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By Max Arocha DMD
April 08, 2020
Category: lanap

Periodontal Gum Disease Increased Death Rate from Pneumonia Almost 3.5 times

Periodontal disease may be a co-morbidity with Coronavirus deaths from pneumoniacoronavirus in the mouth

Periodontal disease may also be a co-morbidity with Coronavirus deaths from pneumonia and patients should be made aware of this possible risk.

A seven-year study to evaluate the association between periodontal disease and pneumonia mortality in dialysis patients. Iwasaki et al, Journal of Clinical Periodontology, October 2017

Materials and Methods

This prospective cohort study included 211 patients (mean age, 64.4 years) undergoing dialysis at a single medical center. The patients underwent a baseline clinical dental examination in 2008 and were then followed up until July 2015. Periodontal gum disease was defined as the presence of clinical attachment loss of ≥4 mm in ≥30% of the probed sites. The primary endpoint, that is death from pneumonia, was determined by reviewing death certificates and was analyzed using the competing‐risks regression model.

Results

At baseline, 92 patients (43.6%) had periodontal disease. The median follow‐ up period was 84 months (interquartile range, 36–86 months). Of the 68 deaths that occurred, 21 were from pneumonia. The multivariable competing ‐ risks regression model showed that periodontal disease was significantly associated with death from pneumonia (adjusted sub hazard ratio, 3.49; 95% confidence interval, 1.14–10.64), after adjusting for other baseline health characteristics.

Conclusion

The results of this study suggest that periodontal disease increased the death rate from pneumonia almost 3.5 times and is independently associated with pneumonia mortality in dialysis patients with kidney failure. Periodontal disease may also be a co-morbidity with Coronavirus deaths from pneumonia and patients should be made aware of this possible risk.

Dental Preparedness Check List

Coronavirus Disease 2019 (COVID-19) is a respiratory disease caused by the SARS-CoV-2 virus. It has spread from China to many other countries around the world, including the United States. Dental-Prepareness-Check-List.pdf

For most dental practice, protecting dental workers will depend on emphasizing basic infection prevention measures. As appropriate, all dental staff should implement good hygiene and infection control practices, including:

  • Promote frequent and thorough hand washing, including by providing workers, customers, and worksite visitors with a place to wash their hands. If soap and running water are not immediately available, provide alcohol-based hand rubs containing at least 60% alcohol.

  • Encourage dental workers to stay home if they are sick.

  • Encourage respiratory etiquette, including covering coughs and sneezes.

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION COMMON PRACTICE

  • Provide paients with tissues and trash receptacles.

  • Dental staff should explore whether they can establish policies and practices, such as flexible worksites (e.g., teledentistry) and flexible work hours (e.g., staggered shifts), to increase the physical distance among dental staff and between dental staff and patients and others if state and local health authorities recommend the use of social distancing strategies.

  • Discourage dental staff workers from using other workers’ phones, desks, offices, or other work tools and equipment, when possible.

  • Maintain regular housekeeping practices, including routine cleaning and disinfecting of surfaces, equipment, and other elements of the work environment. When choosing cleaning chemicals, employers should consult information on Environmental Protection Agency (EPA)-approved disinfectant labels with claims against emerging viral pathogens. Products with EPA-approved emerging viral pathogens claims are expected to be effective against SARS-CoV-2 based on data for harder to kill viruses. Follow the manufacturer’s instructions for use of all cleaning and disinfection products (e.g., concentration, application method and contact time, PPE).

Control guidence for Dental Settings During Coronavirus COVID-19 Response

According to the CDC there are suggested dental settings to consider as follow

  • Dental settings have unique characteristics that warrant additional infection control considerations.
  • Postpone elective procedures, surgeries, and non-urgent dental visits.
  • Proactively communicate to both staff and patients the need for them to stay at home if sick.
  • Know steps to take if a patient with COVID-19 symptoms enters your facility

 

Cleaning Products That Destroy Coronavirus

Soap and Water

Just the friction from scrubbing with soap (any kind of soap) and water can break the coronavirus’s protective envelope. “Scrub like you’ve got sticky stuff on the surface and you really need to get it off,” says Richard Sachleben, an organic chemist and a member of the American Chemical Society. Discard the towel or leave it in a bowl of soapy water for a while to destroy any virus particles that may have survived.

