Gum disease & systemic diseases – plus the impact of sleep-disordered breathing

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Marty Klein: Welcome to Dentistry for the New Millennium. I am Marty Klein, Training Manager at the Institute for Advanced Laser Dentistry, and today we’re speaking with Dr. Sharona Dayan from Beverly Hills, California. Dr. Dayan is a graduate of both UCLA and Harvard and has practiced periodontics in both the Boston and now Los Angeles, California areas. Her expertise in the relationship between Oral Health and its impact on overall health gives her a unique insight when treating patients with other medical conditions. Here we’ll talk about her journey with LANAP® and the PerioLase® and the links between gum disease and several other systemic diseases. Dr. Dayan, thanks so much for being here with us today.

Dr. Sharona Dayan: Thank you. It’s my pleasure.

Marty Klein: So you’re relatively new to adopting the LANAP® Protocol in your practice. And I say that just relative to some other of our guests recently who have been doing this for 15 or 20 years even. So, can you tell me how you became aware of LANAP® and the reasons for incorporating it when you did?

Dr. Sharona Dayan: Sure, when I was a dental student at UCLA, on Friday afternoons, I used to go down to the graduate perio clinic, because I was interested in perio even at that time, and volunteer to be an assistant for the graduate students. I was assigned to Dr. Allen Honigman. So for the duration of my senior year, I would go down on Friday afternoons and assist him doing periodontal surgeries. So fast forward years later, we were both in Los Angeles for a periodontal convention, and I invited him for a family dinner, and he’s turned to me and he said, “Sharona, I can’t believe you’d still don’t have this laser. You’ve got to get it. It’s amazing.” And my cousin, who was sitting across from him, said, “You know, Sharona, you’re my cousin. But if I had gum disease, I would go to him and not you because he has the laser and you don’t.” That was really a wake-up call for me because it made me realize that patients really want to this technology. So I bought the laser the next week! I adopted it into my periodontal practice in Boston, and it took off so well. Once I had the reputation that I was trying to save teeth, people would come and find me because they had been told that their teeth needed to be removed, and they really wanted to try to save them, if at all possible. It was really the best technology that I ever brought into my practice.

Marty Klein: So it’s like you had an old colleague and a patient, in the form of your cousin, at the same time, both ends of that spectrum. Did you have familiarity with any dental lasers before that dinner?

Dr. Sharona Dayan: I did not. And it happened that that dinner was also coinciding with Dr. Marc Nevins’ study that was published recently. I went to school with Dr. Nevins and we were, you know, very good friends at Harvard. So when I saw the study, it really established that not only was this laser patient friendly, but it was based on research and science, so it just made it all easier for me to bring it into my practice

Marty Klein: Thinking back then, too, when you were in school, you mentioned undergraduate at UCLA and then you’re periodontal residency at Harvard, at that time were dental lasers discussed at all?

Dr. Sharona Dayan: No, only at Harvard. They discussed it for doing frenotomies, but not for treating periodontal disease.

Marty Klein: Okay, so you fast forward, and now you have LANAP® in your office, you started doing it when you were still in Boston practicing there. What was the patient response at that point? Or even since then, what have you seen over time in your patients since doing LANAP®?

Dr. Sharona Dayan: Well, I went to school to become a periodontist because I wanted to save teeth and the patient response was overwhelmingly positive. I thought I had a very good case acceptance rate, and with the PerioLase® my case acceptance rate was even better. I had a very big implant practice where I would recommend extracting teeth with periodontal disease and replacing them with dental implants. But when I began to offer the PerioLase® and LANAP® as an alternative, patients were so willing to take the risk to have the LANAP® procedure, even if they might be facing tooth loss anyway, they said, “I don’t care. I want the laser. I want to try to save my tooth,” and we can approach implant therapy as an option in a year based on the results and I have rarely had to resort to the implant option. More than 90% of the time, if I do the LANAP® procedure, I can save the teeth. So that’s been great for me to be able to provide the service. The patients are so comfortable after. They don’t complain of pain. They don’t have any swelling. They just go about their business right away. They love that they don’t have any sutures. So I feel very confident presenting LANAP® as a treatment for my patients.

Marty Klein: Did you have some patients who had previously undergone traditional surgery talk to you about that?

Dr. Sharona Dayan: Yes. And when they found out that I now had this laser, they were so upset with me that I wasn’t able to give them the laser, the PerioLase®, as an option when they needed the periodontal surgery. So yes, patients were kind of upset, “Why didn’t I get the laser?”

Marty Klein: So I was looking at your website earlier, which, by the way, for listeners is auroraperiodontal.com, and it talks a lot there about overall health and overall oral health and the connections between our oral health with other systemic diseases. Can you tell me a little more about how LANAP® fit in with your personal goals of achieving overall health and oral health in particular?

