstream approach is that the treatment is done in sessions. They are usually carried out over two or more sessions, giving bacteria in the untreated side of the mouth every chance to re-infect the treated side.

Patients, who have the full mouth treated within 24 hours, have much better results than the standard protocol of 2-4 sessions a few weeks apart.
Treatment in one session is hugely beneficial, regardless if the treatment is surgical or not.
Another major problem with mainstream treatment is a high rate of relapse. The reason for this may be that after the deep cleaning of the pockets (with re-infection from opposite sides later on) the gums re-adhere at the margin first, locking in the remaining bacteria deep down in the pocket. This creates a hidden chronic infection deep down in the pocket, waiting for the immune system to be under pressure (stress or any other factors) to flare up. This chronic infection can flare up and this means a new acute phase, so the gums detach, and a new pocket opens.
Dr Hoisington who developed BOST treatment explained what happens to the bone: Most periodontists are mainly concerned with how to defeat the bacteria and reduce pockets, but orthopaedic surgeons look at bone as something you should heal if it is broken. Dr Hoisington started looking at damaged periodontal bone as being broken rather than just being infected. This gave him an insight into treating periodontal disease more like a medical problem than a purely dental problem. He set up a protocol of treating the whole mouth in one session rather than in sessions, where re-infection is an obvious problem. Besides this he found that when you do an open flap procedure to get periodontal access to the bone, you cut off the circulation to the bone, which dries it out and you actually kill the superficial bone cells. This greatly contributes to the failure of grafting and any other kind of procedure you are trying to do on the bone.

Advantages of BOST

Keeping your own teeth and gums healthy.
·    We check what bacteria are present and how many, this is to personalise treatment.
·    BOST treatment gives the body a chance to heal itself.
·    Aerobic treatment, NO surgery.
·    Drainage of toxins from pockets.
·    NON-invasive.
·    Perio-aid: prevents early attachment and re-infections. Helps to create sturdy attachment of the gums to the teeth.
·    Patients do not experience much discomfort during or after the treatment.
·    Long-term success.
·    Quick (1/2 day appointment) single session.
·    Helps improve aesthetics / oral health / general health / function / confidence.
·    Keep your own teeth as much as possible.
·    Helps reduce burden on the immune system.
·    Huge reduction of aggressive bacteria, which is good for general health too.
·    Removal of toxins and tartar build up from under the gums.
·    Great alternative to implants.
·    Cost-effective solution.

Practitioners Offering Advanced Gum Treatment (BOST)