Using antibacterial soap won’t give you added protection against the coronavirus because it kills bacteria, not viruses. You can still use it as long as you scrub.

Bleach

The Centers for Disease Control and Prevention recommends a diluted bleach solution (⅓ cup bleach per 1 gallon of water or 4 teaspoons bleach per 1 quart of water) for virus disinfection. Wear gloves while using bleach, and never mix it with ammonia—or anything, in fact—except water. (The only exception is when doing laundry with detergent.) Once mixed, don’t keep the solution for longer than a day because the bleach will lose potency and can degrade certain plastic containers.

“Always clean the surface with water and detergent first, since many materials can react with bleach and deactivate it,” Sachleben says. “Dry the surface, then apply the bleach solution and let it sit for at least 10 minutes before wiping it off.”

Bleach can corrode metal over time, so Sachleben recommends that people not get into the habit of cleaning their faucets and stainless steel products with it. Because bleach is harsh for many countertops as well, you should rinse surfaces with water after disinfecting to prevent discoloration or damage to the surface. 

If you can’t find liquid bleach, you can use bleach tablets instead. You may have seen Evolve bleach tablets, which dissolve in water, at Walmart or on Amazon. Just follow the dilution instructions on the packaging (1 tablet is equal to ½ cup liquid bleach). A label on the bottle states the product is not a disinfectant, but chemically, it’s the same as liquid bleach. A company spokesperson at Custom Bottling & Packaging, which acquired Evolve three years ago, says the company hasn’t had the time or resources to put their product through the Environmental Protection Agency’s registration process that would allow them to make disinfecting and sanitizing claims. As of this update, Evolve is not experiencing any shortages and is supplying hospitals, research centers, and correctional facilities.

Isopropyl Alcohol

Alcohol solutions with at least 70 percent of alcohol are effective against the coronavirus on hard surfaces. First, clean the surface with water and detergent. Apply the alcohol solution (do not dilute it) and let it sit on the surface for at least 30 seconds to disinfect. Alcohol is generally safe for all surfaces but can discolor some plastics, Sachleben says.

Hydrogen Peroxide

According to the Centers for disease control and prevention (CDC), household (3 percent) hydrogen peroxide is effective in deactivating rhinovirus, the virus that causes the common cold, within 6 to 8 minutes of exposure. Rhinovirus is more difficult to destroy than coronaviruses, so hydrogen peroxide should be able to break down the coronavirus in less time. Pour it undiluted into a spray bottle and spray it on the surface to be cleaned, but let it sit on the surface for at least 1 minute. 

Hydrogen peroxide is not corrosive, so it’s okay to use it on metal surfaces. But similar to bleach, it can discolor fabrics if you accidentally get it on your clothes. “It’s great for getting into hard-to-reach crevices,” Sachleben says. “You can pour it on the area, and you don’t have to wipe it off because it essentially decomposes into oxygen and water.”

By Max Arocha DMD
August 18, 2018
Category: lanap
Tags: LANAP   gum laser surgery  

As of 2019 below are our most commonly asked questions on Gum Laser Surgery and periodontal laser treatment.

How long does Laser gum surgery take to perform? (photos)

In many cases, we can do the LASER treatment in one long session of 2-3 hours. Sometimes, it can be split up into two sessions of 1-1.5 hours one week apart.

LANAPDoes periodontal Laser treatment hurt?

No, we always get our patient numb for LASER periodontal treatment just like we would if patients were to get a small cavity filled. We use local anesthesia. Our patients normally have good dental experience during laser dental procedures. Some discomfort may be present after laser periodontal gum surgery.

How far are you located in Fort Lauderdale?

Our Plantation office is part of west Fort Lauderdale. We are about 15 minutes west of downtown Fort Lauderdale or about 8 miles away.

How much does LANAP laser gum treatment cost?