Dr. Sharona Dayan: Yes, well, many of the major diseases that afflict Americans today, especially as they are going into older age, are cardiovascular disease, diabetes, Alzheimer’s and periodontal disease. What all of these diseases have in common is that inflammation is not just a symptom but a causative factor, and once you get one, you are much more likely to get the others. If we think about diabetes, which is the fastest growing epidemic in our country, we have now studies to show that diabetic patients who have their gum disease/periodontal disease treated have better medical outcomes, fewer hospitalizations, fewer visits to the physician, and significantly reduced health care costs. And today, with Alzheimer’s, we have cultured P. gingivalis, the main bacteria in periodontal disease, in the brain tissues of patients with Alzheimer’s. Also, Treponema denticola, another major bacteria in periodontal disease, has been found to travel up the trigeminal nerve tract into the trigeminal ganglia of the brain. And you can have all the tangles in the world in the brain, but if you don’t have neuro inflammation, you don’t get Alzheimer’s disease. Today, the most active area of research for Alzheimer’s is using a drug to stop gingipain, a toxic substance that is produced by P. gingivalis in the brain, to see whether the Alzheimer’s disease symptoms can improve.

In terms of cardiovascular disease, Interleukin one beta (IL-1 beta) is one of the factors produced by the body during chronic inflammation and when a patient has chronic periodontal disease. IL-1 beta is found in higher levels in the blood of patients with periodontal disease, and one of the functions of IL-1 beta is to make the blood vessels sticky. So when there is inflammation, the inflammatory immune cells that are trying to get to the site of attack move fairly quickly. IL-1 beta makes the blood vessels sticky so that they can stick to the area where they’re needed. But when the inflammation becomes chronic, we don’t want this stickiness anymore, and that’s how the atherosclerotic plaques can develop.

Marty Klein: So and I don’t want to put words in your mouth here, but the more patients that you’re able to address their periodontal pathogens, the less likely they are to develop these other diseases. Is that fair to say?

Dr. Sharona Dayan: Yes. Chronic inflammation is considered to be the most harmful condition today in medicine, and with the laser, the PerioLase® and LANAP® therapy, there’s really no reason to avoid treating gum disease. It’s painless. It is effective. It instantly reduces the bacterial load in the mouth. So my suggestion is that if you have gum disease, treat it!

Marty Klein: There is one other disorder that is less talked about, that I read again on your website that you have a little extra insight into, and that’s sleep-disordered breathing. Tell me more about that and how gum diseases is related to that.

Dr. Sharona Dayan: Yes, absolutely. Sleep-disordered breathing has a spectrum that ranges from snoring to upper airway resistance syndrome, where the throat is getting blocked for a period of a few seconds, all the way to sleep apnea, where the obstruction lasts for 10 seconds or more. And basically what all of these have in common is mouth breathing. So the patients are breathing through their mouth throughout the night. Mouth breathing is extremely harmful for the body. The mouth is not the organ that’s designed to breathe in air: it doesn’t filter the air, it doesn’t cleanse the air or purify it. The nose is the organ that is meant for breathing. So throughout the night the patients are breathing in dirty air that’s contaminated, that does not get filtered or purified, and it’s getting introduced to the mouth and the throat. In addition, mouth breathing dries out the tissue so you don’t have the protective saliva that buffers the gums, buffers the teeth, and has all of these amazing immunoglobulins to help fight bacteria, so the gums become a lot more susceptible to harboring bacteria. Lastly, during sleep apnea, because the obstruction lasts for 10 seconds or longer, there is this major negative pressure that draws up gastric juices from the stomach into the mouth. The gastric juices bring acid into the mouth, and we know that the bacteria that cause periodontal disease love acidic environments, as well as the bacteria from the stomach that don’t belong in the mouth. So we’re introducing a new subset of bacteria and this can overwhelm the mouth. The opportunistic bacteria that cause periodontal disease that are just kind of lying and waiting for an opportunity, and the dry environment with increased bacteria and acid just makes it a perfect storm to develop periodontal disease.

Marty Klein: Dr. Dayan, thank you so much for shedding some light on an aspect that we don’t get to talk about very often with the systemic connections, and also just for sharing your story with us. We really appreciate it!

Dr. Sharona Dayan: Thank you very much.

Marty Klein: And if any of the listeners are interested in more information about some of the studies discussed, including Marc Nevins’ human histology study on LANAP®, you can visit lanap.com and click on the Research tab at the top. And for more information about Dr. Dayan and her Beverly Hills, California practice, visit Auroraperiodontal.com.