Periodontal gum laser treatment cost about $3,900 for a full mouth laser periodontal treatment on patients with severe periodontal infection. This treatment includes the cost of local anesthesia and follows visits. The average cost for periodontal scaling and root planing (deep cleaning) is between $275 and about $980. Periodontal maintenance costs after undergoing LANAP average $115 every 3-4 months. Active severe periodontal treatment — which usually consists of laser periodontal treatment like, REPAIR® and LANAP®— cost about $1,000 - $1,100 per quadrant for more detail information about LANAP cost visit https://www.drarocha.com/gum-disease-treatment-cost.html

What is the difference between LANAP® and REPAIR ® laser gum therapy?

They are both FDA approved laser treatment for periodontal disease. Both laser procedures are specifically designed for the treatment of periodontal disease. LANAP®: Laser-assisted new attachment procedure and REPAIR®. In addition, REPAIR® has also FDA approval for removing periodontal bacterial calculus (tartar) under the gums. Calculus (calcified tartar) is the source of all periodontal disease. Both LANAP® and REPAIR® laser periodontal surgery provides much improve methods for saving teeth with moderate and advanced periodontal disease.

How Laser Gum Treatment Works?

Laser gums treatment may be needed when gum pockets are too deep and disease to better remove infected gum tissues and save the teeth. As a periodontal pocket worsen, it provides a greater place for bacteria to live and eat way your gums. Laser gum surgery such as LANAP® and REPAIR® allow certified dentist to access under the gum and remove tartar and plaque reducing bacterial stronghold. For a video detailed information on how laser gum treatment works click this link: https://www.youtube.com/watch?v=7K_3A0gd66k&feature=emb_title

How soon after Laser periodontal surgery can I go back to work and family responsibilities?

LASER surgery enables people to get on with their lives with minimal disruption. With Laser periodontal surgery there is fast recovery time. You might leave the office "numb" but this wears off after a short period of time and you should feel little or no discomfort. A few patients come to mind who, shortly after laser surgery, have traveled, made public or TV appearances or business deals, taken care of children, worked with heavy equipment, performed an airplane pilot or professional musicians.

How much is laser periodontal treatment?

Each patient is different and the fee depends on the severity and extent of the periodontal disease. It varies significantly from about $400 for a severe single tooth to about $4,300 for the whole mouth or four quadrants of Laser periodontal treatment. 

Does insurance cover laser gum surgery?

Yes, most insurance does cover a percentage associated with LASER gum surgery, just like they would with conventional "gum surgery". Maria, at the office, can help you with the insurance paperwork.

Can a patient make payments for the periodontal services such as laser surgery, implants or conventional surgery?

Yes. We offer to finance through the American Dental Association's approved financing programs. Call Maria for details.

How would a dentist determine whether I might be a candidate for laser gum surgery?

By conducting a thorough clinical exam and reviewing a full mouth series digital X-rays.

gum laser treatment

What is the advantage of laser surgery over "conventional" gum surgery? Are the results better than conventional surgery?

With laser periodontal surgery, there is no cutting or stitching of the gums, and therefore, minimal post-operative discomfort. In our office, we are finding the results have been great.

Are you available to give lectures on periodontal laser procedures?

Yes, Dr. Max Arocha has been invited to present his techniques and knowledge on Laser periodontal surgery to dentists at the World Clinical Laser Institute.

I take blood thinners. Do I have to get off these medications before the laser surgery?

No, one of the advantages of laser surgery is that patients don't have to stop their medications as with conventional gum surgery. This eliminates the risk of discontinuing these medications.

Will I have a gum recession after the laser surgery?

No, LASER surgery does not cause any recession of the gums around the natural teeth or crowned teeth. However, once the inflammation that comes from the bacteria gum infection is removed you may notice a slight and mild recession. 

Do I have to follow a special regimen after the laser surgery is completed?

Yes, Dr. Max Arocha will review with you the suggested regimen of cleaning, follow-up and home care instructions.

I see that there are connections between heart attacks, cardiovascular disease, premature births and numerous other medical conditions with "unstable" periodontal disease. Does this laser surgery help?

Yes, LASER energy kills bacteria that cause gum disease. These are the same bacteria that have been linked to a number of medical conditions.

I understand that it is hard to determine the price without seeing a patient, but if you were to compare laser to conventional periodontal surgery as an average, is it higher in cost or lower in cost, and by what percent?

A laser is normally lower in cost than conventional surgery. However, it varies among clinicians and locations.

Do dental insurance policies cover your services?

Most dental insurance plans cover periodontal therapy. We are the in-network provider of most insurance. Please call Maria, so she can check your policy for further details.

Is it ever possible to treat and heal gum pockets as serious as 6 without surgery?

Yes, it is possible in most cases to treat periodontal pockets of 6mm and more.

Can I get laser surgery or treatment even though I have braces?

Yes, it is possible to have laser treatment with braces. We would recommend a thorough clinical exam and radiographs to confirm this mode of treatment. Having periodontal issues during orthodontic treatment is a concern, but intervention is usually successful and oftentimes done with the laser.

Do some problems still, require conventional gum surgery?

Yes. We still use conventional procedures in some clinical circumstances, but even during these procedures, we utilize the laser as much as possible. This reduces after surgery discomfort for our patients.

By Max Arocha DMD
November 10, 2012
Category: lanap
Tags: gums examination  

Gums Examination

gum exam

Gums exams are vital in the maintenance of your oral health as they are used to assess the health of your gums and teeth. They can help your dentist diagnose gum diseases, gingivitis and periodontitis. These gums exams can also reveal receding gums, exposed roots, tooth grinding and other gums related problems, making gums exams vital to maintaining proper oral health. Regular dental exams are important as they can reveal evidence of gum disease in its early stages.

During your gums examination, dentist should check:

  • For any lumps or abnormal areas in the mouth
  • Whether any of your teeth are missing or loose
  • The color, texture, size and shape of your gums
  • Whether you have fillings, crowns, bridges, dentures or implants
  • How much plaque is on your teeth
  • The depth of the space between your tooth and gum

Gingivitis is the first stage of periodontal disease that causes inflammation of the gums. Dental x-rays can determine if the inflammation has spread to the supporting structures on the teeth so treatment can be started to correct the problem. Periodontitis occurs when gingivitis goes untreated, which makes gums exams vital to preventing and putting an end to gum diseases.

We, as dentists in plantation, performer gums exam with each visit, emphasizing the importance of regular, routine dental visits.

By Max Arocha DMD
January 10, 2012
Category: lanap

Your mouth is both a window to your health and a doorway to disease! In fact, an article published in the Harvard Dental Bulletin was entitled, “Floss or die: the link between oral health and cardiac disease.”

Research has linked advanced gum disease to serious and even life-threatening conditions like heart attack and stroke! The more you brush, floss and have regular cleanings, the less likely you are to develop gum disease.

Every day counts!! What you have just read should give you a big hint as to why daily home oral hygiene should be a top priority in your life. Because no matter how busy your schedule the simple fact is that you eat every day. And failure to properly clean your teeth on a daily basis can result in gum disease. Bottom line: Gum disease can lead to tooth loss, bone loss and health losses!

You know what happens to food that’s been left out too long. Something similar happens when you don’t remove food residue from your teeth and gums. That’s when plaque forms!

Plaque, a mixture of saliva, bacterial and food debris, forms on your teeth every single day. An every day, millions of bacteria that clump together in plaque secrete toxins that eventually cause decay and gums disease. Let’s face it: An unhealthy mouth will compromise you health and slow you down. Don’t let dental neglect devour your health time, energy, confidence, and money! Advance gum disease can weaken your immune system, leaving you more vulnerable to other diseases.

By Fort Lauderdale Dentist
December 08, 2011
Category: lanap

Answer: No! Bleeding gums are never normal. Bleeding is a sign of a gum tenderness, irritation and infection. Think of gum tissue as you would the skin on your hands. If your nails bled every time you used a nail brush to clean them, you would instinctively know "something" was wrong. The same holds true when it comes to your gums. Bleeding causes bacterimia which is the presence of bacteria in the blood. Bleeding gums is one of the  signs of periodontitis and gingivitis. 



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